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Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI

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Abstract

Purpose

To investigate the differences between imaging features of spinal tuberculosis (TB) and metastatic cancer measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The presentation of TB on convention MRI may not show the typical TB signs, and they may be mis-diagnosed as malignant diseases. DCE-MRI may provide additional information to help making differential diagnosis.

Materials and methods

DCE-MRI was performed in 24 TB and 22 metastatic cancer patients. The DCE kinetic pattern was determined as “wash-out”, “plateau” or “persistent enhancement”. The characteristic DCE parameters were calculated from the signal intensity time course. The two-compartmental pharmacokinetic model was used to obtain K trans, which is the parameter associated with the delivery of MR contrast agents into the lesion, and k ep, which is the parameter associated with the distribution and clearance of contrast agents from the lesion.

Results

Of the 24 TB, one case showed the wash-out kinetic pattern, 12 cases showed the plateau pattern, and 11 cases showed the persistent enhancement pattern. Of the 22 metastatic cancers, 12 cases showed wash-out, 7 cases showed plateau, and 3 cases showed persistent enhancement patterns. Compared to the metastatic cancer group, the TB group had a lower k ep (0.27 ± 0.15 vs. 0.49 ± 0.23 min−1, P < 0.001). The ROC analysis showed that the area under the curve was 0.780 for k ep.

Conclusions

DCE-MRI may provide additional information for differentiation between spinal TB and metastasis, when their manifestations on conventional imaging were similar.

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References

  1. Go SW, Lee HY, Lim CH et al (2012) Atypical disseminated skeletal tuberculosis mimicking metastasis on PET-CT and MRI. Intern Med 51:2961–2965

    Article  PubMed  Google Scholar 

  2. Zheng CY, Liu DX, Luo SW et al (2011) Imaging presentation highly manifested as tuberculosis in a case of spinal metastatic carcinoma. Orthopedics 34:e436–e438

    PubMed  Google Scholar 

  3. Yu Y, Wang X, Du B et al (2013) Isolated atypical spinal tuberculosis mistaken for neoplasia: case report and literature review. Eur Spine J 22:S302–S305

    Article  PubMed  Google Scholar 

  4. Gernaerdt MJA, Hogendoorn PCW, Bolem JL et al (2000) Cartilaginous tumors: fast contrast-enhanced MR imaging. Radiology 214:539–546

    Article  Google Scholar 

  5. Moulton JS, Blebea JS, Dunco DM et al (1995) MR imaging of soft-tissue masses: diagnostic efficacy and value of distinguishing between benign and malignant lesions. Am J Roentgenol 164:1191–1199

    Article  CAS  Google Scholar 

  6. Hermann G, Abdelwahab LF, Miller TT et al (1992) Tumour and tumour-like conditions of the soft tissue: magnetic resonance imaging features differentiating benign from malignant masses. Br J Radiol 65:14–20

    Article  CAS  PubMed  Google Scholar 

  7. May DA, Good RB, Smith DK et al (1997) MR imaging of musculoskeletal tumors and tumor mimickers with intravenous gadolinium: experiences with 242 patients. Skeletal Radiol 26:2–15

    Article  CAS  PubMed  Google Scholar 

  8. Elemann R, Reiser MF, Peters PE et al (1989) Musculoskeletal neoplasms: static and dynamic Gd-DTPA enhanced MR imaging. Radiology 171:767–773

    Article  Google Scholar 

  9. Lang P, Honda G, Roberts T et al (1995) Musculoskeletal neoplasm: perineoplastic edema versus tumor on dynamic postcontrast MR imaging with spatial mapping of instantaneous enhancement rates. Radiology 197:831–839

    Article  CAS  PubMed  Google Scholar 

  10. Verstraete KL, De Deene Y, Roels H et al (1994) Benign and malignant musculoskeletal lesions: dynamic contrast-enhanced MR imaging-parametric “first-pass” images depict tissue vascularization and perfusion. Radiology 192:835–843

