@article {Baur366, author = {Andrea Baur and Armin Huber and Birgit Ertl-Wagner and Roland D{\"u}rr and Stefan Zysk and Susanne Arbogast and Michael Deimling and Maximilian Reiser}, title = {Diagnostic Value of Increased Diffusion Weighting of a Steady-state Free Precession Sequence for Differentiating Acute Benign Osteoporotic Fractures from Pathologic Vertebral Compression Fractures}, volume = {22}, number = {2}, pages = {366--372}, year = {2001}, publisher = {American Journal of Neuroradiology}, abstract = {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 (δ = 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{\textquoteright}s t test.RESULTS: At δ = 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 δ = 3 and 6.0 ms. With δ = 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.}, issn = {0195-6108}, URL = {https://www.ajnr.org/content/22/2/366}, eprint = {https://www.ajnr.org/content/22/2/366.full.pdf}, journal = {American Journal of Neuroradiology} }