الفهرس 
Anatomy of the Vertebral ColumnOnly 14 pages are availabe for public view
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Abstract
Background: Diffusion-weighted imaging (DWI) is one of the most useful clinical MRI techniques. Including this technique with other sequences used for routine spine scanning improves sensitivity and the capacity to characterize lesions.
This study aims to evaluate the utility of apparent diffusion coefficient obtained from diffusion weighted MR imaging in differentiating between benign and malignant vertebral lesions, and to estimate the sensitivity and the specificity in differentiating benign and malignant vertebral lesions according to the optimal cut-off ADC value
Methods: This study included 30 patients at Ain Shams University hospitals; all of them were subjected to full clinical assessment and magnetic resonance imaging. Data included various signal intensity (T1WIs, T2WIs), presence of soft tissue mass and pattern of Gd-DTPA enhancement were collected and analyzed. Patients were classified into 4 groups: inflammatory lesions (12 cases) followed by malignant/metastatic lesions (7 cases) then benign neoplastic lesions/hemangioma (6 cases) then traumatic lesions (3 cases) and osteoporosis (two cases).
Results: Inflammatory lesions revealed restricted diffusion including pyogenic and tuberculous types. Benign neoplastic lesions/hemangioma showed low signal at DWIs due to free diffusion, while malignant/ metastatic lesions showed restricted diffusion with bright signal intensity in DWIs. Traumatic lesions showed restricted diffusion with bright/heterogeneous bright signal intensity on DWIs. The osteoporotic lesions showed iso to hyper intense signal at DWIs. The mean ADC value of the benign lesions (benign neoplasm, trauma, infection and osteoporosis) was 1.8 ± 0.43 mm2/sec while metastatic tumors was 0.96 ± 0.5 X 10-3 mm2/sec, however overlapping values may be present, The mean ADC of tuberculous spondylitis was 0.65 X10-3 mm2/sec, which was similar to that of malignant acute vertebral fractures.
Conclusion: Compared with benign tumors, malignant tumors have lower ADC values; nevertheless, some lesions, such as tuberculosis, have low ADC values that are similar to those of malignant tumors. Diffusion MRI and ADC coefficient values should always be analyzed in conjunction with standard MRI sequences as well as a thorough clinical history and examination.