Retrospective evaluation of the effectiveness of multiparametric spinal MR imaging in the diagnosis of benign and malign vertebral compression fractur

Vertebral collapse fractures are a disease frequently seen especially in elderly patients. Its etiology may include benign processes such as trauma - osteoporosis or malignant processes such as primary tumor - metastasis - multiple myeloma. Magnetic resonance (MR) examination is an imaging method that can be used to differentiate benign or malignant collapse. Although conventional sequences (T1, T2, fat-suppressed techniques) are generally used for diagnosis, advanced techniques such as diffusion MR and Dynamic contrast-enhanced (DCE) MR perfusion have been preferred for discrimination in recent years. Even though, pathological verification may be required in cases where the suspicion of malignancy is not resolved. This study aimed to evaluate the distinction between benign and vertebral compression fractures of multiparametric spinal MRI using conventional techniques, DCE MR and diffusion MR. The study included 42 patients with vertebral compression fracture who underwent vertebral biopsy and who underwent multiparametric MR examination before the biopsy. The success of distinguishing benign, malignant and myeloma lesions from each other was evaluated using findings in T1-T2 sequences, quantitative diffusion and perfusion MR findings, and perfusion MR curve types. There were 50 pathology results of 42 patients. In both cases, a statistically significant difference was found between the groups in perfusion MR curve type, Ktrans, Kep and ADC parameters (p=0.000-0.02). In the ROC analysis, the highest sensitivity and specificity values were found to be 73.9% and 77,8% for Ktrans, 88% and 77.8% for Kep, and 63% and 87% for ADC in distinguishing between benign and malignant vertebral compression fracture. In the multiparametric evaluation made according to ADC, Ktrans and Kep cut off values, it was found to be 91.30% and 96.29%.Combining the information of quantitative ADC, Kep and Ktrans analysis, multiparametric spinal MRI can differentiate benign from malignant compression fracture with high diagnostic accuracy. With the combined use of each of the techniques included in it, malignancies that may play a role in the etiology of vertebral collapses can be detected with higher accuracy. In this way, the need for invasive procedures to be performed only for diagnostic purposes can be reduced. Keywords: Vertebral compression fracture, MR perfusion, ADC, Kep, Ktrans