Abstract
The retrospective study investigated accuracy of quantitative evaluation of T1-weighted imaging (T1WI) with and without fat suppression (FS), chemical-shift, diffusion-weighted imaging (DWI) and enhanced imaging at 3.0 T MRI for distinguishing spinal hemangiomas from metastases. 27 patients with 33 spinal hemangiomas (15 atypical hemangiomas) and 26 patients with 71 metastases were recruited. T1WI, FS T1WI, in- and out-phase, DWI and enhanced T1WI were acquired. Signal intensities (SIs) of lesions were obtained. Signal intensity ratios (SIRs) and enhancement ratios of lesions in enhanced imaging were assessed. Ratio of SI loss of hemangiomas or atypical hemangiomas between T1WI and FS T1WI was higher than those of metastases (p < 0.001). The accuracies of ratio of SI loss between T1WI and FS T1WI for differentiating hemangiomas and atypical hemangiomas from metastases were 96.15% and 91.86%. Ratio of SI loss between in- and out- phase could differentiate hemangiomas and atypical hemangiomas from metastases with accuracies of 74.04% and 84.88%. Cutoff values for hemangiomas in SIRs of ≤ 1.52 (early phase) and ≤ 1.38 (middle phase) yielded accuracies of 92.31% and 82.69%. Enhancement ratios of atypical hemangiomas in middle and delayed phases were higher than that of metastases. Accuracies of apparent diffusion coefficient for differentiating hemangiomas and atypical hemangiomas from metastases were 70.19% and 89.53%. T1WI with and without fat suppression could distinguish spinal hemangiomas from metastases. Quantitative assessment of chemical-shift, DWI and enhanced imaging were helpful to identification of spinal hemangiomas and metastases.
Highlights
Metastases to spine have been reported to occur in 5-10% of patients with primary neoplasms [1]
Because of no fatty tissue in the metastatic lesions, there was lack of signal loss on fat suppressed imaging compared to non-fat suppressed imaging
Spinal hemangiomas were usually composed of fatty component [8], and a strong signal loss in fat suppressed imaging was expected
Summary
Metastases to spine have been reported to occur in 5-10% of patients with primary neoplasms [1]. A cancer patient undergoing a staging evaluation to detect or rule out bone metastases is important clinically [2]. If metastatic disease is detected, prognosis can change and the treatment regimen can at that point be altered from one of curative therapy to one of palliative treatment [3]. Some benign spinal lesions may be confused with metastatic lesions and may even be treated as neoplasms unnecessarily using irradiation or chemotherapy [4]. Spinal hemangioma is the most common benign tumor of the spine [5]. An 11% incidence www.impactjournals.com/oncotarget of spinal hemangiomas was reported in an autopsy series in the adult population [6]. It is clinically essential to differentiate spinal metastases from hemangiomas in cancer patients
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