Radiology Department, Faculty of Medicine, Cairo University, Egypt.
Eur J Radiol. 2009 Oct;72(1):125-33. doi: 10.1016/j.ejrad.2008.06.019. Epub 2008 Jul 30.
The objective of this study was to establish the cut-off value of the signal intensity drop on chemical shift magnetic resonance imaging (MRI) with appropriate sensitivity and specificity to differentiate osteoporotic from neoplastic wedging of the spine.
All patients with wedging of vertebral bodies were included consecutively between February 2006 and January 2007. A chemical shift MRI was performed and signal intensity after (in-phase and out-phase) images were obtained. A DXA was performed in all.
A total of 40 patients were included, 20 with osteoporotic wedging (group 1) and 20 neoplastic (group 2). They were 21 males and 19 females. Acute vertebral collapse was observed in 15 patients in group 1 and subacute collapse in another 5 patients, while in group 2, 11 patients showed acute collapse and 9 patients (45%) showed subacute vertebral collapse. On the chemical shift MRI a substantial reduction in signal intensity was found in all lesions in both groups. The proportional changes observed in signal intensity of bone marrow lesions on in-phase compared with out-of-phase images showed significant differences in both groups (P<0.05). At a cut-off value of 35%, the observed sensitivity of out-of-phase images was 95%, specificity was 100%, positive predictive value was 100% and negative predictive value was 95.2%.
A chemical shift MRI is useful in order to differentiate patients with vertebral collapse due to underlying osteoporosis or neoplastic process.
本研究旨在建立化学位移磁共振成像（MRI）信号强度下降的截断值，以具有适当的敏感性和特异性来区分骨质疏松性和肿瘤性脊柱楔形变形。
2006 年 2 月至 2007 年 1 月连续纳入所有有椎体楔形变形的患者。进行化学位移 MRI 检查，并获得成像后的信号强度（同相位和反相位）。所有患者均进行 DXA 检查。
共纳入 40 例患者，20 例为骨质疏松性楔形变形（组 1），20 例为肿瘤性（组 2）。患者中有 21 名男性和 19 名女性。组 1 中有 15 例患者出现急性椎体塌陷，另有 5 例患者出现亚急性塌陷，而组 2 中有 11 例患者出现急性塌陷，9 例（45%）患者出现亚急性椎体塌陷。在化学位移 MRI 上，两组所有病变均发现信号强度明显降低。两组中，同相位与反相位图像上骨髓病变信号强度的比例变化差异均有统计学意义（P<0.05）。在截断值为 35%时，反相位图像的观察敏感性为 95%，特异性为 100%，阳性预测值为 100%，阴性预测值为 95.2%。
化学位移 MRI 有助于区分因潜在骨质疏松或肿瘤过程导致椎体塌陷的患者。
