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British Journal of Radiology 75 (2002),207-214 © 2002 The British Institute of Radiology

Full Paper

Acute vertebral body compression fractures: discrimination between benign and malignant causes using apparent diffusion coefficients

J H M Chan, MSc 1 W C G Peh, MD, FRCP, FRCR 2 E Y K Tsui, FRCR 1 L F Chau, FRCR 3 K K Cheung, FRCS 4 K B Chan, FRCS 5 M K Yuen, FRCR 1 E T H Wong, FRCR 1 and K P C Wong, FRCR 1

Departments of 1 Diagnostic Radiology and 4 Orthopedic Surgery, Tuen Mun Hospital, Hong Kong, 2 Department of Diagnostic Radiology, Singapore General Hospital, Singapore and Departments of 3 Diagnostic Radiology and 5 Orthopedic Surgery, North District Hospital, Hong Kong

Correspondence: Wilfred C G Peh, Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 169608

Diffusion weighted MRI was performed on patients with acute vertebral body compression. The usefulness of the apparent diffusion coefficient (ADC) in differentiating between benign and malignant fractures was evaluated. A total of 49 acute vertebral body compression fractures were found in 32 patients. 25 fractures in 18 patients were due to osteoporosis, 18 fractures in 12 patients were histologically proven to be due to malignancy, and 6 fractures in 2 patients were due to tuberculosis. Signal intensities on T1 weighted, short tau inversion recovery (STIR) and diffusion weighted images were compared. ADC values of normal and abnormal vertebral bodies were calculated. Except for two patients with sclerotic metastases, benign acute vertebral fractures were hypointense and malignant acute vertebral fractures were hyperintense with respect to normal bone marrow on diffusion weighted images. Mean combined ADCs (ADCcmb; average of the combined ADCs in the x, y and z diffusion directions) were 0.23x10-3 mm2 s-1 in normal vertebrae, 0.82x10-3 mm2 s-1 in malignant acute vertebral fractures and 1.94x10-3 mm2 s-1 in benign acute vertebral fractures. The differences between ADCcmb values were statistically significant (p<0.001). The ADC is useful in differentiating benign from malignant acute vertebral body compression fractures, but there may be overlapping ADC values between malignant fractures and tuberculous spondylitis.




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