Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI.
OBJECTIVE
To investigate the differences between imaging features of spinal tuberculosis (TB) and metastatic cancer measured by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The presentation of TB on convention MRI may not show the typical TB signs, and they may be mis-diagnosed as malignant diseases. DCE-MRI may provide additional information to help making differential diagnosis.


METHODS
DCE-MRI was performed in 24 TB and 22 metastatic cancer patients. The DCE kinetic pattern was determined as "wash-out", "plateau" or "persistent enhancement". The characteristic DCE parameters were calculated from the signal intensity time course. The two-compartmental pharmacokinetic model was used to obtain K (trans), which is the parameter associated with the delivery of MR contrast agents into the lesion, and k ep, which is the parameter associated with the distribution and clearance of contrast agents from the lesion.


RESULTS
Of the 24 TB, one case showed the wash-out kinetic pattern, 12 cases showed the plateau pattern, and 11 cases showed the persistent enhancement pattern. Of the 22 metastatic cancers, 12 cases showed wash-out, 7 cases showed plateau, and 3 cases showed persistent enhancement patterns. Compared to the metastatic cancer group, the TB group had a lower k ep (0.27 ± 0.15 vs. 0.49 ± 0.23 min(-1), P < 0.001). The ROC analysis showed that the area under the curve was 0.780 for k ep.


CONCLUSIONS
DCE-MRI may provide additional information for differentiation between spinal TB and metastasis, when their manifestations on conventional imaging were similar.
Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People's Republic of China, langning800129@126.com.
Ning
N
Lang
Min-Ying
MY
Su
Hon J
HJ
Yu
Huishu
H
Yuan
D000328:Adult; D000368:Aged; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D014399:Tuberculosis, Spinal / Q000175:diagnosis*
D003287:Contrast Media