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.
abstract: OBJECTIVE
  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 (delta = 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 delta = 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 delta = 3 and 6.0 ms. With delta = 9.0 ms, four fractures became isointense.
  
  
  CONCLUSIONS
  Increasing diffusion weighting can reduce false-positive hyperintense osteoporotic fractures or make hypointensity more obvious in cases of osteoporotic fractures.
authors.affiliation: Department of Diagnostic Radiology, University of Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Baur
authors.forename: A
authors.initials: A
authors.lastname: Huber
authors.forename: B
authors.initials: B
authors.lastname: Ertl-Wagner
authors.forename: R
authors.initials: R
authors.lastname: Dürr
authors.forename: S
authors.initials: S
authors.lastname: Zysk
authors.forename: S
authors.initials: S
authors.lastname: Arbogast
authors.forename: M
authors.initials: M
authors.lastname: Deimling
authors.forename: M
authors.initials: M
authors.lastname: Reiser
mesh_terms: D000208:Acute Disease; D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009369:Neoplasms / Q000150:complications*; D010024:Osteoporosis / Q000150:complications*