title: Standard-b-value vs low-b-value DWI for differentiation of benign and malignant vertebral fractures: a meta-analysis.
abstract: OBJECTIVE
  To determine the comparative diagnostic performance of standard-b-value (≥500 mm(2)) vs low-b-value (<500s mm(-2)) diffusion-weighted imaging (DWI) for discriminating malignant from benign vertebral compression fractures.
  
  
  METHODS
  12 studies with a total of 350 malignant and 312 benign vertebral fractures were included.
  
  
  RESULTS
  The apparent diffusion coefficient (ADC) value of benign vertebral compression fractures was lower than that of malignant vertebral compression fractures (SMD = 1.81, 95% CI 0.98 to 2.64 Z = 4.27, p < 0.05). ADC value difference was more pronounced in the group of low-b-value DWI (SMD = 2.31, 95% CI 1.02 to 3.60 Z = 3.51, p < 0.05) than in the group of standard-b-value DWI (SMD = 1.38, 95% CI 0.18 to 2.59 Z = 2.25, p < 0.05). Ethnicity stratified analysis demonstrated higher ADC values in benign vertebral compression fractures in comparison to malignant tissues in both the Asian and Caucasian subgroups (Asians: SMD = 2.400, 95%CI 1.45 to approximately 3.35, p<0.05; Caucasians: SMD = 0.592, 95 % CI -0.848 to approximately 2.032, p < 0.05). And the ADC value difference was more pronounced in the Asian subgroup.
  
  
  CONCLUSIONS
  ADC value appears to be a reliable method to differentiate benign from malignant fractures. Low-b-value DWI was more a valuable parameter than standard-b-value DWI for discriminating malignant from benign vertebral compression fractures. And the diffusion characteristics of the benign vertebral fractures such as osteoporosis, trauma and infection have rarely been investigated separately.
  
  
  CONCLUSIONS
  The use of low-b-value DWI for differentiation of benign and malignant vertebral fractures is recommended.
authors.affiliation: 1 Southern Medial University, Guangzhou, China.|2 Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing, China.
authors.forename: Zhanpeng
authors.initials: Z
authors.lastname: Luo
authors.affiliation: 2 Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing, China.
authors.forename: Li
authors.initials: L
authors.lastname: Litao
authors.affiliation: 2 Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing, China.
authors.forename: Suxi
authors.initials: S
authors.lastname: Gu
authors.affiliation: 2 Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing, China.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Luo
authors.affiliation: 2 Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing, China.
authors.forename: Dawei
authors.initials: D
authors.lastname: Li
authors.affiliation: 2 Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing, China.
authors.forename: Long
authors.initials: L
authors.lastname: Yu
authors.affiliation: 1 Southern Medial University, Guangzhou, China.|2 Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing, China.
authors.forename: Yuanzheng
authors.initials: Y
authors.lastname: Ma
mesh_terms: D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D050815:Fractures, Compression / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D016103:Spinal Fractures / Q000175:diagnosis* / Q000473:pathology; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000473:pathology