Diffusion-weighted imaging of the spine: is it reliable

During the past few years, diffusion-weighted (DW) imaging of the spine has received considerable attention in the imaging literature, although its use-fulness and efficacy remain controversial. The inter-est in spinal DW imaging stems from the fact that, with conventional MR imaging alone, it is difficult to distinguish benign from pathologic vertebral body compression fractures (1). One of the most reliable signs for this purpose is that of visualizing a fracture line in which the fracture is usually seen on T2- or postcontrast T1-weighted images as a linear hypoin-tensity in the middle of the compressed vertebral body or adjacent to a compressed endplate (2). Other signs that favor benign compression fractures (from the most to the least specific) include the presence o