J Korean Soc Radiol.  2020 Jan;81(1):58-69. 10.3348/jksr.2020.81.1.58.

Diffusion-Weighted Magnetic Resonance Imaging of Spine

• Yoon YC

• KMID: 2469182
• DOI: http://doi.org/10.3348/jksr.2020.81.1.58

Abstract

In this study, we evaluated the technical characteristics and usefulness of diffusion-weighted magnetic resonance imaging for discrimination between benign and malignant vertebral fractures, for detection and differentiation of multiple myeloma or metastases, and for response monitoring in malignant vertebral lesions after anticancer drug therapy or radiation therapy.

MeSH Terms

Diffusion
Discrimination (Psychology)
Drug Therapy
Magnetic Resonance Imaging*
Multiple Myeloma
Neoplasm Metastasis
Spine*

Figure

• 

  Fig. 1 Benign vertebral fracture in a 62-year-old man with hepatocellular carcinoma with coexisting bone metastasis in the adjacent vertebra. A. T1-weighted sagittal image showing decreased height of the L5 vertebral body (arrow) and low signal intensity lesions in the L3, L4, and L5 vertebral bodies. B. T2-weighted sagittal image showing a band-like low signal (arrowheads) parallel with the upper endplate of the L5 vertebral body. C, D. Diffusion-weighted images of b = 0 (C) and b = 800 (D) showing consistently increased signal in the L4 vertebral body (arrows) and seemingly decreased extent of the high signal area in the L5 vertebral body (arrowheads). E. ADC map showing a low ADC value (0.8 × 10−3 mm2/s) of the L4 lesion, indicating a viable metastasis, and a relatively high ADC value (1.5 × 10−3 mm2/s) of the L5 lesion, indicating a benign compression fracture. ADC = apparent diffusion coefficient

• 

  Fig. 2 Pathologic fracture in a 71-year-old man with non-small cell lung cancer. A, B. T1-weighted (A) and T2-weighted (B) images showing areas with heterogeneous low signal in the vertebral bodies and anterior wedging deformity (arrows) with posterior convexity of the T11 vertebral body (arrowheads). C, D. Diffusion-weighted images with b = 0 (C) and b = 800 (D) showing diffusion restriction in multiple thoracolumbar vertebral bodies and spinous processes. E. ADC map showing a low ADC value (0.9 × 10−3 mm2/s) of the T11 lesion, indicating a pathologic compression fracture. ADC = apparent diffusion coefficient

• 

  Fig. 3 Bone marrow edema adjacent to a Schmorl's node in a 24-year-old man with low back pain. A, B. T1-weighted image (A) showing poorly defined slightly low signal area in the bone marrow of the L4 vertebral body (arrowheads); T2-weighted image (B) showing poorly defined fluid-like high signal area (arrow) with adjacent intermediate-to-low signal area in the bone marrow of the L4 vertebral body (arrowheads). C, D. Diffusion-weighted images of b = 0 (C), showing increased signal area in the upper portion of the L4 vertebral body, and b = 800 (D), showing increased signal intensity (T2 shine-through effect) in the upper portion of the L4 vertebral body. E. ADC map showing a high ADC value (2.3 × 10−3 mm2/s) of the L4 lesion, indicating a benign process. ADC = apparent diffusion coefficient

• 

  Fig. 4 Bone metastasis in the L1 vertebral body of a 56-year-old woman with advanced gastric cancer. A. T1-weighted image showing an ovoid area with low signal intensity in the L1 vertebral body. B. T2-weighted image showing iso- to slightly low signal intensity in the same area of the L1 vertebral body. C, D. Diffusion-weighted images with b = 0 (C) and b = 800 (D) showing high signal intensity in the area of the L1 vertebral body, indicating diffusion restriction. E. ADC map showing a low ADC value (0.8 × 10−3mm2/s) of the L1 lesion, indicating a viable bone metastasis. ADC = apparent diffusion coefficient

• 

  Fig. 5 MRI at baseline (A–F) and at 3 months follow-up (G–L) after radiation therapy for metastatic bone tumor in a 50-year-old woman with hepatocellular carcinoma. A–C. T1-weighted sagittal (A), T2-weighted axial (B), and post-contrast T1-weighted axial (C) images showing a metastatic bone lesion with enhancement and central necrosis in the L5 vertebral body. D, E. Diffusion-weighted images of b = 0 (D) and b = 1000 (E) showing diffusion restriction in the periphery of the bone lesion. F. ADC map showing a relatively low ADC value (0.7 × 10−3mm2/s) in the non-necrotic enhancing portion, indicating a viable tumor with high cellularity. G–I. T1-weighted sagittal (G), T2-weighted axial (H) and post-contrast T1-weighted axial (I) images showing decreased extent of the metastatic bone lesion with enhancement and central necrosis in the L5 vertebral body. J–L. Diffusion-weighted images of b = 0 (J) and b = 1000 (K) showing decreased extent of diffusion restriction in the periphery of the bone lesion; ADC map (L) showing an increased ADC value (1.2 × 10−3mm2/s) in the non-necrotic enhancing portion, indicating decreased viable tumor burden. ADC = apparent diffusion coefficient

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