Apparent diffusion coefficient of vertebral haemangiomas allows differentiation from malignant focal deposits in whole-body diffusion-weighted MRI

OBJECTIVES: The aim of this study was to identify apparent diffusion coefficient (ADC) values for typical haemangiomas in the spine and to compare them with active malignant focal deposits. METHODS: This was a retrospective single-institution study. Whole-body magnetic resonance imaging (MRI) scans of 106 successive patients with active multiple myeloma, metastatic prostate or breast cancer were analysed. ADC values of typical vertebral haemangiomas and malignant focal deposits were recorded. RESULTS: The ADC of haemangiomas (72 ROIs, median ADC 1,085×10(-6)mm(2)s(-1), interquartile range 927–1,295×10(-6)mm(2)s(-1)) was significantly higher than the ADC of malignant focal deposits (97 ROIs, median ADC 682×10(-6)mm(2)s(-1), interquartile range 583–781×10(-6)mm(2)s(-1)) with a p-value < 10(-6). Receiver operating characteristic (ROC) analysis produced an area under the curve of 0.93. An ADC threshold of 872×10(-6)mm(2)s(-1) separated haemangiomas from malignant focal deposits with a sensitivity of 84.7 % and specificity of 91.8 %. CONCLUSIONS: ADC values of classical vertebral haemangiomas are significantly higher than malignant focal deposits. The high ADC of vertebral haemangiomas allows them to be distinguished visually and quantitatively from active sites of disease, which show restricted diffusion. KEY POINTS: • Whole-body diffusion-weighted MRI is becoming widely used in myeloma and bone metastases. • ADC values of vertebral haemangiomas are significantly higher than malignant focal deposits. • High ADCs of haemangiomas allows them to be distinguished from active disease.