ADC as a useful diagnostic tool for differentiating benign and malignant vertebral bone marrow lesions and compression fractures: a systematic review and meta-analysis
- 29 Downloads
To assess the sensitivity and specificity of quantitative assessment of the apparent diffusion coefficient (ADC) for differentiating benign and malignant vertebral bone marrow lesions (BMLs) and compression fractures (CFs)
An electronic literature search of MEDLINE and EMBASE was conducted. Bivariate modelling and hierarchical summary receiver operating characteristic modelling were performed to evaluate the diagnostic performance of ADC for differentiating vertebral BMLs. Subgroup analysis was performed for differentiating benign and malignant vertebral CFs. Meta-regression analyses according to subject, study and diffusion-weighted imaging (DWI) characteristics were performed.
Twelve eligible studies (748 lesions, 661 patients) were included. The ADC exhibited a pooled sensitivity of 0.89 (95% confidence interval [CI] 0.80–0.94) and a pooled specificity of 0.87 (95% CI 0.78–0.93) for differentiating benign and malignant vertebral BMLs. In addition, the pooled sensitivity and specificity for differentiating benign and malignant CFs were 0.92 (95% CI 0.82–0.97) and 0.91 (95% CI 0.87–0.94), respectively. In the meta-regression analysis, the DWI slice thickness was a significant factor affecting heterogeneity (p < 0.01); thinner slice thickness (< 5 mm) showed higher specificity (95%) than thicker slice thickness (81%).
Quantitative assessment of ADC is a useful diagnostic tool for differentiating benign and malignant vertebral BMLs and CFs.
• Quantitative assessment of ADC is useful in differentiating vertebral BMLs.
• Quantitative ADC assessment for BMLs had sensitivity of 89%, specificity of 87%.
• Quantitative ADC assessment for CFs had sensitivity of 92%, specificity of 91%.
• The specificity is highest (95%) with thinner (< 5 mm) DWI slice thickness.
KeywordsMeta-analysis Diffusion-weighted MRI Spine Bone marrow neoplasm Compression fracture
Apparent diffusion coefficient
Bone marrow lesion
Best value comparator
Hierarchical summary receiver operating characteristic
Quality Assessment of Diagnostic Accuracy Studies-2
Compliance with ethical standards
The scientific guarantor of this publication is Seong Jong Yun, MD.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors (Chong Hyun Suh, MD) has significant statistical expertise.
Written informed consent was not required for this study because the nature of our study was a systemic review and meta-analysis.
Institutional review board approval was not required because the nature of our study was a systemic review and meta-analysis.
• Meta-analysis performed at one institution
- 2.Kim YP, Kannengiesser S, Paek MY et al (2014) Differentiation between focal malignant marrow-replacing lesions and benign red marrow deposition of the spine with T2*-corrected fat-signal fraction map using a three-echo volume interpolated breath-hold gradient echo Dixon sequence. Korean J Radiol 15:781–791CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Thawait SK, Marcus MA, Morrison WB, Klufas RA, Eng J, Carrino JA (2012) Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine (Phila Pa 1976) 37:E736–E744CrossRefGoogle Scholar
- 19.Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0. The Cochrane Collaboration. http://handbook.cochrane.org/chapter_9/9_5_2_identifying_and_measuring_heterogeneity.htm. Accessed 30 Sept 2017
- 27.Geith T, Biffar A, Schmidt G et al (2015) Physiological background of differences in quantitative diffusion-weighted magnetic resonance imaging between acute malignant and benign vertebral body fractures: correlation of apparent diffusion coefficient with quantitative perfusion magnetic resonance imaging using the 2-compartment exchange model. J Comput Assist Tomogr 39:643–648CrossRefPubMedGoogle Scholar
- 28.Lin F, Lei Y, Li YB (2009) Influence of lesion ratio on diagnostic performance of in-phase/opposed-phase imaging and apparent diffusion coefficient for differentiating acute benign vertebral fractures and metastases. Chin Med J (Engl) 122:1293–1299Google Scholar
- 30.Martel Villagrán J, Bueno Horcajadas Á, Pérez Fernández E, Martín Martín S (2015) Accuracy of magnetic resonance imaging in differentiating between benign and malignant vertebral lesions: role of diffusion-weighted imaging, in-phase/opposed-phase imaging and apparent diffusion coefficient. Radiologia 57:142–149CrossRefPubMedGoogle Scholar
- 41.Tzeng YH, Chang TY, Huang GS, Lan GY, Hou WY, Shen HJ (2004) Diffusion-weighted MR imaging for differentiating acute benign from pathologic compression fractures: a reinvestigation of the usefulness of diffusion-weighted imaging. Chin J Radiol 29:109–115Google Scholar
- 42.Yao WW, Li MH, Yang SX, Zhu LL (2005) Use of diffusion-weighted magnetic resonance imaging to differentiate between acute benign and pathological vertebral fractures: prospective study. J HK Coll Radiol 8:4–8Google Scholar
- 47.Wonglaksanapimon S, Chawalparit O, Khumpunnip S, Tritrakarn SO, Chiewvit P, Charnchaowanish P (2012) Vertebral body compression fracture: discriminating benign from malignant causes by diffusion-weighted MR imaging and apparent diffusion coefficient value. J Med Assoc Thai 95:81–87PubMedGoogle Scholar
- 48.Taskin G, Incesu L, Aslan K (2013) The value of apparent diffusion coefficient measurements in the differential diagnosis of vertebral bone marrow lesions. Turk J Med Sci 43:379–387Google Scholar
- 52.Pozzi G, Albano D, Messina C et al (2017) Solid bone tumors of the spine: diagnostic performance of apparent diffusion coefficient measured using diffusion-weighted MRI using histology as a reference standard. J Magn Reson Imaging. https://doi.org/10.1002/jmri.25826
- 53.Park S, Kwack KS, Chung NS, Hwang J, Lee HY, Kim JH (2017) Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging of focal vertebral bone marrow lesions: initial experience of the differentiation of nodular hyperplastic hematopoietic bone marrow from malignant lesions. Skeletal Radiol 46:675–683CrossRefPubMedGoogle Scholar
- 55.Geith T, Schmidt G, Biffar A et al (2014) Quantitative evaluation of benign and malignant vertebral fractures with diffusion-weighted MRI: what is the optimum combination of b values for ADC-based lesion differentiation with the single-shot turbo spin-echo sequence? AJR Am J Roentgenol 203:582–588CrossRefPubMedGoogle Scholar