title: Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging of focal vertebral bone marrow lesions: initial experience of the differentiation of nodular hyperplastic hematopoietic bone marrow from malignant lesions.
abstract: OBJECTIVE
  To evaluate the ability of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) parameters to differentiate nodular hyperplastic hematopoietic bone marrow (HHBM) from malignant vertebral bone marrow lesions (VBMLs).
  
  
  METHODS
  A total of 33 patients with 58 VBMLs, including 9 nodular HHBM lesions, 39 bone metastases, and 10 myelomas, were retrospectively assessed. All diagnoses were confirmed either pathologically or via image assessment. IVIM diffusion-weighted MRI with 11 b values (from 0 to 800 s/mm2) were obtained using a 3.0-T MR imager. The apparent diffusion coefficient (ADC), pure diffusion coefficient (D), perfusion fraction (f), and pseudodiffusion coefficient (D*) were calculated. ADC and IVIM parameters were compared using the Mann-Whitney U test. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performances of ADC, D, f, and D* in terms of VBML characterization. The diagnostic performance of morphological MR sequences was also assessed for comparison.
  
  
  RESULTS
  The ADC and D values of nodular HHBM were significantly lower than those of malignant VBML (both p values < 0.001), whereas the f value was significantly higher (p < 0.001). However, there were no significant differences in D* between the two groups (p = 0.688). On ROC analysis, the area under the curve (AUC) for D was 1.000, which was significantly larger than that for ADC (AUC = 0.902).
  
  
  CONCLUSIONS
  Intravoxel incoherent motion diffusion-weighted MRI can be used to differentiate between nodular HHBM and malignant VBML. The D value was significantly lower for nodular HHBM, and afforded a better diagnostic performance than the ADC, f, and D* values in terms of such differentiation.
authors.affiliation: Division of Musculoskeletal Radiology, Department of Radiology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, South Korea, 16499.|Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea.
authors.forename: Sunghoon
authors.initials: S
authors.lastname: Park
authors.affiliation: Division of Musculoskeletal Radiology, Department of Radiology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, South Korea, 16499. xenoguma@gmail.com.|Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea. xenoguma@gmail.com.
authors.forename: Kyu-Sung
authors.initials: KS
authors.lastname: Kwack
authors.affiliation: Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea.
authors.forename: Nam-Su
authors.initials: NS
authors.lastname: Chung
authors.affiliation: Department of Clinical Science, Philips Healthcare, Seoul, South Korea.
authors.forename: Jinwoo
authors.initials: J
authors.lastname: Hwang
authors.affiliation: Regional Clinical Trial Center, Ajou University Medical Center, Suwon, South Korea.|Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Division of Musculoskeletal Radiology, Department of Radiology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, South Korea, 16499.|Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000000981:diagnostic imaging; D001855:Bone Marrow Diseases / Q000000981:diagnostic imaging; D019046:Bone Marrow Neoplasms / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging
keywords: Bone marrow; Diffusion; Hyperplastic hematopoietic bone marrow; Intravoxel incoherent motion; Magnetic resonance imaging; Metastasis; Spine