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Neuroimaging and Stereotactic Body Radiation Therapy (SBRT) for Spine Metastasis. Top Magn Reson Imaging 2019; 28:85-96. [PMID: 31022051 DOI: 10.1097/rmr.0000000000000199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Historically, management options for spinal metastases include surgery for stabilization and decompression and/or external beam radiation therapy (EBRT). EBRT is palliative in nature, as it lacks accurate targeting such that the prescribed radiation doses must be limited in order to maintain safety. Modern advancement in imaging and radiotherapy technology have facilitated the development of stereotactic body radiation therapy (SBRT), which provides increased targeted precision for radiation delivery to tumors resulting in lower overall toxicity, particularly to regional structures such as the spinal cord and esophagus, while delivering higher, more effective, and radically ablative radiation doses.Over the past decade, SBRT has been increasingly utilized as a method of treating spinal metastases either as the primary modality or following surgical intervention in both de novo and reirradiation setting. Numerous studies suggest that SBRT is associated with an 80% to 90% rate of 1-year local control across clinical scenarios. For example, studies of SBRT as the primary treatment modality suggest long-term local control rate of 80% to 95% for spinal metastases. Similarly, SBRT in the adjuvant setting following surgery is associated with local control rates ranging from 70% to 100%. Furthermore, because SBRT allows for lower dose to the spinal cord, it has also been used in patients who have had prior radiation therapy, with studies showing 66% to 93% local control in this scenario.
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Kumar Y, Hayashi D. Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC Musculoskelet Disord 2016; 17:310. [PMID: 27448661 PMCID: PMC4957861 DOI: 10.1186/s12891-016-1169-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/12/2016] [Indexed: 01/12/2023] Open
Abstract
Magnetic resonance imaging (MRI) has been playing an increasingly important role in the spinal trauma patients due to high sensitivity for detection of acute soft tissue and cord injuries. More and more patients are undergoing MRI for spinal trauma in the emergency settings, thus necessitating the interpreting physicians to be familiar with MRI findings in spinal trauma. In this pictorial review, we will first describe the normal anatomy of various ligamentous structures. Indications of MRI in spinal trauma as well as the role of MRI in diagnosing spinal cord and soft tissue injuries will then be discussed. Illustrated cases are mainly of cervical spine trauma, but thoracolumbar spine injuries are also included where appropriate in our review.
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Affiliation(s)
- Yogesh Kumar
- Department of Radiology, Bridgeport Hospital, Yale New Haven Health System, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Daichi Hayashi
- Department of Radiology, Bridgeport Hospital, Yale New Haven Health System, 267 Grant Street, Bridgeport, CT, 06610, USA. .,Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
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The Value of Radionuclide Bone Imaging in Defining Fresh Fractures Among Osteoporotic Vertebral Compression Fractures. J Craniofac Surg 2016; 27:745-8. [DOI: 10.1097/scs.0000000000002594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Geith T, Reiser M, Baur-Melnyk A. [Differentiation between acute osteoporotic and metastatic vertebral body fractures by imaging]. Unfallchirurg 2015; 118:222-9. [PMID: 25783690 DOI: 10.1007/s00113-014-2690-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This article discusses the morphological criteria for the differentiation between acute osteoporotic and metastatic vertebral body fractures and new imaging methods, such as diffusion-weighted and chemical shift magnetic resonance imaging (MRI) are presented. BACKGROUND The differential diagnostics of osteoporotic and metastatic vertebral body fractures can be difficult in some cases. Both entities normally occur without adequate trauma and predominantly in elderly patients. IMAGING Conventional X-ray examination is the initial imaging method of choice but is not able to reliably differentiate between the osteoporotic or metastatic etiology of a fracture. Computed tomography (CT) clearly depicts osseous destruction in metastatic fractures but lacks specificity. Magnetic resonance imaging (MRI) shows a higher sensitivity and specificity in differentiating osteoporotic and metastatic fractures. DIFFERENTIAL DIAGNOSTICS The combination CT and MRI allows an accurate diagnosis with respect to an osteoprorotic or metastatic etiology in most of cases but bone marrow edema in acute fractures sometimes leads to ambiguous results and differential diagnostic problems.
