Differential Diagnosis Value Of Conventional And Diffusion Weighted Magnetic Resonance Imaging In Benign And Malignant Vertebral Compression Fractures

Objective:To evaluate the differential diagnosis value of conventional and diffusion weighted magnetic resonance imaging in benign and malignant vertebral compression fractures.Method:Retrospective review of the conventional MR(T1WI,T2WI and STIR)and diffusion weighted MR(SE EPI sequence)of 85 patients(147 vertebral fractures)with pathologically or(and)clinically proven,of which 55 were malignant fractures,and 30 benign fractures(17 traumatic;13 osteoporotic).The contrast group was composed of 69 patients with 69 normal vertebrae adjacent to abnormal vertebrae.The b-value was 0,300 s/mm2.The signs of conventional MR and signal intensities on DWI were compared,apparent diffusion coeffient(ADC)values of normal and abnormal vertebral bodies were calculated.ADC values of vertebral bodies were quantitatively analyzed and compared in the benign,malignant and normal groups.Results:On conventional magnetic resonance imaging,compression fracture vertebras had fracture lines(benign group,48.9%;malignant group,3%),III degree vertebral compression fracture(benign group,34.0%;malignant group,12.0%),ledging sign of vertebral edge(benign group,12.8%;malignant group,1.0%),proso-straight signs of spinal stenosis(benign group,19.1%;malignant group,0.0%),I degree vertebral compression(benign group,23.4%;malignant group,50.0%)and medium degree enhanced(9 enhanced patients with 12 vertebras in benign group,6 vertebras medium degree enhanced,50.0%;24 enhanced patients with 43 vertebras in malignant group,38 vertebras medium degree enhanced,88.4%),the above differences were significant between two groups patients(p<0.05).The percentage of II degree vertebral compression of benign group(38.3%)was close to that of malignant group(31.0%)(p>0.05),but II degree collapse fracture with iso-or hypointense(benign group,34.0%;malignant group,0.0%)or with signal increased(benign group,4.3%;malignant group,31.0%)were significant difference between two groups patients(p<0.05).Iso-or hypointense were 70.2%(33/47)in benign fracture group,slightly hyperintense 23.4%(11/47),hyperintense 6.4%(3/47);iso-or hypointense were 5.0%(5/100)in malignant fracture group,slightly hyperintense 34.0%(34/100),hyperintense 61.0%(61/100).By x2 analysis,there were significant difference among isointense,hypointense and hyperintense fracture(p=0.00,p<0.05),slightly hyperintense fracture were not significant difference between two groups(p=0.61,p>0.05),slightly hyperintense fracture with ADC>6×10-4mm2/s(benign group,19.1%;malignant group,27.3%),collapse fracture signal increased with abnormal intense of vertebro-attachment(benign group,2.1%;malignant group,49.0%),collapse fracture signal increasing with soft tissues lump(benign group,0.0%;malignant group,19.0%),above signs were significant difference between two groups patients(p<0.05);ADC values of benign,malignant and normal group were(6.95±1.97)×10-4mm2/s,(4.54±1.10)×10-4mm2/s and(1.41±0.84)×10-4 mm2/s respectively,slightly hyperintense of vertebra with ADC>6 × 10-4 mm2/s(benign group,19.2%;malignant group,27.3%),vertebra signal increased with abnormal intense of vertebro-attachment(benign group,2.1%;malignant group,49.0%),vertebral signal increased with soft tissues lump(benign group,0.0%;malignant group,19.0%),above vertebral signs were significant difference between two groups patients(p<0.05);ADC values of benign,malignant and normal group were(6.95 ± 1.97)×10-4mm2/S,(4.54 ± 1.10)×10-4mm2/s and(1.41±0.84)× 10-4mm2/s respectively;the differences of ADC values were statistically significant among benign,malignant and normal group(p<0.05).Conclusion:The following signs of benign and malignant group on conventional magnetic resonance imaging,the Percentage of vertebral fracture lines,I and III degree vertebral compression,ledging sign of vertebral edge and proso-straight signs of spinal stenosis were significant difference between two groups patients(p<0.05);hypintense,hyperintense,difference ADC value,vertebro-attachment lesions and soft tissues lump were useful in differentiating benign from malignant vertebral body compression fractures,but there might be overlapped of them,ADC value or(and)signals should were combined with conventional MR of collapse fracture to improve diagnostic rate.