Julio Arevalo Perez MD, Presenter: Nothing to Disclose

John Lyo MD, Abstract Co-Author: Nothing to Disclose

Kyung K. Peck PhD, Abstract Co-Author: Nothing to Disclose

Eric Lis MD, Abstract Co-Author: Nothing to Disclose

Sasan Karimi MD, Abstract Co-Author: Nothing to Disclose

Differentiating pathologic from benign vertebral fractures can be challenging especially among cancer patients who are prone to developing both types. We hypothesize that DCE-MRI can aid in non-invasive distinction between pathologic and benign fractures, improving patient care and management.

Consecutive patients with vertebral fractures who underwent DCE MRI, biopsy and kyphoplasty were reviewed. A total of 47 fractures were analyzed for this study. Fractures were divided into 2 groups according to biopsy results; 19 pathologic fractures from 12 patients and 28 benign fractures from 9 patients (subgroups 13 chronic and 15 acute). ROIs were placed over fractured and normal appearing vertebral bodies on sagittal imaging. Perfusion parameters: blood plasma volume (Vp), time-dependent leakage (Ktrans), wash-in slope, peak enhancement and area under the curve(AUC) were calculated. Indices were compared between the 3 different groups of fractures: pathologic and benign, chronic and acute, and pathologic and acute. A Mann-Whitney U test at a significance level of corrected p<0.01 was conducted to assess the difference between the groups.

Pathologic fractures had significantly higher perfusion parameters (Vp, Ktrans, wash-in slope, peak enhancent and AUC) (p<0.01) when compared with benign fractures. Among benign vertebral fractures we also found significant differences (p<0.001) in all parameters comparing chronic and acute fractures. Vp and Ktrans were also able to discriminate between pathologic and acute fractures (p<0.01). Wash in was only marginally significant (p<0.02). No significant differences were found with peak enhancement (p<0.21) and AUC (p<0.4) in this last group.

Our data demonstrates that DCE – MRI helps to distinguish between pathologic and benign, acute and chronic and even benign acute and pathologic vertebral fractures. Adding DCE perfusion maps to standard MRI can aid to improve diagnostic accuracy.

DCE MRI is a useful non invasive method that could help to distinguish between pathologic and benign vertebral fractures, avoiding unnecessary biopsy or preventing diagnostic and treatment delay

Arevalo Perez, J, Lyo, J, Peck, K, Lis, E, Karimi, S, Differentiating Benign from Malignant Vertebral Fractures with Dynamic Contrast-enhanced MRI.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011245.html