title: SSH-EPI diffusion-weighted MR imaging of the spine with low b values: is it useful in differentiating malignant metastatic tumor infiltration from benign fracture edema?
abstract: OBJECTIVE
  Conventional MR sequences are sometimes not helpful in differentiating benign from pathologic fractures. Our aim was to evaluate the usefulness of single-shot echo-planar imaging sequences (diffusion-weighted imaging (DWI)/SSH-EPI) with low b value in differentiating malignant metastatic tumor infiltration of vertebral bone marrow from benign vertebral fracture edema.
  
  
  METHODS
  A total of 47 patients, 20 with benign fractures and 27 with tumor infiltration, were included in this prospective study. Diffusion-weighted MR images were obtained by single-shot echo-planar imaging technique with diffusion gradient (b = 300 s/mm2; TR/TE, 1,400/100), using a 1.5 T MR scanner. T1- and T2-weighted images and short inversion time inversion-recovery images were available for all 64 lesions. The lesions on DWI/SSH-EPI were categorized as having hypo-, iso-, or hyperintense signal intensity relative to normal vertebrae by two experienced radiologists.
  
  
  RESULTS
  We evaluated signal intensity patterns on DWI/SSH-EPI in 64 lesions, which showed low signal intensity on T1-weighted images in both benign fractures and metastasis. With the exception of sclerotic metastases in two patients, malignant metastatic tumor infiltration was hyperintense with respect to normal bone marrow on diffusion-weighted images; all but four benign vertebral fractures were isointense with respect to normal bone marrow.
  
  
  CONCLUSIONS
  Single-shot echo-planar imaging sequences (DWI/SSH-EPI) with low b value provided excellent distinction between metastatic tumor infiltration and benign vertebral fracture edema. Hyperintense signal intensity on DWI/SSH-EPI was highly specific for the diagnosis of metastatic tumor infiltration of the spine.
authors.affiliation: Department of Radiology, Bozyaka Training and Research Hospital, Izmir, Turkey. oztekinozgur@gmail.com
authors.forename: Ozgur
authors.initials: O
authors.lastname: Oztekin
authors.forename: Ebru
authors.initials: E
authors.lastname: Ozan
authors.forename: Zehra
authors.initials: Z
authors.lastname: Hilal Adibelli
authors.forename: Gökhan
authors.initials: G
authors.lastname: Unal
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Abali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging; D017352:Echo-Planar Imaging / Q000379:methods; D004487:Edema / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016103:Spinal Fractures / Q000175:diagnosis*; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000473:pathology