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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 22:366-372 (2 2001)
© 2001 American Society of Neuroradiology

ARTICLE

Diagnostic Value of Increased Diffusion Weighting of a Steady-state Free Precession Sequence for Differentiating Acute Benign Osteoporotic Fractures from Pathologic Vertebral Compression Fractures

Andrea Baur^,a, Armin Huber^a, Birgit Ertl-Wagner^a, Roland Dürr^a, Stefan Zysk^a, Susanne Arbogast^a, Michael Deimling^a and Maximilian Reiser^a

^a From the Departments of Diagnostic Radiology (A.B., A.H., B.E-W., M.R.), Orthopaedic Surgery (R.D., S.Z.), and Pathology (S.A.), University of Munich, Germany; and Siemens Medical Systems, Erlangen, Germany (M.D.).

BACKGROUND AND PURPOSE: Differentiating acute benign from neoplastic vertebral compression fractures can pose a problem in differential diagnosis on routine MR sequences, as signal changes can be quite similar. Our purpose was to assess the value of increasing the diffusion weighting of a diffusion-weighted steady-state free precession (SSFP) sequence for differentiating these two types of vertebral compression fractures.

METHODS: Twenty-nine patients with 32 acute vertebral compression fractures caused by osteoporosis (n = 15) or malignancy (n = 17) were examined with a diffusion-weighted SSFP sequence, a T1-weighted spin-echo sequence, and a short-inversion-time inversion recovery sequence. The SSFP sequence was performed with increased diffusion weighting ( = 0.6, 3.0, 6.0, and 9.0 ms). The signal intensities of the fractured vertebral bodies were rated on a five-point scale from markedly hypointense to markedly hyperintense relative to normal adjacent vertebral bodies. Quantitative analysis was performed by region-of-interest measurements and by calculating the bone marrow contrast ratio. Statistical analysis was performed with the Mann Whitney U test and Student's t test.

RESULTS: At = 3 ms, the osteoporotic fractures yielded hypointense signal in seven cases, isointense signal in six, and hyperintense signal in two. The fractures showed a progressive signal loss with increased diffusion weighting, so that hypointensity was reached in all but one case. All metastatic fractures had hyperintense signal with = 3 and 6.0 ms. With = 9.0 ms, four fractures became isointense.

CONCLUSION: Increasing diffusion weighting can reduce false-positive hyperintense osteoporotic fractures or make hypointensity more obvious in cases of osteoporotic fractures.

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