Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures

Radiology. 1998 May;207(2):349-56. doi: 10.1148/radiology.207.2.9577479.


Purpose: To evaluate the usefulness of diffusion-weighted magnetic resonance (MR) imaging of bone marrow for differentiating between benign and pathologic vertebral compression fractures.

Materials and methods: Thirty patients with 39 vertebral compression fractures were examined with MR imaging. Diffusion-weighted MR imaging was performed with a steady-state free precession sequence in 22 acute benign osteoporotic and/or traumatic fractures and 17 pathologic compression fractures. Biplanar radiographs, T1-weighted spin-echo (SE) MR images, and short inversion time inversion-recovery (STIR) MR images were available for all patients. The signal intensity characteristics were analyzed qualitatively and quantitatively (bone marrow contrast ratios and signal-to-noise ratios) for all sequences.

Results: At diffusion-weighted MR imaging, all benign vertebral compression fractures were hypo- to isointense to adjacent normal vertebral bodies. Pathologic compression fractures were hyperintense to normal vertebral bodies. Benign vertebral fractures had negative bone marrow contrast ratios at diffusion-weighted imaging, whereas pathologic vertebral fractures had positive values (P < .001). The difference in bone marrow contrast ratios for benign and pathologic compression fractures at T1-weighted SE and STIR imaging was not significant (P > .01).

Conclusion: Diffusion-weighted MR imaging provided excellent distinction between pathologic and benign vertebral compression fractures.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Body Water
  • Bone Marrow / diagnostic imaging
  • Bone Marrow / pathology*
  • Diffusion
  • Edema / diagnosis
  • Edema / pathology
  • Extracellular Space
  • Female
  • Follow-Up Studies
  • Fractures, Spontaneous / diagnosis
  • Fractures, Spontaneous / diagnostic imaging
  • Fractures, Spontaneous / etiology*
  • Humans
  • Image Enhancement / methods
  • Image Processing, Computer-Assisted / methods
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Osteoporosis / complications
  • Prospective Studies
  • Radiography
  • Spinal Fractures / diagnosis
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / etiology*
  • Spinal Injuries / complications
  • Spinal Neoplasms / complications*
  • Spinal Neoplasms / diagnosis
  • Spinal Neoplasms / diagnostic imaging
  • Spinal Neoplasms / secondary
  • Spine / diagnostic imaging
  • Spine / pathology