title: Diffusion-weighted magnetic resonance imaging in differentiating acute infectious spondylitis from degenerative Modic type 1 change; the role of b-value, apparent diffusion coefficient, claw sign and amorphous increased signal.
abstract: OBJECTIVE
  To examine the effect of using different b-values on the utility of diffusion-weighted (DW) MRI in differentiating acute infectious spondylitis from Modic type 1 and the discriminative accuracy of related apparent diffusion coefficient (ADC), claw-sign and amorphous increased signal.
  
  
  METHODS
  43 patients with equivocal diagnosis of acute infectious spondylitis/Modic type 1 by using MR images were prospectively studied. The discriminative accuracy of DW MRI using three b-values of 50, 400, 800 s mm(-2), ADC, claw sign and amorphous increased signal was examined.
  
  
  RESULTS
  DW MRI differentiated infectious spondylitis from Modic type 1 change most accurately when a b-value of 800 s mm(-2) was chosen [sensitivity, 91.7%; specificity, 96.8%; positive-predictive value (PPV), 91.7%; negative-predictive value (NPV), 96.8%; and accuracy, 95.3%]. The optimal cut-off ADC value was 1.52 × 10(-3) mm(2) s(-1) (sensitivity, 91.7%; specificity, 100%; PPV, 100%; NPV, 96.9%; and accuracy, 97.7%). Best visualized at a b-value of 50 s mm(-2), claw sign (for degeneration) and amorphous increased signal (for infection) were 100% accurate.
  
  
  CONCLUSIONS
  Should DW MRI be used in differentiating acute infectious spondylitis from degeneration, large b-values are required. With low b-values, however, claw sign and amorphous increased signal are very accurate in this regard.
  
  
  CONCLUSIONS
  DW MRI using large b-values could be used in differentiating acute infectious spondylitis from Modic type I.
authors.affiliation: 1 Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Daghighi
authors.affiliation: 1 Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Poureisa
authors.affiliation: 1 Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Safarpour
authors.affiliation: 2 Department of Radiology, Zabol University of Medical Sciences, Zabol, Islamic Republic of Iran.
authors.forename: Razieh
authors.initials: R
authors.lastname: Behzadmehr
authors.affiliation: 3 Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Fouladi
authors.affiliation: 4 Department of Neurosurgery, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Meshkini
authors.affiliation: 5 Department of Infectious Disease, Sina Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Varshochi
authors.affiliation: 1 Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Kiani Nazarlou
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013166:Spondylitis / Q000000981:diagnostic imaging* / Q000473:pathology*; D014057:Tomography, X-Ray Computed