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Affiliation(s)
- T Geith
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland,
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Osteoporotic or malignant vertebral fracture? This is the question. What can we do about it? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Quantitative analysis of acute benign and malignant vertebral body fractures using dynamic contrast-enhanced MRI. AJR Am J Roentgenol 2013; 200:W635-43. [PMID: 23701095 DOI: 10.2214/ajr.12.9351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate quantitative dynamic contrast-enhanced MRI (DCE-MRI) based on tracer kinetic modeling of perfusion in the differentiation of benign from malignant vertebral fractures. SUBJECTS AND METHODS Patients with 26 osteoporotic vertebral fractures (18 women, eight men; mean age, 69 years) and patients with 20 malignant vertebral fractures (nine women, 11 men; mean age, 63.4 years) underwent dynamic contrast-enhanced MRI. T1-weighted, STIR, and T2-weighted sequences were acquired at 1.5 T. Dynamic contrast-enhanced image sets were acquired with a 2D saturation-recovery spoiled gradient-echo sequence. Regions of interest in parameter maps of mean transit time (MTT) and plasma flow in the fractured vertebral bodies were analyzed with a two-compartment tracer kinetic model. Plasma flow, plasma volume (PV), extraction flow, and interstitial volume were calculated. The forward volume transfer constant (K(trans)) and the extracellular volume (ECV) were derived. A two-tailed Fisher exact test, Mann-Whitney U test, and receiver operating characteristic analysis were performed. RESULTS Forty-four vertebral fractures in 44 patients could be evaluated. In spots of increased plasma flow, interstitial volume (p = 0.0003), ECV (p = 0.002), and extraction flow (p = 0.03) for osteoporotic and malignant vertebral fractures were significantly different. The mean interstitial volume was 28.62 mL/100 mL for osteoporotic fractures and 11.73 mL/100 mL for malignant fractures, and the area under the curve (AUC) was 0.819 for a cutoff of 11.72 mL/100 mL or less indicating malignancy (sensitivity, 63.2%; specificity, 96.0%). The mean ECV was 52.68 mL/100 mL for osteoporotic fractures and 36.71 mL/100 mL for malignant fractures, and the AUC was 0.802 for a cutoff of 35.83 mL/100 mL or less indicating malignancy (sensitivity, 63.2%; specificity, 92.0%). The mean extraction flow was 15.19 mL/100 mL/min for osteoporotic fractures and 23.67 mL/100 mL/min for malignant fractures, and the AUC was 0.693 for a cutoff of 6.52 mL/100 mL/min or less indicating malignancy (sensitivity, 57.9%; specificity, 92.0%). K(trans), plasma flow, and PV in the spots of increased plasma flow and all quantitative perfusion parameters in the regions of increased MTT did not show any significant differences between benign and malignant fractures. CONCLUSION In spots of high plasma flow, which can be determined with a deconvolution analysis, the quantitative perfusion parameters of interstitial volume, ECV, and extraction flow are significantly different between acute osteoporotic and malignant vertebral fractures and can aid in the distinction between the two entities.
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Abstract
As in the brain, the sensitivity of diffusion-weighted imaging (DWI) to ischemic damage in the spinal cord may provide early identification of infarction. Diffusion anisotropy may enhance the detection and understanding of damage to the long fiber tracts with clinical implications for diseases such as multiple sclerosis and amyotrophic lateral sclerosis and may also yield insight into damage that occurs with spondylotic and traumatic myelopathy. This article reviews the basis for DWI for the evaluation of the spinal cord, osseous, and soft tissues of the spine and reviews the imaging appearance of a variety of disease states.
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Affiliation(s)
- Lawrence N Tanenbaum
- Department of Diagnostic Imaging, Mount Sinai School of Medicine, New York, NY 10007, USA.
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Comparison of Four Prediction Models to Discriminate Benign From Malignant Vertebral Compression Fractures According to MRI Feature Analysis. AJR Am J Roentgenol 2013; 200:493-502. [DOI: 10.2214/ajr.11.7192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Comparison of Qualitative and Quantitative Evaluation of Diffusion-Weighted MRI and Chemical-Shift Imaging in the Differentiation of Benign and Malignant Vertebral Body Fractures. AJR Am J Roentgenol 2012; 199:1083-92. [DOI: 10.2214/ajr.11.8010] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Tang ZB, Lei Z, Yang HL, Chen KW. Value of bone scan imaging in determining painful vertebrae of osteoporotic vertebral compression fractures patients with contraindications to MRI. Orthop Surg 2012; 4:172-6. [PMID: 22927151 DOI: 10.1111/j.1757-7861.2012.00187.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the value of bone scan imaging in determining painful vertebrae of osteoporotic vertebral compression fractures (OVCFs) patients with contraindications to MRI. METHODS Twenty-three OVCFs patients with contraindications to MRI, diagnosed and treated in our hospital between December 2007 and November 2010, were enrolled in this retrospective study. There were 18 females and five males, aged from 57 to 87 years, with a mean age of 69.5 years. All patients underwent X-ray, CT scans examinations and bone scan to determine painful vertebrae. After the painful vertebra was defined, percutaneous kyphoplasty (PKP) was performed. Efficacy of PKP was assessed with visual analog (VAS) pain scale and the Oswestry Disability Index (ODI) preoperatively, postoperatively and during final follow-up assessments. RESULTS The painful vertebrae shown on radiological films did not accord with those found based on bone scan imaging, with a high rate of incongruent findings (27.3%, 9/33). Radiological films showed 33 vertebrae with fractures, but only 26 vertebrae (22 patients) were selected as painful vertebrae for PKP based on bone scan imaging. There were statistically significant differences in mean VAS and ODI between the preoperative and the postoperative assessments; no significant differences were observed between postoperative and final follow-up assessments. CONCLUSIONS For the OVCFs patients with contraindications to MRI, bone scan imaging could be used to determine painful vertebrae, which is an effective method.
