Objectives: To differentiate benign from malignant vertebral lesions using Diffusion Weighted MRI Images (DWI) and Apparent Diffusion Coefficient (ADC) values.

Background: In elderly individuals, with no or minimal history of trauma, it is important to diagnose and differentiate benign and malignant lesions affecting the vertebrae. Conventional MRI cannot reliably differentiate benign from malignant vertebral lesions. DWI with ADC is a relatively novel and fast sequence which characterizes lesions based on their cellularity. Our hypothesis is that malignant lesions will show lower ADC values compared to benign by virtue of hypercellularity.

Materials and Methods: A hospital based prospective observational study was conducted with the guidelines of the ethical committee of the hospital. 46 patients with known vertebral lesions and who fulfilled the inclusion criteria were included in this study. Images were acquired on our 3T Philips Ingenia MRI machine and individual ADC values were obtained.

Results: Among 23 benign and 23 malignant vertebral lesions, malignant pathologies showed lower ADC values (0.62 x 10-3mm2/s) compared to benign lesions (1.08 x 10-3mm2/s). Cut-off ADC to distinguish benign from malignant lesions was found to be 0.73 ×10-3 mm2/s with a sensitivity and specificity of 95.7% and 82.6% respectively. There was overlap between ADC values for TB (Tuberculosis) and malignancy.

Keywords: ADC; Osteoporosis; TB; Metastases