In vertebral metastasis, degeneration and spondylodiscitis non-cpmg ss-fse diffusion weighted imaging

SUMMARYPurpose:To evaluate the efficacy of diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values with non-CPMG SS-FSE DWI technique in the differential diagnosis of spondylodiscitis, Modic type 1 spinal degenerative changes, and spinal metastases.Materials and Methods:MRI examinations of fifty-seven patients (24 spinal metastases, 18 spondylodiscitis (9 pyogenic, 9 granulomatous), 15 Modic type 1 spinal degenerative changes) were obtained together with non-CPMG SS-FSE DWI technique. Qualitative evaluation, was performed by using signal intensity on the DWI and ADC maps. In quantitative evaluation the signal intensities of the normal and affected vertebrae were measured, and ADC values were calculated. In addition, DWI signal intensities and ADC values of the normal and affected vertebrae were rationed. These values and ratios were compared between spondylodiscitis, degenerative changes, and spinal metastases. Statistical analyze, were performed by using nonparametric tests.Results:At the qualitative assessment of the DWI, spondylodiscitis showed mixed signal intensity in four and high signal intensity in the remaining. The degenerative changes showed mixed signal intensity in four, low signal intensity in one, and high signal intensity in the remaining on DWI. Metastases demonstrated high signal intensity in six, mixed signal intensity in two, and low signal intensity in the remaining when compared to adjacent normal vertebral body on the diffusion-weighted images. However, ADC maps of all these groups showed increased signal intensity.The mean ADC values for normal and pathological groups were 0,25±0,05 mm2/sn and 1,07±0,22 mm2/sn respectively. There was significant difference between normal and pathological groups. The ADC values and ADC ratios in both spondylodiscitis and Modic type I degeneration were significantly higher than the metastatic group. Statistically significant difference was demonstrated between the ADC values and ratios of the bening and malignant groups.Conclusion:The ADC values and ratios obtained by using Non-CPMG SS-FSE DWI may increase the specificity of conventional MRI sequences particularly for differentiating the spondylodiscitis, spinal metastases, and degenerative changes. However, it is necessary to study a large number of patients before reaching a conclusion.