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Abstract：
Objective The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) and chemical shift imaging (CSI) for the differentiation of benign and malignant vertebral lesions. Methods Patients with vertebral lesions underwent routine magnetic resonance imaging (MRI) along with DWI and CSI. Qualitative analysis of the morphological features was done by routine MRI. Quantitative analysis of apparent diffusion coefficient (ADC) from DWI and fat fraction (FF) from CSI was done and compared between benign and malignant vertebral lesions. Results Seventy-two patients were included. No significant difference was noted in signal intensities of benign and malignant lesions on conventional MRI sequences. Posterior element involvement, paravertebral soft-tissue lesion, and posterior vertebral bulge were common in malignant lesion, whereas epidural/paravertebral collection, absence of posterior vertebral bulge, and multiple compression fractures were common in benign vertebral lesion ( p < 0.001). The mean ADC value was 1.25 ± 0.27 mm 2 /s for benign lesions and 0.9 ± 0.19 mm 2 /s for malignant vertebral lesions ( p ≤ 0.001). The mean value of FF was 12.7 ± 7.49 for the benign group and 4.04 ± 2.6 for the malignant group ( p < 0.001). A receiver operating characteristic (ROC) curve analysis showed that an ADC cutoff of 1.05 × 10 -3 mm 2 /s and an FF cutoff of 6.9 can differentiate benign from malignant vertebral lesions, with the former having 86% sensitivity and 82.8% specificity and the latter having 93% sensitivity and 96.6% specificity. Conclusion The addition of DWI and CSI to routine MRI protocol in patients with vertebral lesions promises to be very helpful in differentiating benign from malignant vertebral lesions when difficulty in qualitative interpretation of conventional MR images arises.
摘要：
目的探讨磁共振弥散加权成像(DWI)和化学位移成像(CSI)对椎体良恶性病变的鉴别诊断价值。方法对椎体病变患者进行常规磁共振成像（MRI）以及DWI和CSI。通过常规MRI对形态学特征进行定性分析。对DWI的表观扩散系数（ADC）和CSI的脂肪分数（FF）进行定量分析，并比较良性和恶性椎体病变。结果共纳入72例患者。在常规MRI序列上，良性和恶性病变的信号强度没有显着差异。后部元素受累，椎旁软组织病变,椎体后隆起常见于恶性病变，而硬膜外/椎旁收集，没有椎体后隆起，良性椎体病变常见多发压缩性骨折（p<0.001）。良性病变的平均ADC值为1.25±0.27mm2/s，恶性椎体病变的平均ADC值为0.9±0.19mm2/s（p≤0.001）。良性组平均FF值为12.7±7.49,恶性组平均FF值为4.04±2.6(p<0.001)。受试者工作特征（ROC）曲线分析表明，ADC截止值1.05×10-3mm2/s和FF截止值6.9可以区分良性和恶性椎体病变，前者的敏感性为86%，特异性为82.8%，后者的敏感性为93%，特异性为96.6%。结论当难以定性解释常规MR图像时，在脊柱病变患者的常规MRI方案中添加DWI和CSI有望有助于区分良性和恶性脊柱病变。
