Intravoxel incoherent motion MR imaging for differentiating malignant lesions in spine: A pilot study

Abstract Purpose To determine the diagnostic potential of Intravoxel Incoherent Motion (IVIM) MRI for differentiating malignant spinal tumours from acute vertebral compression fractures and tuberculous spondylitis, and to compare IVIM with diffusion-weighted imaging (DWI) and chemical shift imaging (CSI). Methods The Institutional Review Board approved this prospective study, and informed consent was obtained. IVIM MRI, DWI, and CSI at 1.5 T were performed in 25 patients with 12 acute compression fractures, 14 tuberculous spondylitis, and 18 malignant spinal tumours. The parameters of these techniques were assessed using the Kruskal–Wallis test. The diagnostic performance of the parameters was evaluated using receiver operating characteristic (ROC) analysis. Results ADC, SIR, Dslow, Dfast, and f values of malignant tumours were significantly different from those of acute compression fracture (for all, p   0.05). Dslow•f showed the highest AUC value of 0.980 (95%CI: 0.942–1.000) in differentiating acute compression fracture and malignant spinal tumours. Dslow showed the highest AUC value of 0.877 (95%CI: 0.713-0.966) in differentiating tuberculous spondylitis and malignant spinal tumours. Conclusions IVIM MR imaging may be helpful for differentiating malignant spinal tumours from acute vertebral compression fractures and tuberculous spondylitis.