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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



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  		Figure 1. 68-year-old man with malignant acute vertebral compression fracture. Sagittal diffusion weighted MR image with a b-factor of 200 s mm-2 showing location of region of interest cursor in the fractured lumbar vertebral body.

 


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  		Figure 2. 65-year-old man with malignant vertebral body compression fracture due to metastasis from pulmonary carcinoma. (a) Sagittal T1 weighted spin echo MR image (TR=500 ms, TE=8 ms) showing L2 vertebral body signal hypointensity with respect to the normal bone marrow. (b)Sagittal fast STIR MR image (TR=3220 ms, TE=65 ms, TI=150 ms, echo train length=8) showing L2 vertebral body signal hyperintensity with respect to the normal bone marrow. Mild vertebral retropulsion is present.

 


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  		Figure 3. 43-year-old man with traumatic vertebral body compression fracture. (a) Sagittal T1 weighted spin echo MR image (TR=500 ms, TE=8 ms) showing L1 vertebral body signal hypointensity with respect to the normal bone marrow. (b) Sagittal fast STIR MR image (TR=3220 ms, TE=65 ms, TI=150 ms, echotrain length=8) showing L1 vertebral body signal hyperintensity with respect to the normal bone marrow.

 


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  		Figure 4. (a) 60-year-old man with benign acute vertebral body compression fractures. Sagittal MR diffusion weighted image (TR/TE 8000/92) with b-factor of1000 s mm-2 showing signal hypointensity in the fractured vertebral body (arrow) of the lumbar spine. (b) 71-year-old woman with malignant (pulmonary carcinoma metastasis) acute vertebral bodycompression fractures. Sagittal MR diffusion weighted image (TR/TE 8000/92) with b-factor of 1000 s mm-2 showing signal hyperintensity in the fractured vertebral bodies of the lumbar spine (arrow).

 


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  		Figure 5. 67-year-old man with TB spondylitis. (a) Sagittal T1 weighted spin echo MR image (TR=450 ms, TE=8 ms) showing L2 and L3 vertebral body signal hypointensity with respect to the normal bone marrow. (b) Sagittal fast STIR MR image (TR=3300 ms, TE=65 ms, TI=150 ms, echo train length=8) showing L2 and L3 vertebral body signal hyperintensity with respect to the normal bone marrow.

 


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  		Figure 6. Graph showing the relative apparent diffusion coefficients (ADCs) of normal vertebral bodies, malignant acute vertebral bodycompression fractures, TB spondylitis and benign acute vertebral bodycompression fractures. There is overlap between the ADC values of the malignant and TB spondylitis vertebral body compression fractures.

 




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