Diffusion-weighted  MR  imaging  for  differentiation  of  benign  compression  fracture  edema  and   tumor infiltration of the vertebral body

Hussein Abdullah

Diffusion-weighted MR imaging for differentiation of benign compression fracture edema and tumor infiltration of the vertebral body

Hussein Abdullah

Al-Azhar University, Egyp

: J Diagn Tech Biomed Anal

Abstract

Aim: The aim of our study was to assess the diagnostic accuracy of MR diffusion weighted image (isotropic diffusion map) in differentiation between benign and malignant vertebral compression fractures. Materials & Methods: This study was conducted on 30 patients with 40 vertebral collapse lesions. Philips MR 1.5 Tscanner T1 and T2 &DWI & ADC were performed to all lesions& T2 STIR & Dual phase for some lesions, without intravenous contrast injection. Final diagnoses were reached either by tissue biopsy or clinical correlation & follow up. Results: The common clinical presentations were back pain. The other clinical presentations include paraplegia & para paresis. Most common involved location were the lower dorsal, upper lumbar followed by cervical spine regions. In this study 28 benign vertebral fractures and 12 pathological fractures with 6 para spinal soft tissue mass lesions. 8 lesions diagnosed as multiple myeloma, 3 lesions of metastases of breast cancer and HCC. 1lesion was TB spondylitis with pre vertebral collection & irregular end plates were correctly diagnosed and showed low and high signal intensity on DWI images respectively. Conventional T1- and T2-weighted images were low signal intensity and intermediate signal respectively. Conclusion: Tumor packing present in pathologic fractures led to restriction of water diffusion and thus high signal intensity on DW images that allowed differentiation of benign fracture edema and tumor infiltration and provided excellent distinction between benign and malignant compression vertebral fractures. Additionally, T2 STIR & Dual phase technique has high soft tissue definition and low bony changes sensitivity in our series.