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Affiliation(s)
- Zhi-bing Tang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
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Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine (Phila Pa 1976) 2012; 37:E736-44. [PMID: 22210011 DOI: 10.1097/brs.0b013e3182458cac] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study is a research synthesis of the published literature evaluating the performance of magnetic resonance imaging (MRI) for differentiation of malignant from benign vertebral compression fractures (VCFs). OBJECTIVE Perform a systematic review and meta-analysis to summarize and combine the published data on MRI for discriminating malignant from benign VCFs. SUMMARY OF BACKGROUND DATA The differentiation between benign and malignant VCFs in the spine is a challenging problem confronting spine practitioners. METHODS MEDLINE, EMBASE, and other databases were searched by 2 independent reviewers to identify studies that reported the performance of MRI for discriminating malignant from benign VCF. Included studies were assessed for described MRI features and study quality. The sensitivity, specificity, and diagnostic odds ratio (OR) of each feature were pooled with a random-effects model weighted by the inverse of the variance of each individual estimate. RESULTS A total of 31 studies with 1685 subjects met the selection criteria. All the studies focused on describing specific features rather than overall diagnostic performance. Signal intensity ratio on opposed phase (chemical shift) imaging 0.8 or more (OR = 164), apparent diffusion coefficient on echo planar diffusion-weighted images 1.5 × 10(-3) mm2/s or less with b value 500 s/mm2 (OR = 130), presence of other noncharacteristic vertebral lesions (OR = 55), presence of paraspinal mass (OR = 33), involvement of posterior element (OR = 28), involvement of pedicle (OR = 24), complete replacement of normal bone marrow in VCF (OR = 19), presence of epidural mass (OR = 13), and diffuse convexity of posterior vertebral border (OR = 10) were associated with malignant VCFs, whereas coexisting healed benign VCF (OR = 0.006), presence of "fluid sign" (OR = 0.08), presence of focal posterior vertebral border convexity/retropulsion (OR = 0.08), and band-like shape of abnormal signal (OR = 0.07) were associated with benign VCFs. CONCLUSION Several specific MRI features using signal intensity characteristics, morphological characteristics, quantitative techniques, and findings at other levels can be useful for distinguishing benign from malignant VCFs and can serve as inputs for a prediction model. Observer performance reliability has not been adequately assessed.
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Diffusion-weighted MR imaging in differentiation between osteoporotic and neoplastic vertebral fractures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21 Suppl 1:S123-7. [PMID: 22411038 DOI: 10.1007/s00586-012-2227-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the usefulness of magnetic resonance imaging (MRI) with spin-echo echo-planar diffusion-weighted imaging (SE-EPI-DWI) in differentiation between vertebral osteoporotic fractures and pathological neoplastic fractures. MATERIALS AND METHODS Thirty-three patients with both osteoporotic or neoplastic vertebral fractures diagnosed with X-ray or TC were studied with MRI exam, (1.5 T unit) with DWI sequences. DWI sequences were qualitatively analyzed. Apparent diffusion coefficient (ADC) values were also determined and compared to the definitive histologic diagnosis. RESULTS DWI of neoplastic lesions showed hyperintensity signal in 22 out of 23 cases. Mean ADC value of neoplastic fractures was 1.241 ± 0.4 × 10(-3) mm(2)/s; mean ADC value of osteoporotic fractures was 0.646 ± 0.368 × 10(-3) mm(2)/s. Neoplastic fractures showed ADC values significantly higher than osteoporotic ones (p < 0.001). DWI imaging and histology showed a significant correlation. CONCLUSION DWI provides reliable information to support MRI diagnosis of neoplastic versus osteoporotic fractures. ADC value appears as a useful adjunctive parameter.
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Quantitative analysis of the diffusion-weighted steady-state free precession signal in vertebral bone marrow lesions. Invest Radiol 2012; 46:601-9. [PMID: 21610504 DOI: 10.1097/rli.0b013e31821e637d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES : Diffusion-weighted steady-state free precession (DW-SSFP) sequences have shown great potential for the differential diagnosis of benign osteoporotic and malignant neoplastic vertebral compression fractures, which appear hypo- to isointense or hyperintense in DW-SSFP magnetic resonance imaging, respectively. In contrast to other diffusion weighting sequences, the DW-SSFP signal depends not only on the apparent diffusion coefficient (ADC), but also on the tissue relaxation times and sequence parameters. The purpose of the present study was to provide a detailed analysis of the DW-SSFP signal in benign and malignant vertebral lesions (VLs) and in vertebral bone marrow (VBM) to understand the observed signal alterations and their dependence on tissue and sequence parameters. MATERIALS AND METHODS : Magnetic resonance imaging was performed in 40 patients with benign (n = 20) or malignant (n = 20) VLs to determine the fat fraction and tissue parameters (ADC, T1, T2, T2*) for both the water and fat signal. With these values, the DW-SSFP signal was simulated and compared with the measured signals for different diffusion gradients by determining the signal intensity ratio between the SSFP signals of the lesions and of normal-appearing VBM for both malignant and benign VLs. RESULTS : The simulated DW-SSFP contrast agreed well with the measured contrast and provided a very good differentiation between benign osteoporotic and malignant VLs. ADCs were significantly different in both lesion types (malignant 1.36 vs. osteoporotic 1.77 × 10 mm/s); however, the observed contrast differences were caused predominantly by an opposed-phase readout in combination with significantly different T2* values (malignant 22 vs. osteoporotic 14 ms) and fat fractions (malignant 3.9% vs. osteoporotic 12%) in the lesions as well as significantly different fat fractions in normal-appearing VBM (malignant 42% vs. osteoporotic 52%) of both patient groups. CONCLUSIONS : Although the ADCs of the evaluated malignant and benign VLs showed highly significant differences, the influence of diffusion on the DW-SSFP signal contrast is relatively low compared with other tissue parameters due to the very complex signal mechanism of the SSFP sequence. Thus, the observed DW-SSFP signal contrast of different VLs (hypo-/isointense vs. hyperintense signal) is rather fat- and T2*-weighted than diffusion-weighted. The intermediate diffusion weighting of the applied SSFP sequence, however, helps to shift the different contrasts into a signal range that is easily visually accessible.
