title: Vertebrae adjacent to spinal bone lesion are inconsistent reference markers: a magnetic resonance spectroscopic viewpoint.
abstract: OBJECTIVE
  To ascertain the suitability of vertebrae adjacent to spinal bone lesions as a signal intensity reference on MRI, and compare the MR spectroscopic appearance of vertebral body compression fractures due to malignant tumor infiltration, bone weakening (e.g., osteoporosis), and/or minor trauma.
  
  
  METHODS
  Twenty-five patients with spinal compression fractures underwent routine spinal MRI with an additional 1H MRS study protocol to assess the percent fat fraction of the compressed vertebrae as well as the adjacent bony environment. Peak areas for water and total lipid were calculated from short-TE single-voxel 1H MR spectra using the LCModel analyzing tool.
  
  
  RESULTS
  There were consistent water-only patterns in the fractured vertebra suggesting either near complete marrow replacement by malignant tissue or local edematous fluid/hemorrhage within the marrow spaces. However, the adjacent vertebrae showed a wide range of patterns from a dominant lipid signal to the inverse of a pronounced water level. These results far exceed the normal variation expected based on age and sex.
  
  
  CONCLUSIONS
  The results suggest that the adjacent vertebrae may not be an accurate reference, especially in diffusion-weighted imaging (DWI), because of the large difference between the two compartments. Furthermore, in the case of gradient-echo measurements, the in-phase vs. opposed-phase effects are significant.
authors.affiliation: Department of Diagnostic Radiology, Singapore General Hospital, Singapore. helmut.rumpel@pacific.net.sg
authors.forename: Helmut
authors.initials: H
authors.lastname: Rumpel
authors.forename: Ling Ling
authors.initials: LL
authors.lastname: Chan
authors.forename: Lai Peng
authors.initials: LP
authors.lastname: Chan
authors.forename: Meng Ai
authors.initials: MA
authors.lastname: Png
authors.forename: Raymond K L
authors.initials: RK
authors.lastname: Tan
authors.forename: Winston E H
authors.initials: WE
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005598:Fractures, Spontaneous / Q000473:pathology; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000473:pathology; D013122:Spinal Diseases / Q000473:pathology*; D016103:Spinal Fractures / Q000473:pathology*; D013124:Spinal Injuries / Q000473:pathology*