title: Diffusion-weighted MR imaging of metastatic disease of the spine: assessment of response to therapy.
abstract: OBJECTIVE
  In cases of metastatic disease of the spine, monitoring the response to medical therapy with plain radiography, bone scanning, and conventional spin-echo sequence MR imaging is unsatisfactory because of the insensitivity or nonspecific findings of these imaging modalities. The purpose of this study was to investigate signal intensity changes of bone marrow after therapy by using diffusion-weighted MR imaging to monitor the response to medical therapy in cases of metastatic disease of the spine.
  
  
  METHODS
  Twenty-four patients with metastatic disease of the spine were examined with MR imaging. Diffusion-weighted MR imaging and spin-echo MR imaging were performed in all patients before and after radiation therapy. Follow-up diffusion-weighted MR imaging and spin-echo MR imaging were performed for comparison purposes in nine cases at 1 month, in seven cases at 2 months, in seven cases at 3 months, and in three cases at 6 months after therapy. The diffusion-weighted MR imaging sequences were based on a steady-state free precession with a low b value (165 s/mm(2)) and a single shot stimulated echo-acquisition mode with a high b value (650 s/mm(2)). Apparent diffusion coefficient maps were obtained using two different b values incorporated in a diffusion-weighted single shot stimulated echo-acquisition mode sequence. Apparent diffusion coefficient maps were obtained in three cases. Signal intensity changes of the metastatic disease of the vertebral bone marrow before and after therapy on conventional spin-echo sequence and diffusion-weighted MR images were evaluated.
  
  
  RESULTS
  As shown by diffusion-weighted MR imaging, metastatic disease of the vertebral bone marrow included in our study before therapy was hyperintense to normal vertebral bodies. In 23 patients with clinical improvement, metastatic disease of the spine after therapy was hypointense relative to normal vertebral bodies on the follow-up diffusion-weighted MR images. In one patient with hepatocellular carcinoma, the clinical symptoms did not improve and follow-up bone scanning performed 6 months after therapy showed increased uptake. Persistent hyperintense bone marrow after therapy was also noted on diffusion-weighted MR images. Decreased signal intensity of the metastatic disease of the spine on diffusion-weighted MR images was observed >1 month after therapy.
  
  
  CONCLUSIONS
  Diffusion-weighted MR imaging shows that, with successful therapy, there is decreased signal intensity of metastatic disease of the vertebral bone marrow.
authors.affiliation: Department of Diagnostic Radiology, College of Medicine, Yeungnam University, Namku, Daegu, Korea.
authors.forename: Woo Mok
authors.initials: WM
authors.lastname: Byun
authors.forename: Sei One
authors.initials: SO
authors.lastname: Shin
authors.forename: Yongmin
authors.initials: Y
authors.lastname: Chang
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Jurgen
authors.initials: J
authors.lastname: Finsterbusch
authors.forename: Jens
authors.initials: J
authors.lastname: Frahm
mesh_terms: D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary*; D013131:Spine / Q000473:pathology; D016896:Treatment Outcome