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Khoo MMY, Tyler PA, Saifuddin A, Padhani AR. Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review. Skeletal Radiol 2011; 40:665-81. [PMID: 21311884 DOI: 10.1007/s00256-011-1106-6] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/11/2010] [Accepted: 01/13/2011] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging (MRI) is the mainstay of diagnosis, staging and follow-up of much musculoskeletal pathology. Diffusion-weighted magnetic resonance imaging (DWI) is a recent addition to the MR sequences conventionally employed. DWI provides qualitative and quantitative functional information concerning the microscopic movements of water at the cellular level. A number of musculoskeletal disorders have been evaluated by DWI, including vertebral fractures, bone marrow infection, bone marrow malignancy, primary bone and soft tissue tumours; post-treatment follow-up has also been assessed. Differentiation between benign and malignant vertebral fractures by DWI and monitoring of therapy response have shown excellent results. However, in other pathologies, such as primary soft tissue tumours, DWI data have been inconclusive in some cases, contributing little additional information beyond that gained from conventional MR sequences. The aim of this article is to critically review the current literature on the contribution of DWI to musculoskeletal MRI.
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Affiliation(s)
- Michael M Y Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
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Abstract
Magnetic resonance imaging (MRI) is the mainstay of diagnosis, staging and follow-up of much musculoskeletal pathology. Diffusion-weighted magnetic resonance imaging (DWI) is a recent addition to the MR sequences conventionally employed. DWI provides qualitative and quantitative functional information concerning the microscopic movements of water at the cellular level. A number of musculoskeletal disorders have been evaluated by DWI, including vertebral fractures, bone marrow infection, bone marrow malignancy, primary bone and soft tissue tumours; post-treatment follow-up has also been assessed. Differentiation between benign and malignant vertebral fractures by DWI and monitoring of therapy response have shown excellent results. However, in other pathologies, such as primary soft tissue tumours, DWI data have been inconclusive in some cases, contributing little additional information beyond that gained from conventional MR sequences. The aim of this article is to critically review the current literature on the contribution of DWI to musculoskeletal MRI.
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The comparison of bone scan and MRI in osteoporotic compression fractures. Asian Spine J 2010; 4:89-95. [PMID: 21165311 PMCID: PMC2996633 DOI: 10.4184/asj.2010.4.2.89] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Revised: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 12/02/2022] Open
Abstract
Study Design Retrospective study. Purpose To estimate the usefulness of bone scan and magnetic resonance imaging (MRI) for the diagnosis of new fracture in osteoporotic vertebral fractures. Overview of Literature The diagnosis of new fractrure in osteoporotic vertebral fractures requires simple X-ray and supplementary studies. Methods We analyzed 87 vertebrae in 44 patients, who diagnosed with osteoporotic vertebral fractures using bone scan and MRI within 2 months interval between August 2001 and July 2008. We compared hot uptakes in bone scan with MRI findings such as new fractures, old fractures and degenerative lesions. Results Hot uptakes in bone scan was matched to 48 new fractures, 26 old fractures and 13 degenerative lesions in MRI findings. It was 55% of concordance between hot uptakes in bone scan and new fractures in MRI. The rate of new vertebral fractures confirmed by MRI according to 1 level hot uptakes in bone scan was 96%, 2 levels was 50% and 3 more levels was 36%. Conclusions The diagnosis of new fracture in osteoporotic vertebral fractures requires simple X-ray and supplementary studies such as bone scan and MRI. We recommend more careful interpretation in multiple osteoporotic vertebral fracture patients about hot uptake lesions of bone scan.
