Diffusion-weighted MR imaging offers no advantage over routine noncontrastMR imaging in the detection of vertebral metastases

BACKGROUND AND PURPOSE: Diffusion-weighted MR imaging of the spine has been used to differentiate benign from pathologic vertebral body compression fr actures. We sought to determine the utility of diffusion-weighted MR imagin g in the detection of vertebral metastases and to compare it with conventio nal noncontrast T1- and T2-weighted MR imaging. METHODS: Fifteen patients with metastases to the spine were studied using c onventional MR imaging and diffusion-weighted imaging. Blinded review of al l images was undertaken, and patients were categorized according to whether they had focal or multiple lesions. The signal intensity of the lesions wa s compared on T1-, T2- (fast spin-echo), and diffusion-weighted images. RESULTS: In five patients with focal disease, metastases were hypointense o n T1-weighted images; hypointense (n = 2), isointense (n = 1), or hyperinte nse (n = 2) on T2-weighted images; and hypointense (n = 3) or hyperintense (n = 2) on diffusion-weighted images with respect to presumed normal bone m arrow. In 10 patients with disease in multiple sites, all lesions were hypo intense on T1-weighted images; hypointense (n = 2), isointense (n = 4), hyp erintense (n = = 2), or mixed (n = 2) on T2-weighted images; and hypointens e (n = 5), hyperintense (n = 3), or mixed (n = 2) on diffusion-weighted ima ges with respect to presumed normal bone marrow. CONCLUSION: As used in this study, diffusion-weighted MR imaging of the spi ne showed no advantage in the detection and characterization of vertebral m etastases as compared with noncontrast T1-weighted imaging, hut was conside red superior to T2-weighted imaging.