Combined intravoxel incoherent motion diffusion-weighted MR imaging and magnetic resonance spectroscopy in differentiation between osteoporotic and metastatic vertebral compression fractures

Hui Tan,Zhaoguo Zhang,Shaoyu Wang,Nan Yu,Yue Li,Zhen Yang,Hui Xu,Feifei Luo,Qiuju Fan,Yong Yu

doi:10.1186/s13018-019-1350-3

Abstract

PurposeOur purpose was to combine intravoxel incoherent motion diffusion-weighted MR imaging (IVIM-DWI) and magnetic resonance spectroscopy (MRS) to differentiate osteoporotic fractures from osteolytic metastatic vertebral compression fractures (VCFs).MethodsA total of 70 patients with VCFs were included and divided into two groups, according to their causes of fractures based on pathological findings or clinical follow-up. All patients underwent conventional sagittal T1WI, T2WI, STIR, IVIM-DWI, and single-voxel MRS. The diffusion coefficient (D), pseudo diffusion (D*), and perfusion fraction (f) parameters from IVIM-DWI and the lipid water ratio (LWR) and fat fraction (FF) parameters from MRS were obtained and compared among groups. Furthermore, the diagnostic performance of MRS, IVIM-DWI, and IVIM-DWI combined with MRS for differentiation between osteoporotic and osteolytic metastatic VCFs was assessed by using receiver operating characteristic (ROC) curve analysis.ResultsCompared with the osteoporotic group, the metastatic group had significantly lower values for f, D, and FF, but higher D* (all P < 0.05). The area under the receiver operating characteristic (ROC) curve of MRS, IVIM-DWI, and IVIM-DWI combined with MRS were 0.73, 0.88, and 0.94, respectively. Among these, the IVIM-DWI combined with MRS showed the highest sensitivity, specificity, and accuracy, which are 90.63% (29/32), 97.37 % (37/38), and 94.29% (66/70), respectively.ConclusionsIVIM-DWI combined with MRS can be more accurate and efficient for differentiation between osteoporotic and osteolytic metastatic VCFs than single MRS or IVIM-DWI.

Highlights

Vertebral compression fractures (VCFs) are common and occurred frequently among the elderly, which are caused by osteoporosis
Regular diagnosis is very important for the option of treatments and prognosis for patients; the unnecessary vertebral biopsy can be evitable in patients with osteoporotic VCFs [1]
Among the 138 patients, the following exclusion criteria were applied: (i) Unsatisfactory image quality or an artifact caused by a metal device (n = 5), (ii) old compression fractures (n = 9), (iii) chemotherapy or radiation therapy before Magnetic resonance imaging (MRI) examination (n = 11), (iv) patients with presumed osteoporotic or metastatic without more than 3 months follow-up or did not have pathological confirmation (n = 10), and (v) primary vertebral tumors (e.g., lymphoma(n = 2) and multiple myeloma (n = 3)), sclerotic metastases (n = 6), diffuse hematologic disorders (n = 2), spondylitis (n = 2), spinal tuberculosis (n = 5)

Summary

Introduction

Vertebral compression fractures (VCFs) are common and occurred frequently among the elderly, which are caused by osteoporosis. The spine is a frequent location of metastatic that may result in pathologic fractures in one third of patients with cancer. Regular diagnosis is very important for the option of treatments and prognosis for patients; the unnecessary vertebral biopsy can be evitable in patients with osteoporotic VCFs [1]. Morphological features only based on CT may be misleading. Magnetic resonance imaging (MRI) plays an increasingly vital role in differentiating osteoporotic from metastatic VCFs. A T1- or T2-weighted imaging and shortT1 inversion recovery (STIR) sequence are performed for the clinical assessment with low specificity [2]

Methods

Results

Conclusion