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Multiparameter MRI assessment of normal-appearing and diseased vertebral bone marrow. Eur Radiol 2010; 20:2679-89. [PMID: 20556393 DOI: 10.1007/s00330-010-1833-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/12/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate spin-lattice (T1) and spin-spin (T2) relaxation times as well as apparent diffusion coefficients (ADCs) of the fat and water components in the vertebral bone marrow (vBM) of patients with benign and malignant lesions. METHODS Forty-four patients were examined at 1.5 T: there were 24 osteoporotic vertebral fractures (15 women, 9 men; median age: 73, 48-86 years) and 20 malignant vertebral infiltrations (9 women, 11 men; median age: 60, 25-87). Relaxation times were determined separately for the water and the fat component using a saturation-recovery technique for T1 and measurements with variable echo times for T2. ADCs were determined with a diffusion-weighted (DW) echo-planar imaging (EPI) and a single-shot turbo-spin-echo (ssTSE) sequence. RESULTS T1 of the water component and ADCs were significantly increased in the lesions compared with normal-appearing vBM (malignant: 1,252 vs. 828 ms, osteoporotic: 1,315 vs. 872 ms). ADCs determined with the DW-ssTSE were significantly increased compared with the DW-EPI. ADCs determined with the DW-ssTSE differed significantly between osteoporotic and malignant lesions (1.74 vs 1.35 x 10⁻³ mm²/s. CONCLUSIONS All parameters exhibit significant differences between normal-appearing vBM and the lesions. However, only the ADCs determined with the DW-ssTSE differed significantly between osteoporotic fractures and malignant lesions, potentially allowing for a differential diagnosis of these two entities.
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Solomou E, Kazantzi A, Romanos O, Kardamakis D. Magnetic Resonance Imaging Of Metastatic Bone Disease. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-1-4020-9819-2_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Kim CH, Park JH, Chung SK, Kim KJ, Bang JS, Kim HJ. Enhancing Box Sign : Enhancement Pattern of Acute Osteoprotic Compression Fracture. J Korean Neurosurg Soc 2009; 46:528-31. [DOI: 10.3340/jkns.2009.46.6.528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 09/23/2009] [Accepted: 11/09/2009] [Indexed: 11/27/2022] Open
Affiliation(s)
- Choong-Hyo Kim
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Jae Hyo Park
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sang Ki Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, East-West Neo Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Kakitsubata Y, Theodorou DJ, Theodorou SJ, Nabeshima K, Tamura S. Metastatic disease involving the discovertebral junction of the spine. Joint Bone Spine 2009; 76:50-6. [DOI: 10.1016/j.jbspin.2008.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 03/07/2008] [Indexed: 11/27/2022]
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Herneth AM, Ringl H, Memarsadeghi M, Fueger B, Friedrich KM, Krestan C, Imhof H. Diffusion weighted imaging in osteoradiology. Top Magn Reson Imaging 2007; 18:203-12. [PMID: 17762384 DOI: 10.1097/rmr.0b013e3180cac61d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diffusion weighted imaging gained attention as an imaging modality, which provides information on the microstructure of a tissue, which can be used for tissue characterization. This is of importance in patients where other diagnostic tools provide equivocal or unspecific information. In addition quantitative diffusion measurements provide objective parameters for unbiased comparison of treatment response, which is mandatory for therapy monitoring. Technical restriction limited the use of Diffusion Weighted Imaging to the brain. However, with the improvement in scanner technology and the availability of new MR sequences investigation of the Muskulo Skeletal System was made possible. We describe the potential of Diffusion Weighted Imaging as a non-invasive technique to evaluate pathological, inflammatory and physiological processes in osteoradiology.
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Affiliation(s)
- Andreas M Herneth
- Departmentsof Radiology, Medical University of Vienna, Vienna, Austria.
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Diffusion weighted MR imaging in acute vertebral compression fractures: differentiation between malignant and benign causes. Biomed Imaging Interv J 2006; 2:e12. [PMID: 21614224 PMCID: PMC3097619 DOI: 10.2349/biij.2.2.e12] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 09/30/2005] [Accepted: 12/19/2005] [Indexed: 11/17/2022] Open
Abstract
Aim The primary objective of this study was to evaluate the specificity and sensitivity of diffusion weighted MR imaging (DWI) in the differentiation and characterisation between benign and malignant vertebral compression fractures compared with conventional T1 WI, T2 WI and fat suppressed contrast enhanced T1 WI in the Malaysian population. Materials and Methods Thirty five patients with 68 vertebral compression fractures were imaged using the conventional T1 WI, T2 WI, fat suppressed contrast enhanced T1-weighted, and steady state free precession diffusion-weighted (SSFP DWI) sequences on a 1.5 T MR scanner. Signal intensities were analysed qualitatively for all the sequences by comparison to adjacent normal marrow. A quantitative assessment of the signal intensity in the SSFP DWI was also performed. Results T1 WI and T2 WI images are of limited diagnostic value because of the variability in signal intensities. Contrast enhanced images had sensitivity and specificity of 93% and 71%, respectively with a negative predictive value (NPV) of 93%. On diffusion-weighted MR imaging, sensitivity was 87% with specificity of 92%. The positive predicative value (PPV) and NPV were both 90%. The quantitative assessment of ratio revealed a statistical significant difference between the benign (0.96) and the malignant (1.73) group of lesion (Mann-Whitney U-test, p=0.0001). Conclusions We found that absence of contrast enhancement has a high NPV (90%) while SSFP DWI has both a high PPV (90%) and high NPV (90%) in detecting malignant vertebral compression fractures. Furthermore, in our study the ratio of lesion intensity technique offers an excellent criterion to differentiate between the benign and malignant lesions, and the presence of iso- or hypointensity of the collapsed vertebral bodies is suggestive of a benign lesion while hyperintensity is highly suggestive of malignancy. We also found that using the NLMR showed a statistical significant difference between the malignant and benign groups (p<0.0001) with osteoporotic and malignant lesions have mean values of 0.96 (SD 0.25) and 1.73 (SD 0.4) respectively.
