Comparison of Qualitative and Quantitative Evaluation of Diffusion-Weighted MRI and Chemical-Shift Imaging in the Differentiation of Benign and Malignant Vertebral Body Fractures : American Journal of Roentgenology : Vol. 199, No. 5 (AJR)

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Comparison of Qualitative and Quantitative Evaluation of Diffusion-Weighted MRI and Chemical-Shift Imaging in the Differentiation of Benign and Malignant Vertebral Body Fractures

November 2012, Volume 199, Number 5

Musculoskeletal Imaging

Original Research

Comparison of Qualitative and Quantitative Evaluation of Diffusion-Weighted MRI and Chemical-Shift Imaging in the Differentiation of Benign and Malignant Vertebral Body Fractures

Tobias Geith¹, Gerwin Schmidt¹, Andreas Biffar¹, Olaf Dietrich¹, Hans Roland Dürr¹, Maximilian Reiser¹ and Andrea Baur-Melnyk¹

+ Affiliation:

¹ All authors: Institute of Clinical Radiology, LMU University of Munich, Campus Grosshadern, Marchioninistrasse 15, Munich, Bavaria 81377, Germany.

Citation: American Journal of Roentgenology. 2012;199: 1083-1092. 10.2214/AJR.11.8010

ABSTRACT :

OBJECTIVE. The objective of our study was to compare the diagnostic value of qualitative diffusion-weighted imaging (DWI), quantitative DWI, and chemical-shift imaging in a single prospective cohort of patients with acute osteoporotic and malignant vertebral fractures.

SUBJECTS AND METHODS. The study group was composed of patients with 26 osteoporotic vertebral fractures (18 women, eight men; mean age, 69 years; age range, 31 years 6 months to 86 years 2 months) and 20 malignant vertebral fractures (nine women, 11 men; mean age, 63.4 years; age range, 24 years 8 months to 86 years 4 months). T1-weighted, STIR, and T2-weighted sequences were acquired at 1.5 T. A DW reverse fast imaging with steady-state free precession (PSIF) sequence at different delta values was evaluated qualitatively. A DW echo-planar imaging (EPI) sequence and a DW single-shot turbo spin-echo (TSE) sequence at different b values were evaluated qualitatively and quantitatively using the apparent diffusion coefficient. Opposed-phase sequences were used to assess signal intensity qualitatively. The signal loss between in- and opposed-phase images was determined quantitatively. Two-tailed Fisher exact test, Mann-Whitney test, and receiver operating characteristic analysis were performed. Sensitivities, specificities, and accuracies were determined.

RESULTS. Qualitative DW-PSIF imaging (delta = 3 ms) showed the best performance for distinguishing between benign and malignant fractures (sensitivity, 100%; specificity, 88.5%; accuracy, 93.5%). Qualitative DW-EPI (b = 50 s/mm² [p = 1.00]; b = 250 s/mm² [p = 0.50]) and DW single-shot TSE imaging (b = 100 s/mm² [p = 1.00]; b = 250 s/mm² [p = 0.18]; b = 400 s/mm² [p = 0.18]; b = 600 s/mm² [p = 0.39]) did not indicate significant differences between benign and malignant fractures. DW-EPI using a b value of 500 s/mm² (p = 0.01) indicated significant differences between benign and malignant vertebral fractures. Quantitative DW-EPI (p = 0.09) and qualitative opposed-phase imaging (p = 0.06) did not exhibit significant differences, quantitative DW single-shot TSE imaging (p = 0.002) and quantitative chemical-shift imaging (p = 0.01) showed significant differences between benign and malignant fractures.

CONCLUSION. The DW-PSIF sequence (delta = 3 ms) had the highest accuracy in differentiating benign from malignant vertebral fractures. Quantitative chemical-shift imaging and quantitative DW single-shot TSE imaging had a lower accuracy than DW-PSIF imaging because of a large overlap. Qualitative assessment of opposed-phase, DW-EPI, and DW single-shot TSE sequences and quantitative assessment of the DW-EPI sequence were not suitable for distinguishing between benign and malignant vertebral fractures.

Keywords: chemical-shift imaging, diffusion-weighted imaging, metastatic fracture, musculoskeletal imaging, osteoporotic fracture, spine, vertebral body fractures

We thank Fabian Bamberg for his invaluable assistance with the statistical part of the study.

Supported by the Deutsche Forschungsgemeinschaft (DFG grant DI 1413/1-1).

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Address correspondence to T. Geith (tobias.[email protected]uni-muenchen.de).

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November 2012, Volume 199, Number 5

Musculoskeletal Imaging

Original Research

Comparison of Qualitative and Quantitative Evaluation of Diffusion-Weighted MRI and Chemical-Shift Imaging in the Differentiation of Benign and Malignant Vertebral Body Fractures

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