Differentiation of osteoporotic and neoplastic vertebral fractures by chemical shift {in-phase and out-of phase} MR imaging

• Published in: European journal of radiology Vol. 72; no. 1; pp. 125 - 133
• Main Authors: Ragab, Yasser, Emad, Yasser, Gheita, Tamer, Mansour, Maged, Abou-Zeid, A, Ferrari, Serge, Rasker, Johannes J
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01.10.2009; Elsevier
• Subjects: Biological and medical sciences; Chemical shift MRI (in-phase and out-phase); Diagnosis, Differential; Diseases of the osteoarticular system; DXA measurements; Female; Humans; Injuries of the limb. Injuries of the spine; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Neoplastic fractures; Opposed-phased imaging; Osteoporosis - complications; Osteoporosis - diagnosis; Osteoporosis. Osteomalacia. Paget disease; Osteoporotic fractures; Radiology; Reproducibility of Results; Sensitivity and Specificity; Spinal Fractures - diagnosis; Spinal Fractures - etiology; Spinal Neoplasms - complications; Spinal Neoplasms - diagnosis; Traumas. Diseases due to physical agents; Vertebral fractures; Chemical shift MRI (in-phase and out-phase); Vertebral fractures; Neoplastic fractures; Opposed-phased imaging; Osteoporotic fractures; DXA measurements; Nuclear medicine; Diseases of the osteoarticular system; Vertebra; Fracture; Malignant tumor; Trauma; Nuclear magnetic resonance imaging; Osteoporosis; Radiology; Medical imagery; Cancer
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2008.06.019

Abstract Objective The objective of this study was to establish the cut-off value of the signal intensity drop on chemical shift magnetic resonance imaging (MRI) with appropriate sensitivity and specificity to differentiate osteoporotic from neoplastic wedging of the spine. Patients and methods All patients with wedging of vertebral bodies were included consecutively between February 2006 and January 2007. A chemical shift MRI was performed and signal intensity after (in-phase and out-phase) images were obtained. A DXA was performed in all. Results A total of 40 patients were included, 20 with osteoporotic wedging (group 1) and 20 neoplastic (group 2). They were 21 males and 19 females. Acute vertebral collapse was observed in 15 patients in group 1 and subacute collapse in another 5 patients, while in group 2, 11 patients showed acute collapse and 9 patients (45%) showed subacute vertebral collapse. On the chemical shift MRI a substantial reduction in signal intensity was found in all lesions in both groups. The proportional changes observed in signal intensity of bone marrow lesions on in-phase compared with out-of-phase images showed significant differences in both groups ( P < 0.05). At a cut-off value of 35%, the observed sensitivity of out-of-phase images was 95%, specificity was 100%, positive predictive value was 100% and negative predictive value was 95.2%. Conclusion A chemical shift MRI is useful in order to differentiate patients with vertebral collapse due to underlying osteoporosis or neoplastic process.