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Herneth AM, Friedrich K, Weidekamm C, Schibany N, Krestan C, Czerny C, Kainberger F. Diffusion weighted imaging of bone marrow pathologies. Eur J Radiol 2005; 55:74-83. [PMID: 15921871 DOI: 10.1016/j.ejrad.2005.03.031] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 03/16/2005] [Accepted: 03/18/2005] [Indexed: 01/25/2023]
Abstract
Diffusion weighted imaging of non-CNS tissue has attracted much attention during the last years. Its capability of probing the microstructure of a biologic tissue at a sub-millimeter range is used to evaluate its diffusion capacity, which is tissue specific and can be used for tissue characterization. Processes involving bone marrow where the primary target for DWI during the last years. Most experience has been gained for differentiating benign from pathologic vertebral compression fractures, which can be reliably done when quantitative diffusion measurements are available. However, preliminary results exist indicating that this non-invasive technique may be a potential tool for therapy monitoring, which will revise the management of cancer patients. Moreover, this will be the first non-invasive and quantifiable tool for evaluating the effectiveness of modern tumor treatment. In this article, we will give an overview on the current status of DWI in the evaluation of bone marrow alterations; on currently available DWI techniques and a short out-look on future aspects of DWI in bone marrow pathologies.
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Affiliation(s)
- Andreas M Herneth
- Medical University of Vienna, Austria, Department of Radiology, Division of MSK, Wahringer Gurtel 18-20, A-1090, Vienna, Austria.
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Uetani M, Hashmi R, Hayashi K. Malignant and benign compression fractures: differentiation and diagnostic pitfalls on MRI. Clin Radiol 2004; 59:124-31. [PMID: 14746781 DOI: 10.1016/j.crad.2003.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The distinction between malignant and benign compression fractures is a common problem in clinical practice. Various imaging techniques (plain radiography, computed tomography, bone scintigraphy) have been used to differentiate these conditions but they are often inadequate in distinguishing the nature of compression fracture. This review illustrates the magnetic resonance imaging (MRI) features of malignant and benign compression fractures with emphasis on the usefulness, limitations and pitfalls of MRI.
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Affiliation(s)
- M Uetani
- Department of Radiology and Radiation Research, Nagasaki University Hospital, Graduate School of Medical Sciences, Sakamoto, Nagasaki, Japan.
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Kato K, Aoki J, Endo K. Utility of FDG-PET in differential diagnosis of benign and malignant fractures in acute to subacute phase. Ann Nucl Med 2003; 17:41-6. [PMID: 12691129 DOI: 10.1007/bf02988257] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the usefulness of positron emission tomography with [fluorine-18] 2-deoxy-2-fluoro-D-glucose (FDG-PET) for early differential diagnosis of benign and malignant fractures. MATERIALS AND METHODS Among 1,164 patients who had received FDG-PET between January 1999 and December 2000, 20 patients were found to have an acute fracture on review of clinical charts and/or radiologic images taken within one month before or after FDG-PET examination. The fractures were finally diagnosed by clinical follow up of at least five months duration. Standardized uptake values (SUV) for the benign and malignant bone lesions were calculated and compared. RESULTS Ten of the 20 patients were finally diagnosed to have a benign fracture, nine patients to have a malignant fracture, and one patient to have both a benign and a malignant fracture at different locations. A statistically significant difference in the SUV was found between the benign group (SUV: 1.36 +/- 0.49) and the malignant group (SUV: 4.46 +/- 2.12) (p = 0.0006, the nonparametric Mann-Whitney U test). CONCLUSIONS FDG-PET can be a useful method for early differentiation between acute benign and metastatic fractures. Our retrospective study indicates that an acute benign fracture itself does not show significant FDG uptake.
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MESH Headings
- Aged
- Aged, 80 and over
- Bone Neoplasms/classification
- Bone Neoplasms/complications
- Bone Neoplasms/diagnosis
- Bone Neoplasms/diagnostic imaging
- Bone Neoplasms/secondary
- Diagnosis, Differential
- Female
- Fluorodeoxyglucose F18
- Fractures, Bone/classification
- Fractures, Bone/diagnosis
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/etiology
- Fractures, Spontaneous/classification
- Fractures, Spontaneous/diagnosis
- Fractures, Spontaneous/diagnostic imaging
- Fractures, Spontaneous/etiology
- Humans
- Male
- Middle Aged
- Neoplasms, Unknown Primary/classification
- Neoplasms, Unknown Primary/complications
- Neoplasms, Unknown Primary/diagnosis
- Neoplasms, Unknown Primary/diagnostic imaging
- Radiopharmaceuticals
- Retrospective Studies
- Tomography, Emission-Computed/methods
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Affiliation(s)
- Katsuya Kato
- Department of Diagnostic Radiology, Gunma University School of Medicine, Maebashi, Japan.
