[Differentiation of benign osteoporotic and neoplastic vertebral compression fractures with a diffusion-weighted, steady-state free precession sequence].
OBJECTIVE
To evaluate the diagnostic accuracy of a diffusion-weighted, steady-state free precession (SSFP) sequence for the differentiation of acute benign osteoporotic and neoplastic vertebral compression fractures.


METHODS
85 patients with 102 vertebral compression fractures were examined with MR imaging using a spine array surface coil (Siemens, Vision, 1.5 Tesla). The following sequences were performed in sagittal orientation: T1-weighted spin echo (SE), short-tau inversion recovery (STIR) and a diffusion-weighted SSFP sequence (TR = 25 msec, diffusion pulse length delta = 3 msec). The SSFP images were evaluated qualitatively on a 5-grade scale from strongly hypointense to strongly hyperintense. Quantitative analysis was performed with region of interest measurements (ROI) and calculation of a bone marrow ratio.


RESULTS
60 fractures were due to osteoporosis and 42 fractures were caused by malignancy. "Hyperintensity" in a vertebral fracture on a SSFP sequence provided a sensitivity of 100 % and a specificity of 93 %. The positive predictive value was 91 %, the negative predictive value was 100 %. Quantitative analysis of the bone marrow ratio showed a statistically significant difference between the osteoporosis and the tumor group (p < 0.001). The mean value for the osteoporotic fractures was - 0.32 (SD 0.33) and + 2.07 (SD 1.37) for the tumor group.


CONCLUSIONS
The SSFP sequence provides a high accuracy in the differentiation of benign osteoporotic and neoplastic vertebral compression fractures.
Baur
A
A
Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians, Universität, München, Germany. Andrea.Baur@ikra.med.uni-muenchen.de
Huber
A
A
Dürr
H R
HR
Nikolaou
K
K
Stäbler
A
A
Deimling
M
M
Reiser
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D017352:Echo-Planar Imaging; D005260:Female; D005598:Fractures, Spontaneous / Q000175:diagnosis*; D006801:Humans; D007089:Image Enhancement; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis*; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary; D013904:Thoracic Vertebrae / Q000473:pathology