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Quantitative Assessment of Diffusion Abnormalities in Benign and Malignant Vertebral Compression Fractures by Line Scan Diffusion-Weighted Imaging

¹ Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
² Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115.

View larger version (16K): [in a new window]   Fig. 1. —Summary of apparent diffusion coefficient (ADC) values in abnormal vertebrae. ADC values in benign compression fractures (n = 20) are significantly higher than those in malignant compression fractures (n = 16, p < 0.01). Note considerable overlap between benign and malignant compression fracture ranges. Differences in ADC values between malignant compression fractures and metastases without compression fractures (n = 47) are not statistically significant. NS = not significant.

View larger version (75K): [in a new window]   Fig. 2A. —65-year-old woman with osteoporotic vertebral compression fracture of 12th thoracic vertebral body who received steroids for Churg-Strauss syndrome. T1-weighted spin-echo image (TR/TE, 400/8) shows low signal intensity in compression fracture (arrow). Fatty marrow is partially reserved, particularly in dorsal area (arrowhead).

View larger version (79K): [in a new window]   Fig. 2B. —65-year-old woman with osteoporotic vertebral compression fracture of 12th thoracic vertebral body who received steroids for Churg-Strauss syndrome. T2-weighted fast spin-echo image (3,000/105) shows mixed (iso- and hypo-) signal intensity in compression fracture.

View larger version (72K): [in a new window]   Fig. 2C. —65-year-old woman with osteoporotic vertebral compression fracture of 12th thoracic vertebral body who received steroids for Churg-Strauss syndrome. Diffusion-weighted image (b value = 1,000 sec/mm2) shows mixed (iso- and hypo-) signal intensity (arrow) relative to adjacent normal vertebral bodies.

View larger version (83K): [in a new window]   Fig. 2D. —65-year-old woman with osteoporotic vertebral compression fracture of 12th thoracic vertebral body who received steroids for Churg-Strauss syndrome. Apparent diffusion coefficient (ADC) map shows increased diffusion in compression fracture (arrow). ADC value of compression fracture is 1.26 x 10–3 mm2/sec. ADC in area of reserved fatty marrow (arrowhead) is low.

View larger version (79K): [in a new window]   Fig. 3A. —51-year-old woman without history of primary malignancy who was initially referred for MRI for suspected benign compression fracture. Open biopsy later revealed primary sarcoma not otherwise specified. T1-weighted spin-echo image (TR/TE, 400/8) shows low signal intensity in compression fracture of third lumbar vertebral body (arrow).

View larger version (57K): [in a new window]   Fig. 3B. —51-year-old woman without history of primary malignancy who was initially referred for MRI for suspected benign compression fracture. Open biopsy later revealed primary sarcoma not otherwise specified. Fat-suppressed T2-weighted fast spin-echo image (3,000/105) shows mixed (iso- and hyper-) signal intensity in compression fracture. No definite abnormalities are seen in other vertebrae.

View larger version (74K): [in a new window]   Fig. 3C. —51-year-old woman without history of primary malignancy who was initially referred for MRI for suspected benign compression fracture. Open biopsy later revealed primary sarcoma not otherwise specified. Diffusion-weighted image (b = 1,000 sec/mm2) shows hypointensity (arrow) in compressed vertebral body.

View larger version (89K): [in a new window]   Fig. 3D. —51-year-old woman without history of primary malignancy who was initially referred for MRI for suspected benign compression fracture. Open biopsy later revealed primary sarcoma not otherwise specified. Apparent diffusion coefficent (ADC) map shows increased diffusion in compressed vertebral body (arrow). ADC value of compressed vertebral body is 0.97 x 10–3 mm2/sec.

View larger version (61K): [in a new window]   Fig. 4A. —70-year-old woman with multiple metastatic vertebrae from lung cancer who died 12 days after MRI examination. Autopsy revealed necrosis in central regions and viable tumor cells in peripheral regions. T1-weighted spin-echo (TR/TE, 400/8) (A) and fat-suppressed T2-weighted fast spin-echo (3,000/105) (B) images show compression fractures of third and fourth lumbar vertebral bodies (arrows, A) as well as multiple metastatic vertebrae without compression fractures. First lumbar vertebra (arrowhead, A) shows normal signal intensity.

View larger version (58K): [in a new window]   Fig. 4B. —70-year-old woman with multiple metastatic vertebrae from lung cancer who died 12 days after MRI examination. Autopsy revealed necrosis in central regions and viable tumor cells in peripheral regions. T1-weighted spin-echo (TR/TE, 400/8) (A) and fat-suppressed T2-weighted fast spin-echo (3,000/105) (B) images show compression fractures of third and fourth lumbar vertebral bodies (arrows, A) as well as multiple metastatic vertebrae without compression fractures. First lumbar vertebra (arrowhead, A) shows normal signal intensity.

View larger version (72K): [in a new window]   Fig. 4C. —70-year-old woman with multiple metastatic vertebrae from lung cancer who died 12 days after MRI examination. Autopsy revealed necrosis in central regions and viable tumor cells in peripheral regions. Contrast-enhanced T1-weighted spin-echo image (550/8) shows heterogeneity of metastatic vertebrae. Regions of faint or no enhancement correspond to high signal areas on T2-weighted images, suggesting necrosis.

View larger version (71K): [in a new window]   Fig. 4D. —70-year-old woman with multiple metastatic vertebrae from lung cancer who died 12 days after MRI examination. Autopsy revealed necrosis in central regions and viable tumor cells in peripheral regions. Diffusion-weighted image (b = 1,000 sec/mm2) shows mixed (iso- and hypo-) signal intensity of compressed vertebrae (arrows) relative to normal vertebral bodies (arrowhead).

View larger version (80K): [in a new window]   Fig. 4E. —70-year-old woman with multiple metastatic vertebrae from lung cancer who died 12 days after MRI examination. Autopsy revealed necrosis in central regions and viable tumor cells in peripheral regions. Apparent diffusion coefficient (ADC) map shows increased diffusion in compressed third and fourth lumbar vertebral bodies (arrows). ADC values of compressed vertebral bodies are 1.14 and 1.31 x 10–3 mm2/sec, respectively. Normal vertebra (arrowhead) shows decreased diffusion.

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