The value of apparent diffusion coefficient measurements in the differential diagnosis of vertebral bone marrow lesions

Abstract

Aim: To be able to differentiate benign vertebral bone marrow lesions from malign lesions according to apparent diffusion coefficient (ADC) values, enabling quantitative assessment, and to determine the sensitivity and the specificity in differentiating benign and malign lesions according to the optimal cutoff ADC value. Materials and methods: In 99 patients, 133 lesions in total were included in the study, 59 of which were benign (acute vertebral compression fracture depending on osteoporosis or trauma, spondylitis, atypical hemangioma), and 74 malign (malign compression fracture, metastasis). Each of the benign lesions was compared to the malign lesions. In the statistical analysis, normality tests, variance analysis tests, and the Tukey HSD multi-discriminant analysis tests were performed for all measurable variables. The optimal cutoff ADC value was determined by ROC analysis in the differentiation of benign and malignant lesions. Results: The mean ADC value of the benign induced acute compression fractures was significantly higher than that of the malign induced compression fractures, and the mean ADC value of the spondylitis atypical hemangiomas was significantly higher than that of the malign lesions (P < 0.0001). According to the optimal cutoff value of 1.32 x 10(-3) mm2/s, determined for the differentiation of benign and malignant vertebral bone-marrow lesions, sensitivity was 96.5%, specificity 95.2%, positive predictive value 96.5%, and negative predictive value 95.2%. Conclusion: Vertebral bone-marrow pathologies were differentiated as benign or malignant with high sensitivity and specificity with the aid of ADC values calculated from maps obtained by DWI.