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Vertebral Metastases: Assessment with Apparent Diffusion Coefficient¹

¹ From the Department of Radiology (A.M.H., M.O.P., M.F., H.I.) and Clinic for Radiation Therapy (J.N.), University of Vienna, AKH-Wien, 8F, Währinger Gürtel 18-20, A-1090 Vienna, Austria; Department for Digital Picture Analysis, University of Technology Graz, Austria (R.R.B.); and Lucas MRI Center, Stanford University School of Medicine, Palo Alto, Calif (R.B.). Received October 18, 2001; revision requested January 2, 2002; final revision received April 25; accepted April 30. Address correspondence to A.M.H. (e-mail: andreas.herneth@univie.ac.at).

View larger version (22K): [in a new window]   Figure 1a. Box plots of the ADCs (a) in normal vertebrae (VBod) and vertebral metastases (VMet) and (b) in benign (benFX) and pathologic (pathFX) vertebral compression fractures. The horizontal lines are mean values, the boxes show minimum and maximum values, and the whiskers indicate plus or minus 2 SDs. Mean ADCs for the vertebral bodies and vertebral metastases are significantly different, and there is no overlap of absolute values.

View larger version (22K): [in a new window]   Figure 1b. Box plots of the ADCs (a) in normal vertebrae (VBod) and vertebral metastases (VMet) and (b) in benign (benFX) and pathologic (pathFX) vertebral compression fractures. The horizontal lines are mean values, the boxes show minimum and maximum values, and the whiskers indicate plus or minus 2 SDs. Mean ADCs for the vertebral bodies and vertebral metastases are significantly different, and there is no overlap of absolute values.

View larger version (149K): [in a new window]   Figure 2. Sagittal MR images of the lower thoracic and upper lumbar spine in a 63-year-old woman with breast cancer, known vertebral metastasis at L1 (arrows), and acute pathologic compression fractures at T11 and T12 (arrowheads). Vertebral compression fractures are (A) hypointense on T1-weighted MR image (500/14) and (B) hyperintense on T2-weighted MR image (2,687/120). On diffusion-weighted echo-planar images (C, b value of 440 sec/mm2; D, b value of 880 sec/mm2), the vertebral metastasis and vertebral compression fractures appear hyperintense. E, ADC map shows both vertebral metastasis and acute pathologic vertebral compression fractures with low ADCs, which indicate hindered diffusion of water protons and the pathologic nature of these findings. Note the hyperintense area located centrally in the fracture of L1, which possibly indicates unhindered diffusion in an area of debris.

View larger version (109K): [in a new window]   Figure 3. Sagittal MR images of the thoracic spine in a 57-year-old woman with lung cancer and an acute vertebral compression fracture (T6) following trauma. The benign vertebral compression fracture (arrows) is (A) hypointense on T1-weighted spin-echo image (500/14) and (B) hyperintense on short inversion time inversion-recovery image (1,400/30/150) as a result of replacement of fatty bone marrow by edema. On diffusion-weighted echo-planar MR images (C, b value of 440 sec/mm2; D, b value of 880 sec/mm2), this area appears hyperintense as a result of T2 shine-through effects. E, ADC map shows high ADCs as a result of the unhindered mobility of water protons, which indicates the benign nature of the acute vertebral compression fracture. The diagnosis was confirmed at follow-up MR imaging, which was performed at 3 months after the initial survey (34). Note the hyperintense area located centrally in the fracture of L1, which possibly indicates unhindered diffusion in an area of debris. Analogous SI changes (arrowheads) can be seen in the ventral portion of T7 and the dorsal portion of T8, which indicates posttraumatic edema.