Quantitative assessment of diffusion abnormalities in benign and malignant vertebral compression fractures by line scan diffusion-weighted imaging

OBJECTIVE. Acute vertebral collapse is common, and it is sometimes difficult to determine whether the cause is benign or malignant. Recently, diffusion-weighted imaging has been reported to be useful for differentiating the two types. The purpose of this study was to evaluate diffusion abnormalities quantitatively in benign and malignant compression fractures using line scan diffusion-weighted imaging. SUBJECTS AND METHODS. Line scan diffusion-weighted imaging was prospectively performed in 17 patients with 20 acute vertebral compression fractures caused by osteoporosis or trauma, in 12 patients with 16 vertebral compression fractures caused by malignant tumors, and in 35 patients with 47 metastatic vertebrae without collapse. Images were obtained at b values of 5 and 1,000 sec/mm(2). The apparent diffusion coefficient (ADC) was measured in vertebral compression fractures and metastatic vertebrae without collapse. RESULTS. The ADC (mean +/- SD) was 1.21 +/- 0.17 x 10(3) mm(2)/sec in benign compression fractures, 0.92 +/- 0.20 x 10(-3) mm(2)/sec in malignant compression fractures, and 0.83 +/- 0.17 x 10(-3) mm(2)/sec in metastatic vertebral lesions without collapse. The ADC was significantly higher in benign compression fractures than in malignant compression fractures (p < 0.01), although the two types showed considerable overlap. CONCLUSION. Although the quantitative assessment of vertebral diffusion provides additional information concerning compressed vertebrae, the benign and malignant compression fracture ADC values overlap considerably. Therefore, even a quantitative vertebral diffusion assessment may not always pen-nit a clear distinction between benign and malignant compression fractures.