PT - JOURNAL ARTICLE AU - Andrea Baur AU - Armin Huber AU - Birgit Ertl-Wagner AU - Roland Dürr AU - Stefan Zysk AU - Susanne Arbogast AU - Michael Deimling AU - Maximilian Reiser TI - Diagnostic Value of Increased Diffusion Weighting of a Steady-state Free Precession Sequence for Differentiating Acute Benign Osteoporotic Fractures from Pathologic Vertebral Compression Fractures DP - 2001 Feb 01 TA - American Journal of Neuroradiology PG - 366--372 VI - 22 IP - 2 4099 - http://www.ajnr.org/content/22/2/366.short 4100 - http://www.ajnr.org/content/22/2/366.full SO - Am. J. Neuroradiol.2001 Feb 01; 22 AB - 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'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.