Spuentrup E, Buecker A, Adam G, van Vaals J J, Guenther R W
Cardiovascular Division/Cardiac MRI, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA.
AJR Am J Roentgenol. 2001 Feb;176(2):351-8. doi: 10.2214/ajr.176.2.1760351.
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.
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.
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.
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.
本研究旨在探讨扩散加权磁共振成像用于鉴别伴有或不伴有骨折的良性骨折水肿与肿瘤浸润。
在10名志愿者中，在临床1.5-T扫描仪上对扩散加权自旋回波、脂肪抑制自旋回波和激励回波序列进行优化。对34例患者进行了有无扩散敏感梯度的磁共振成像（自旋回波和脂肪抑制自旋回波中b = 598秒/毫米²，激励回波中b = 360秒/毫米²）。分析了35个病变，其中18个由急性（≤10天）骨质疏松性或创伤性骨折引起，17个由未经治疗的恶性椎体浸润引起，包括9个伴有骨折的病例。计算扩散加权图像中的信号衰减和对比噪声比。由两名放射科医生分析扩散加权图像。
34例患者中有3例因运动伪影而被排除图像。在骨质疏松性和创伤性骨折中，可见骨髓水肿的强烈信号衰减。与此相反，恶性肿瘤浸润仅引起轻微信号衰减（p < 0.05），与是否伴有病理性骨折无关。所有序列均显示信号强度的相同变化。4例患者的初始诊断因扩散加权图像的结果而改变。
扩散加权自旋回波、脂肪抑制自旋回波和激励回波序列同样适用于脊柱成像。信号衰减的计算和信号特征的观察能够鉴别良性骨折水肿与肿瘤浸润，并在我们的系列研究中对良性和恶性椎体骨折提供了出色的区分。
