Investigation into the usefulness of T1 signal intensity values and ratios in distinguishing between benign and malignant spinal bone lesions

This study aims to investigate the feasibility of using non-contrast magnetic resonance imaging (MRI) parameters (T1 signal, T1 signal decay rate, apparent diffusion coefficient (ADC) and normalised ADC) to differentiate between benign and malignant vertebral bone marrow lesions. MRI archives obtained at Süleyman Demirel University Faculty of Medicine between 2015 and 2025 were retrospectively reviewed, and a total of 337 vertebral bone marrow lesions that met the inclusion criteria were included in the study. ROC analyses were used to examine the diagnostic performance in distinguishing atypical hemangiomas from metastatic lesions (active–inactive). Measurements were performed using the freehand ROI method. The T1 signal intensity values of atypical hemangiomas were found to be higher than those of other lesion types, and consequently, T1 signal decrease ratios were determined to be the most powerful parameter in the differential diagnosis of lesions. Threshold values of ≤0.38–0.39 in T1 signal decay rates showed high sensitivity and specificity in distinguishing atypical hemangiomas from metastases (active–inactive). However, ADC and nADC measurements were found to be more sensitive than T1 signal intensity values and T1 signal intensity decay rates in the differential diagnosis of active–inactive metastatic lesions. ADC and nADC measurements were found to be lower in malignant lesions and higher in benign lesions. nADC was seen to provide a significant diagnostic contribution, especially in differentiating between metastatic (active–inactive) lesions