Differential diagnosis of hemangiomas from spinal osteolytic metastases using 3.0 T MRI: comparison of T1-weighted imaging, chemical-shift imaging, diffusion-weighted and contrast-enhanced imaging

The retrospective study investigated accuracy of quantitative evaluation of T1-weighted imaging (T1WI) with and without fat suppression (FS), chemical-shift, diffusion-weighted imaging (DWI) and enhanced imaging at 3.0 T MRI for distinguishing spinal hemangiomas from metastases. 27 patients with 33 spinal hemangiomas (15 atypical hemangiomas) and 26 patients with 71 metastases were recruited. T1WI, FS T1WI, in- and out-phase, DWI and enhanced T1WI were acquired. Signal intensities (SIs) of lesions were obtained. Signal intensity ratios (SIRs) and enhancement ratios of lesions in enhanced imaging were assessed. Ratio of SI loss of hemangiomas or atypical hemangiomas between T1WI and FS T1WI was higher than those of metastases (p < 0.001). The accuracies of ratio of SI loss between T1WI and FS T1WI for differentiating hemangiomas and atypical hemangiomas from metastases were 96.15% and 91.86%. Ratio of SI loss between in- and out- phase could differentiate hemangiomas and atypical hemangiomas from metastases with accuracies of 74.04% and 84.88%. Cutoff values for hemangiomas in SIRs of ≤ 1.52 (early phase) and ≤ 1.38 (middle phase) yielded accuracies of 92.31% and 82.69%. Enhancement ratios of atypical hemangiomas in middle and delayed phases were higher than that of metastases. Accuracies of apparent diffusion coefficient for differentiating hemangiomas and atypical hemangiomas from metastases were 70.19% and 89.53%. T1WI with and without fat suppression could distinguish spinal hemangiomas from metastases. Quantitative assessment of chemical-shift, DWI and enhanced imaging were helpful to identification of spinal hemangiomas and metastases.