Luo Zhanpeng, Litao Li, Gu Suxi, Luo Xiaobo, Li Dawei, Yu Long, Ma Yuanzheng
1 Southern Medial University, Guangzhou, China.
2 Department of Orthopedics, The 309th Hospital of Chinese PLA, Beijing, China.
Br J Radiol. 2016;89(1058):20150384. doi: 10.1259/bjr.20150384. Epub 2015 Nov 27.
To determine the comparative diagnostic performance of standard-b-value (≥500 mm(2)) vs low-b-value (<500s mm(-2)) diffusion-weighted imaging (DWI) for discriminating malignant from benign vertebral compression fractures.
12 studies with a total of 350 malignant and 312 benign vertebral fractures were included.
The apparent diffusion coefficient (ADC) value of benign vertebral compression fractures was lower than that of malignant vertebral compression fractures (SMD = 1.81, 95% CI 0.98 to 2.64 Z = 4.27, p < 0.05). ADC value difference was more pronounced in the group of low-b-value DWI (SMD = 2.31, 95% CI 1.02 to 3.60 Z = 3.51, p < 0.05) than in the group of standard-b-value DWI (SMD = 1.38, 95% CI 0.18 to 2.59 Z = 2.25, p < 0.05). Ethnicity stratified analysis demonstrated higher ADC values in benign vertebral compression fractures in comparison to malignant tissues in both the Asian and Caucasian subgroups (Asians: SMD = 2.400, 95%CI 1.45 to approximately 3.35, p<0.05; Caucasians: SMD = 0.592, 95 % CI -0.848 to approximately 2.032, p < 0.05). And the ADC value difference was more pronounced in the Asian subgroup.
ADC value appears to be a reliable method to differentiate benign from malignant fractures. Low-b-value DWI was more a valuable parameter than standard-b-value DWI for discriminating malignant from benign vertebral compression fractures. And the diffusion characteristics of the benign vertebral fractures such as osteoporosis, trauma and infection have rarely been investigated separately.
The use of low-b-value DWI for differentiation of benign and malignant vertebral fractures is recommended.
确定标准b值（≥500 mm²）与低b值（<500 s mm⁻²）扩散加权成像（DWI）在鉴别恶性与良性椎体压缩性骨折方面的比较诊断性能。
纳入12项研究，共350例恶性椎体骨折和312例良性椎体骨折。
良性椎体压缩性骨折的表观扩散系数（ADC）值低于恶性椎体压缩性骨折（标准化均数差[SMD]=1.81，95%置信区间0.98至2.64，Z=4.27，p<0.05）。低b值DWI组的ADC值差异比标准b值DWI组更明显（SMD=2.31，95%置信区间1.02至3.60，Z=3.51，p<0.05）（SMD=1.38，95%置信区间0.18至2.59，Z=2.25，p<0.05）。种族分层分析表明，在亚洲和白种人亚组中，良性椎体压缩性骨折的ADC值均高于恶性组织（亚洲人：SMD=2.400，95%置信区间1.45至约3.35，p<0.05；白种人：SMD=0.592，95%置信区间-0.848至约2.032，p<0.05）。且ADC值差异在亚洲亚组中更明显。
ADC值似乎是区分良性与恶性骨折的可靠方法。对于鉴别恶性与良性椎体压缩性骨折，低b值DWI比标准b值DWI是更有价值的参数。而良性椎体骨折如骨质疏松、创伤和感染的扩散特征很少被单独研究。
推荐使用低b值DWI鉴别良性和恶性椎体骨折。
