Diagnostic value of apparent diffusion coefficient to differentiate benign from malignant vertebral bone marrow lesions

AbstractBackgroundVertebral collapse is a common problem due to benign bone marrow lesions, trauma or malignant process. The diagnosis is often correctly predicted from characteristic imaging appearance. Some vertebral collapses have atypical imaging appearance that may cause diagnostic confusion.AimTo evaluate the value of the ADC obtained in DW-MR sequences for the differentiation between benign and malignant bone marrow lesions.PatientsSixty patients were included in this study, referred from Neurosurgery and Radiotherapy Departments and proved to have vertebral compression based on conventional MR imaging.ResultsThe ADC value resulted in statistically significant characterization between (osteoporotic and post-traumatic collapse) and (malignant vertebral collapse) (P<0.0001) while there was no statistically significant findings between infective spondylodiscitis and malignant vertebral collapse (P>0.05). The sensitivity, specificity, PPV, NPD of DWI and ADC values in differentiating benign from malignant vertebral collapse were 100%, 83.3%, 60% and 100% respectively.ConclusionsADC values are a useful complementary MRI tool to characterize bone marrow lesions, in order to distinguish acute benign fractures from malignant or infectious bone marrow lesions. However, ADC values are not valuable in order to differentiate malignancy from infection with diagnostic overlap in the subacute traumatic vertebral collapse