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Jung HS, Jee WH, McCauley TR, Ha KY, Choi KH. Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics 2003; 23:179-87. [PMID: 12533652 DOI: 10.1148/rg.231025043] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A study was performed to determine which magnetic resonance (MR) imaging findings are useful in discrimination between metastatic compression fractures and acute osteoporotic compression fractures of the spine. The MR imaging findings in 27 patients with metastatic compression fractures and 55 patients with acute osteoporotic compression fractures were compared by using the chi(2) test. MR imaging findings suggestive of metastatic compression fractures were as follows: a convex posterior border of the vertebral body, abnormal signal intensity of the pedicle or posterior element, an epidural mass, an encasing epidural mass, a focal paraspinal mass, and other spinal metastases. MR imaging findings suggestive of acute osteoporotic compression fractures were as follows: a low-signal-intensity band on T1- and T2-weighted images, spared normal bone marrow signal intensity of the vertebral body, retropulsion of a posterior bone fragment, and multiple compression fractures. The signal intensity on fast spin-echo T2-weighted images obtained without fat suppression played little role in distinguishing between metastatic compression fractures and acute osteoporotic compression fractures.
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Affiliation(s)
- Hee-Sun Jung
- Departments of Diagnostic Radiology, Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea
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Baur A, Stäbler A, Arbogast S, Duerr HR, Bartl R, Reiser M. Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging. Radiology 2002; 225:730-5. [PMID: 12461253 DOI: 10.1148/radiol.2253011413] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the occurrence, location, and shape of the fluid sign in acute osteoporotic and neoplastic vertebral compression fractures at magnetic resonance (MR) imaging. MATERIALS AND METHODS The study group comprised 87 consecutive patients with acute vertebral compression fractures due to osteoporotic (n = 52) or neoplastic (n = 35) infiltration. The MR imaging protocol included nonenhanced T1-weighted spin-echo and short inversion time inversion-recovery sequences and a 1.5-T system. Readers blinded to the outcome documented the occurrence, shape, and location of the fluid sign with consensus. The fluid sign was correlated with the cause, age, and severity of the fracture. The diagnosis was confirmed with surgery, follow-up MR imaging, clinical follow-up, or unequivocal imaging findings. Wilcoxon and chi(2) tests were used to assess significance. RESULTS In fractured vertebral bodies, the fluid sign was adjacent to the fractured end plates and exhibited signal intensity isointense to that of cerebrospinal fluid. The fluid sign was linear (n = 16), triangular (n = 5), or focal (n = 2) and was significantly associated with osteoporotic fractures (21 [40%] of 52; P <.001). The fluid sign occurred in two (6%) of 35 neoplastic compression fractures. Histologic examination demonstrated osteonecrosis, edema, and fibrosis at the site of the fluid sign. There was a tendency toward older fractures exhibiting the fluid sign, but this relationship was not significant (P >.05). In osteoporotic fractures, the fluid sign was significantly associated with fracture severity (P <.05). CONCLUSION The fluid sign is featured in acute vertebral compression fractures that show bone marrow edema. It can be an additional sign of osteoporosis and rarely occurs in metastatic fractures.
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Affiliation(s)
- Andrea Baur
- Departments of Clinical Radiology, University of Munich-Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
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Herneth AM, Philipp MO, Naude J, Funovics M, Beichel RR, Bammer R, Imhof H. Vertebral metastases: assessment with apparent diffusion coefficient. Radiology 2002; 225:889-94. [PMID: 12461275 DOI: 10.1148/radiol.2253011707] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors evaluated the apparent diffusion coefficient (ADC) in the assessment of vertebral metastases and acute vertebral compression fractures in 22 patients with known or suspected vertebral metastases. On the basis of significantly (P <.03) different ADCs, vertebral metastases (0.69 x 10(-3) mm2/sec) and pathologic compression fractures (0.65 x 10(-3) mm2/sec) can be safely distinguished from vertebral bodies (1.66 x 10(-3) mm2/sec) and benign compression fractures (1.62 x 10(-3) mm2/sec). Thus, the use of ADCs may increase the specificity of magnetic resonance imaging in these patients.