    Article  CAS  PubMed  Google Scholar 

  11. Stäbler A, Baur A, Bartl R et al (1996) Contrast enhancement and quantitative signal analysis in MR imaging of multiple myeloma: assessment of focal and diffuse growth patterns in marrow correlated with biopsies and survival rates. Am J Roentgenol 167:1029–1036

    Article  Google Scholar 

  12. Baur A, Stäbler A, Bartl R et al (1997) MRI gadolinium enhancement of bone marrow: age-related changes in normals and in diffuse neoplastic infiltration. Skeletal Radiol 26:414–418

    Article  CAS  PubMed  Google Scholar 

  13. Zhang L, Mandel C, Yang ZY et al (2006) Tumor infiltration of bone marrow in patients with hematological malignancies: dynamic contrast-enhanced magnetic resonance imaging. Chin Med J 119:1256–1262

    PubMed  Google Scholar 

  14. Hillengass J, Zechmann C, Bäuerle T et al (2009) Dynamic contrast-enhanced magnetic resonance imaging identifies a subgroup of patients with asymptomatic monoclonal plasma cell disease and pathologic microcirculation. Clin Cancer Res 15:3118–3125

    Article  PubMed  Google Scholar 

  15. Lang N, Su MY, Yu HJ et al (2013) Differentiation of myeloma and metastatic cancer in the spine using dynamic contrast enhanced MRI. Magn Reson Imaging 31:1285–1291

    Article  PubMed Central  PubMed  Google Scholar 

  16. Barrett T, Brechbiel M, Bernardo M et al (2007) MRI of tumor angiogenesis. J Magn Reson Imaging 26:235–249

    Article  PubMed  Google Scholar 

  17. Tofts PS, Kermode AG (1991) Measurement of the blood–brain barrier permeability and leakage space using dynamic MR imaging. 1 Fundamental concepts. Magn Reson Med 17:357–367

    Article  CAS  PubMed  Google Scholar 

  18. Tofts PS (1997) Modeling tracer kinetics in dynamic Gd-DTPA MR imaging. J Magn Reson Imaging 7:91–101

    Article  CAS  PubMed  Google Scholar 

  19. Tofts PS, Brix G, Buckley DL et al (1999) Estimating kinetic parameters from dynamic contrast-enhanced T(1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging 10:223–232

    Article  CAS  PubMed  Google Scholar 

  20. Parker GJ, Roberts C, Macdonald A et al (2006) Experimentally-derived functional form for a population-averaged high-temporal-resolution arterial input function for dynamic contrast-enhanced MRI. Magn Reson Med 56:993–1000

    Article  PubMed  Google Scholar 

  21. Rosai Juan (2004) Rosai and Ackerman’s surgical pathology. Elsevier, Philadelphia, pp 352–353

    Google Scholar 

  22. Tokuda O, Hayashi N, Taguchi K et al (2005) Dynamic contrast-enhanced perfusion MR imaging of diseased vertebrae: analysis of three parameters and the distribution of the time-intensity curve patterns. Skeletal Radiol 34:632–638

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People’s Republic of China

    Ning Lang & Huishu Yuan

  2. Department of Radiological Sciences, Tu and Yuen Center for Functional Onco-Imaging, University of California, 164 Irvine Hall, Irvine, CA, 92697-5020, USA

    Min-Ying Su & Hon J. Yu

Authors
  1. Ning Lang
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  2. Min-Ying Su
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  3. Hon J. Yu
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  4. Huishu Yuan
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Corresponding authors

Correspondence to Min-Ying Su or Huishu Yuan.

Additional information

This work was supported in part by a research grant R01 CA 127927 from the National Institute of Health in the United States and the National Natural Science Foundation of China (81471634).

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Lang, N., Su, MY., Yu, H.J. et al. Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI. Eur Spine J 24, 1729–1737 (2015). https://doi.org/10.1007/s00586-015-3851-z

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  • DOI: https://doi.org/10.1007/s00586-015-3851-z

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