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Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging of focal vertebral bone marrow lesions: initial experience of the differentiation of nodular hyperplastic hematopoietic bone marrow from malignant lesions

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Abstract

Objective

To evaluate the ability of intravoxel incoherent motion (IVIM) diffusion-weighted magnetic resonance imaging (MRI) parameters to differentiate nodular hyperplastic hematopoietic bone marrow (HHBM) from malignant vertebral bone marrow lesions (VBMLs).

Materials and methods

A total of 33 patients with 58 VBMLs, including 9 nodular HHBM lesions, 39 bone metastases, and 10 myelomas, were retrospectively assessed. All diagnoses were confirmed either pathologically or via image assessment. IVIM diffusion-weighted MRI with 11 b values (from 0 to 800 s/mm2) were obtained using a 3.0-T MR imager. The apparent diffusion coefficient (ADC), pure diffusion coefficient (D), perfusion fraction (f), and pseudodiffusion coefficient (D*) were calculated. ADC and IVIM parameters were compared using the Mann–Whitney U test. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performances of ADC, D, f, and D* in terms of VBML characterization. The diagnostic performance of morphological MR sequences was also assessed for comparison.

Results

The ADC and D values of nodular HHBM were significantly lower than those of malignant VBML (both p values < 0.001), whereas the f value was significantly higher (p < 0.001). However, there were no significant differences in D* between the two groups (p = 0.688). On ROC analysis, the area under the curve (AUC) for D was 1.000, which was significantly larger than that for ADC (AUC = 0.902).

Conclusion

Intravoxel incoherent motion diffusion-weighted MRI can be used to differentiate between nodular HHBM and malignant VBML. The D value was significantly lower for nodular HHBM, and afforded a better diagnostic performance than the ADC, f, and D* values in terms of such differentiation.

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Abbreviations

ADC:

Apparent diffusion coefficient

D:

Pure diffusion coefficient

D*:

Pseudodiffusion coefficient

f:

Perfusion fraction

HHBM:

Hyperplastic hematopoietic bone marrow

IVIM:

Intravoxel incoherent motion

VBML:

Vertebral bone marrow lesion

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Authors and Affiliations

  1. Division of Musculoskeletal Radiology, Department of Radiology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, South Korea, 16499

    Sunghoon Park, Kyu-Sung Kwack & Jae Ho Kim

  2. Musculoskeletal Imaging Laboratory, Ajou University Medical Center, Suwon, South Korea

    Sunghoon Park, Kyu-Sung Kwack & Jae Ho Kim

  3. Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, South Korea

    Nam-Su Chung

  4. Department of Clinical Science, Philips Healthcare, Seoul, South Korea

    Jinwoo Hwang

  5. Regional Clinical Trial Center, Ajou University Medical Center, Suwon, South Korea

    Hyun Young Lee

  6. Department of Biostatistics, Yonsei University College of Medicine, Seoul, South Korea

    Hyun Young Lee

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  1. Sunghoon Park
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Correspondence to Kyu-Sung Kwack.

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Park, S., Kwack, KS., Chung, NS. et al. Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging of focal vertebral bone marrow lesions: initial experience of the differentiation of nodular hyperplastic hematopoietic bone marrow from malignant lesions. Skeletal Radiol 46, 675–683 (2017). https://doi.org/10.1007/s00256-017-2603-z

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  • DOI: https://doi.org/10.1007/s00256-017-2603-z

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