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Affiliation(s)
- Andreas M Herneth
- Department of Radiology, University of Vienna, AKH-Wien, 8F, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Spuentrup E, Buecker A, Adam G, van Vaals JJ, Guenther RW. Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body. AJR Am J Roentgenol 2001; 176:351-8. [PMID: 11159073 DOI: 10.2214/ajr.176.2.1760351] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration with and without accompanying fracture. SUBJECTS AND METHODS In 10 volunteers, diffusion-weighted spin-echo, fat-suppressed spin-echo, and stimulated-echo sequences were optimized on a clinical 1.5-T scanner. In 34 patients, MR imaging with and without diffusion-sensitizing gradients (b = 598 sec/mm(2) in spin-echo and fat-suppressed spin-echo, b = 360 sec/mm(2) in stimulated-echo) was performed. Thirty-five lesions were analyzed, with 18 caused by acute (< or =10 days old) osteoporotic or traumatic fractures and 17 caused by untreated malignant vertebral infiltration including nine fractures. Signal attenuation in diffusion-weighted images and contrast-to-noise ratio were calculated. The diffusion-weighted images were analyzed by two radiologists. RESULTS Images from three of 34 patients were excluded because of motion artifact. In osteoporotic and traumatic fractures, a strong signal attenuation of bone marrow edema was seen. In contrast to this, malignant-tumor infiltration caused only minor signal attenuation (p < 0.05), independent of accompanying pathologic fracture. All sequences showed identical changes of signal intensities. In four patients, initial diagnosis was changed by the findings in the diffusion-weighted images. CONCLUSION Diffusion-weighted spin-echo, fat-suppressed spin-echo, and stimulated-echo sequences are equally suitable for imaging of the spine. Calculation of signal attenuation and observation of signal characteristics allowed differentiation of benign fracture edema and tumor infiltration and provided excellent distinction between benign and malignant vertebral fractures in our series.
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Affiliation(s)
- E Spuentrup
- Cardiovascular Division/Cardiac MRI, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA
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Tehranzadeh J, Andrews C, Wong E. Lumbar spine imaging. Normal variants, imaging pitfalls, and artifacts. Radiol Clin North Am 2000; 38:1207-53, v-vi. [PMID: 11131630 DOI: 10.1016/s0033-8389(08)70004-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Accurate recognition and reporting of spine abnormalities on MRI requires knowledge of normal anatomy and its variants. This article deals with common normal variants, points out pitfalls which may be sources of errors in interpretation and describes imaging artifacts which are essential to be recognized and not mistaken for true pathologies.
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Affiliation(s)
- J Tehranzadeh
- Department of Radiological Sciences, University of California Irvine, Orange, USA.
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Leeds NE, Kumar AJ, Zhou XJ, McKinnon GC. Magnetic resonance imaging of benign spinal lesions simulating metastasis: role of diffusion-weighted imaging. Top Magn Reson Imaging 2000; 11:224-34. [PMID: 11133064 DOI: 10.1097/00002142-200008000-00003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In an attempt to avoid unnecessary therapy, this article demonstrates benign vertebral body lesions that mimic metastatic disease in cancer patients with back pain. The magnetic resonance imaging features that aid in differential diagnosis are demonstrated. In addition, the value of diffusion-weighted spinal imaging to further aid in distinguishing benign from malignant disease is described.
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Affiliation(s)
- N E Leeds
- Division of Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, USA
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Shih TT, Huang KM, Li YW. Solitary vertebral collapse: distinction between benign and malignant causes using MR patterns. J Magn Reson Imaging 1999; 9:635-42. [PMID: 10331758 DOI: 10.1002/(sici)1522-2586(199905)9:5<635::aid-jmri4>3.0.co;2-e] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Differentiation of benign from malignant causes of vertebral compression fracture can be difficult at a single location. We studied 37 patients with solitary vertebral collapse (SVC) in the spine using magnetic resonance imaging (MRI). Sixteen of them were found to have a benign cause of SVC, while the remaining 21 were found to have malignancy. The following four MRI characteristics were investigated: ill- or well-defined margin of the intravertebral lesion (P < 0.005); pedicle involvement (P < 0.05); MR enhancement pattern (P < 0.005); and paravertebral soft tissue lesion (PSL) (P < 0.025). It was found that cases of malignant SVC tended to have an ill-defined margin, abnormal signal involvement of the pedicle, a marked and heterogenous MR enhancement pattern, and irregular nodular-type PSL. Pedicle change with expansile lesion totally excluded a benign cause. By using these criteria, we were able to differentiate benign or malignant causes of SVC accurately.
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Affiliation(s)
- T T Shih
- Department of Radiology, National Taiwan University, Medical College and Hospital, Taipei.
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Burnett SJ, Stoker DJ. Practical limitations of magnetic resonance imaging in orthopaedics. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/0268-0890(95)90025-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Li J, Tio FO, Jinkins JR. Contrast-enhanced MRI of healed pathologic vertebral compression fracture mimicking active disease in a patient treated for lymphoma. Neuroradiology 1993; 35:506-8. [PMID: 8232875 DOI: 10.1007/bf00588707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Despite the valuable contribution of MRI, the distinction between benign and malignant compression fractures of the spine is sometimes difficult, and cannot with certainty be based on T1- and T2-weighted signal criteria alone, or on the configuration of the compression fracture. This case report demonstrates that in certain instances neither can gadolinium enhancement specifically make this determination in cases of treated malignancy of the spinal column. Because treated neoplasia having benign histologic characteristics may continue to enhance with IV gadolinium, biopsy evaluation must be undertaken in this setting in order to prove the diagnosis.
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Affiliation(s)
- J Li
- Neuroradiology Section, University of Texas Health Science Center, San Antonio 78284-7800
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