الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 170 |  |  |
| | | from | 170 | | |
Abstract
Magnetic resonance imaging (MRI) of the spine is widely used to detect and characterize vertebral compression fractures (VCFs), which remain highly prevalent in the population. In order to initiate appropriate treatment and improve outcome, it is important for clinicians to differentiate between benign and malignant VCFs, which can be challenging in practice. Sometimes at conventional MRI, malignant compression fractures exhibit signal intensities and morphologic changes similar to those of acute osteoporotic compression fractures, necessitating invasive bone biopsy to confirm the nature of the vertebral compression fracture. This may affect treatment strategy and the prognosis. Both DWI and DTI are diffusion imaging and can noninvasively observe the microscopic diffusion motion of water molecules in living tissues, DWI reflects the restricted motion of water molecules by measuring the ADC value, and DTI is an advanced form of diffusion imaging that allows a more accurate description of water molecules in tissues. So, our study aimed to study the diagnostic accuracy of MR-DTI in differentiating malignant from benign compressed vertebrae. The current study included 30 patients with vertebral fractures. Their ages ranged between 34 and 70 years old with a mean of 56.333 ± 12.491; 73.33% of them were males, and the remaining 26.67% were females. They were presented with different clinical manifestations mostly back pain. Thirty subjects were included as a control group. All the studied subjects were examined with MRI including DTI technique. The most common site of vertebral fracture was the lumbar region. Regarding the final outcome of the studied patients depending on histopathological findings, clinical history of the patients as well as follow up studied which were accepted as a standard reference, there were 14 patients with benign vertebral fractures, and 16 patients with malignant vertebral fractures. In the patients group, conventional MRI revealed loss of height of all the examined 30 fractured vertebral bodies in 100% of patients. By DTI, the mean FA value in benign vertebral fracture (0.253±0.114) was less than the mean FA value (0.419±0.094) in malignant vertebral fracture compared to the mean FA in control group (0.807±0.066), which was statistically significant. Also, the mean ADC value in benign vertebral fracture (1.579 ±0.368) was higher than the mean ADC value (0.884±0.253) in malignant vertebral fracture compared to the mean ADC in control group (0.291±0.050), which was statistically significant. The mean MD value in benign vertebral fracture (1.605±0.363) was higher than the mean MD value (0.878±0.242) in malignant vertebral fracture compared to the mean MD in control group (0.262±0.065), which was statistically significant. Fractional anisotropy is more sensitive than ADC& MD in differentiating benign from malignant compression fractures with sensitivity of 93.75% % versus 87.50% &87.50% respectively. Conclusion This study realized that DTI with its quantitative indices is a valuable tool in differentiating malignant from benign compressed vertebrae when compared to conventional MRI. FA values in benign vertebral fracture were significantly less than the FA values in malignant vertebral fracture. ADC & MD values in benign vertebral fracture were significantly higher than the ADC&MD values in malignant vertebral fracture. FA is more sensitive and accurate in differentiating malignant from benign compressed vertebrae. We recommend using DTI as a routine investigation in vertebral fractures complementary to MRI for differentiating malignant from benign compressed vertebrae.