FIGURE 1.
A 50-year-old woman with breast cancer and focal benign vertebral bone marrow lesion (VBML) (arrows). A round-shaped, abnormal signal intensity change in the bone marrow is evident in the L1 body on sagittal T1-weighted (A), short tau inversion recovery (STIR), (B), contrast-enhanced fat- satureted T1-weighted (C) in-phase T1-weighted (D), out-of-phase T1-weighted (E) images. Apparent diffusion coefficient (ADC) (F) value is 1.74 x 10−3 mm2/s. The signal intensity ratio (SIR) value is calculated as 0.8 and is consistent with benignity. Standardized Uptake Value (SUV) on PET scan excluded malignancy. After one year of follow-up, the lesion STIR/postcontrast hyperintensity almost disappeared.
FIGURE 2.
A 75-year-old woman with breast cancer and five focal malignant vertebral bone marrow lesions (VBMLs), the most prominent in the L1 body (arrows) which we chose to analyze. Abnormal signal intensity change is evident on sagittal T1-weighted (A), short tau inversion recovery (STIR), (B), contrast-enhanced fat-satureted T1-weighted (C) in-phase T1-weighted (D), and out-of-phase T1-weighted (E). Apparent diffusion coefficient (ADC) (F) value is 0.99 x 10−3 mm2/s. The signal intensity ratio (SIR) value is calculated as 1.07. which indicates the malignant lesion. Sci suggested malignant lesions.
TABLE 1.
Diagnostic performance of the signal intensity ratio (SIR), apparent diffusion coefficient (ADC), and combination (SIR, ADC) for differentiating benign from malignant vertebral bone marrow lesions (VBMLs)
| Parameters | AUC (95% CI) | Standard error | p | Cut-off | Sensitivity (%) | Specificity (%) |
|---|---|---|---|---|---|---|
| SIR | 0.953 (0.886–0.987) | 0.029 | < 0.001 | > 0.82 | 93.6 | 88.5 |
| ADC | 0.894 (0.769–0.965) | 0.077 | < 0.001 | ≤ 1.57 | 88.2 | 92.3 |
| Combination (SIR, ADC) | 0.988 (0.872–1.000) | 0.014 | < 0.001 | > 0.19 | 100.0 | 90.9 |
FIGURE 3.
The receiver operating characteristic (ROC) curves of the apparent diffusion coefficient (ADC) (red line), signal intensity ratio (SIR) (green line), and combined SIR and ADC (blue line). The ROC curves show that the combined SIR and ADC have the highest AUC for differentiating benign from malignant vertebral bone marrow lesions (VBMLs), followed by the SIR and ADC.
TABLE 2.
The studies of diffusion-weighted imaging in the differentiation of bone marrow lesions
| Authors | No. of lesions | Clinical features | Technical parameters No. of image planes | Technical parameters b values (s/mm2) | ADC cut-off values (× 10−3 mm2/s) |
|---|---|---|---|---|---|
| Park et al.9 | 86 | Traumatic CFs vs. tumor infiltration with/without malignant CFs | Single shot SE EPI | 0, 400, 1000 | 1.14 |
| Kwack et al.10 | 126 | Focal benign lesion vs. metastases | Single-shot echo-planar | 0, 800 | 0.995 |
| Geith et al.12 | 46 | Osteoporotic vs. malignant CFs | Single shot TSE | 100, 250, 400 | 1.7 |
| Park et al.23 | 58 | Hyperplastic hematopoietic BM vs. malignant BM lesions | Single shot SE EPI | 0, 800 | 0.695 |
| Schmeel et al.27 | 89 | Benign (traumatic, inflammatory, and primary) vs. malignant (metastatic and hematologic) | Single-shot spin-echo echo-planar with multislice short TI inversion recovery fat suppression | 0, 800 | 1.08 |
| Pozzi et al.29 | 116 | Benign primary tumors vs. bone metastases vs. malignant primary tumors | Spin-echo echo-planar technique | 0, 1000 | 0.952 (benign vs. malignant tumors) |
| Hajalioghli et al.30 | 23 | Atypical hemangiomas and metastases | Spin-echo single-shot echo-planar with fat suppression | 50, 400 | 0.958 |
| Lee et al.31 | 51 | Schmorl nodes vs. bone metastases | Single-shot (FOCUS, GE Healthcare) | 0, 400, 1000 | 1.028 |