title: Differential diagnosis of vertebral compression fracture using in-phase/opposed-phase and short TI inversion recovery imaging.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) is highly useful for detecting diseases of the bone marrow. The sensitivity for detecting compression fracture is very high, but specificity is low for differential diagnosis between malignant and benign cases.
  
  
  OBJECTIVE
  To evaluate the usefulness of in-phase/opposed-phase and short TI inversion recovery (STIR) magnetic resonance imaging (MRI) of bone marrow for differentiation between benign and malignant vertebral compression fractures.
  
  
  METHODS
  A retrospective review of 66 patients with 70 vertebral compression fractures was performed. The signal intensity ratio (SIR) defined as SIR (opposed/in) was calculated from in-phase/opposed-phase MR images, and the signal intensity ratio as SIR (STIR) was calculated from STIR MR images. The relationships between values of SIR (opposed/in) and SIR (STIR) and the differential diagnosis of malignant vs. benign fractures were considered.
  
  
  RESULTS
  When SIR (opposed/in) was less than 1.0, bone marrow was benign. The bone marrow was malignant when both SIR (opposed/in) was greater than 1.0 and SIR (STIR) was less than 2.0.
  
  
  CONCLUSIONS
  In cases of acute compression fracture, malignant bone marrow showed SIR(STIR) values less than 2.0 and SIR (in/opposed) greater than 1.0. In contrast, benign bone marrow showed SIR (STIR) values greater than 2.5. For chronic compression fracture, malignant bone marrow showed SIR (in/opposed) greater than 1.0. Bone marrow was benign in all cases with SIR (in/opposed) less than 1.0.
authors.affiliation: Department of Radiology, Kyoto City Hospital, Japan. a-ogura@mbox.kyoto-inet.or.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Ogura
authors.forename: Katsumi
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Fumie
authors.initials: F
authors.lastname: Maeda
authors.forename: Fumito
authors.initials: F
authors.lastname: Saeki
authors.forename: Ai
authors.initials: A
authors.lastname: Syukutani
authors.forename: Sachiko
authors.initials: S
authors.lastname: Shibutani
authors.forename: Emi
authors.initials: E
authors.lastname: Kuroda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D059629:Signal-To-Noise Ratio; D016103:Spinal Fractures / Q000175:diagnosis* / Q000473:pathology; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary