ADC as a useful diagnostic tool for differentiating benign and malignant vertebral bone marrow lesions and compression fractures: a systematic review and meta-analysis

• Published in: European radiology Vol. 28; no. 7; pp. 2890 - 2902
• Main Authors: Suh, Chong Hyun, Yun, Seong Jong, Jin, Wook, Lee, Sun Hwa, Park, So Young, Ryu, Chang-Woo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2018; Springer Nature B.V
• Subjects: Adult; Aged; Benign; Bivariate analysis; Blood cancer; Bone marrow; Bone Marrow - diagnostic imaging; Bone Marrow - pathology; Compression; Compression tests; Confidence intervals; Diagnosis, Differential; Diagnostic Radiology; Diagnostic software; Diagnostic systems; Diffusion coefficient; Diffusion Magnetic Resonance Imaging - methods; Female; Fractures; Fractures, Compression - diagnostic imaging; Humans; Imaging; Internal Medicine; Interventional Radiology; Lesions; Male; Medical diagnosis; Medicine; Medicine & Public Health; Meta-analysis; Middle Aged; Modelling; Musculoskeletal; Neuroradiology; Radiology; Regression analysis; ROC Curve; Sensitivity; Sensitivity analysis; Sensitivity and Specificity; Spine - diagnostic imaging; Spine - pathology; Statistical analysis; Subgroups; Systematic review; Ultrasound; Vertebrae; Compression fracture; Bone marrow neoplasm; Spine; Diffusion-weighted MRI; Meta-analysis
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-018-5330-5

Objectives To assess the sensitivity and specificity of quantitative assessment of the apparent diffusion coefficient (ADC) for differentiating benign and malignant vertebral bone marrow lesions (BMLs) and compression fractures (CFs) Methods An electronic literature search of MEDLINE and EMBASE was conducted. Bivariate modelling and hierarchical summary receiver operating characteristic modelling were performed to evaluate the diagnostic performance of ADC for differentiating vertebral BMLs. Subgroup analysis was performed for differentiating benign and malignant vertebral CFs. Meta-regression analyses according to subject, study and diffusion-weighted imaging (DWI) characteristics were performed. Results Twelve eligible studies (748 lesions, 661 patients) were included. The ADC exhibited a pooled sensitivity of 0.89 (95% confidence interval [CI] 0.80–0.94) and a pooled specificity of 0.87 (95% CI 0.78–0.93) for differentiating benign and malignant vertebral BMLs. In addition, the pooled sensitivity and specificity for differentiating benign and malignant CFs were 0.92 (95% CI 0.82–0.97) and 0.91 (95% CI 0.87–0.94), respectively. In the meta-regression analysis, the DWI slice thickness was a significant factor affecting heterogeneity ( p < 0.01); thinner slice thickness (< 5 mm) showed higher specificity (95%) than thicker slice thickness (81%). Conclusions Quantitative assessment of ADC is a useful diagnostic tool for differentiating benign and malignant vertebral BMLs and CFs. Key Points • Quantitative assessment of ADC is useful in differentiating vertebral BMLs. • Quantitative ADC assessment for BMLs had sensitivity of 89%, specificity of 87%. • Quantitative ADC assessment for CFs had sensitivity of 9 2 %, specificity of 91%. • The specificity is highest (95%) with thinner (< 5 mm) DWI slice thickness.