Vertebral body compression fracture: Discriminating benign from malignant causes by diffusion-weighted MR imaging and apparent diffusion coefficient value

Abstract

Objective: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) value in discriminating benign from malignant vertebral compression fracture. Material and Method: 22 symptomatic patients with compression fracture of vertebra referred for conventional MRI spines during January 2009-March 2010 underwent additional diffusion weighted MR techniques. Evaluation of diffusion weighted MR imaging and quantified ADC value from reconstructed ADC map were performed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of apparent diffusion coefficient (ADC) value were calculated. Results: A total of 39 vertebral fractures; 7 malignant compression fractures and 32 benign compression fractures were evaluated. The difference between ADC values of malignant, benign compression fracture and normal vertebrae were statistically significant (p < 0.0001). The accuracy, sensitivity and specificity were 89.7%, 85.7% and 90.6% respectively with the ADC threshold of 0.89 to discriminate malignancy. Conclusion: The ADC promises to be an effective implement for characterization of vertebral body compression fracture in differentiating benign and malignant compression fractures.