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Benign versus metastatic vertebral compression fractures: combined diffusion-weighted MRI and MR spectroscopy aids differentiation

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Abstract

Objectives

To determine the residual lipid fraction in fractured vertebrae by 1H MR spectroscopy (MRS) and its confounding effect on differentiating benign from metastatic compression fractures of the spine using apparent diffusion coefficient (ADC) obtained by diffusion-weighted read-out-segmented echo-planar imaging.

Methods

Fifty-two patients presenting with back pain and/or vertebral compression fractures related to different degrees of acute trauma, osteoporosis or clinically known metastatic disease underwent imaging at 1.5 T using (a) single-voxel MRS for water and lipid compositions over the fractured vertebral marrow, and (b) DWI at b = 0 and 650 s/mm2 to compute the ADC values.

Results

In 46 fractured vertebrae, the amount of lipid displaced was variable. In low-impact trauma, lipid was either displaced partially (ADC of 1.60 ± 0.20 × 10−3 mm2/s) or almost totally with a higher ADC (2.20 ± 0.27 × 10−3 mm2/s). In acute high-impact trauma, the lipid fraction was negligible, yet an intermediate ADC was observed. In tumour infiltration, ADC was also intermediate (1.22 ± 0.14 × 10−3 mm2/s) despite a negligible lipid fraction. The ROC curve yielded a diagnostic accuracy of 0.944.

Conclusion

ADC-MRS analysis provides knowledge of the residual lipid fraction in fractured vertebrae that could aid in the differentiation between benign and metastatic vertebral fractures in low-impact trauma.

Key Points

• Trauma causes displacement of lipid in normal vertebral bone marrow.

• A high content of remaining lipids confounds and lowers the ADC.

• ADC alone is ambiguous in differentiating osteoporotic and neoplastic vertebral fractures.

• Differentiation is aided by using ADC in combination with MRS.

• Diffusion-weighted read-out-segmented echo-planar imaging improves spinal image quality.

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Abbreviations

DW-rs-EPI:

diffusion-weighted read-out-segmented echo-planar imaging

DW-ss-EPI:

diffusion-weighted single-shot echo-planar imaging

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Acknowledgements

This study was funded by SingHealth Grant Singapore.

Dr David A Porter is an employee at Siemens AG Healthcare Sector, Erlangen, Germany

The MR methodology and preliminary results were presented at RSNA 2010, entitled ‘Readout-segmented echo-planar diffusion-weighted MRI and 1H MR spectroscopy in benign and metastatic vertebral compression fractures’.

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Authors and Affiliations

  1. Department Diagnostic Radiology, Singapore General Hospital, Outram Rd., Singapore, 169608, Singapore

    Helmut Rumpel, Yi Chong & Ling L. Chan

  2. Siemens AG Healthcare Sector, Erlangen, Germany

    David A. Porter

Authors
  1. Helmut Rumpel
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  2. Yi Chong
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  3. David A. Porter
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  4. Ling L. Chan
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Correspondence to Helmut Rumpel.

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Rumpel, H., Chong, Y., Porter, D.A. et al. Benign versus metastatic vertebral compression fractures: combined diffusion-weighted MRI and MR spectroscopy aids differentiation. Eur Radiol 23, 541–550 (2013). https://doi.org/10.1007/s00330-012-2620-1

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  • DOI: https://doi.org/10.1007/s00330-012-2620-1

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