Intravoxel incoherent motion to differentiate spinal metastasis: A pilot study

BACKGROUND: To investigate the value of intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) to discriminate spinal metastasis from tuberculous spondylitis. METHODS: This study included 50 patients with spinal metastasis (32 lung cancer, 7 breast cancer, 11 renal cancer), and 20 with tuberculous spondylitis. The IVIM parameters, including the single-index model (apparent diffusion coefficient (ADC)-stand), double exponential model (ADC(slow), ADC(fast), and f), and the stretched-exponential model parameters (distributed diffusion coefficient (DDC) and α), were acquired. Receiver operating characteristic (ROC) and the area under the ROC curve (AUC) analysis was used to evaluate the diagnostic performance. Each parameter was substituted into a logistic regression model to determine the meaningful parameters, and the combined diagnostic performance was evaluated. RESULTS: The ADC(fast) and f showed significant differences between spinal metastasis and tuberculous spondylitis (all p < 0.05). The logistic regression model results showed that ADC(fast) and f were independent factors affecting the outcome (P < 0.05). The AUC values of ADC(fast) and f were 0.823 (95% confidence interval (CI): 0.719 to 0.927) and 0.876 (95%CI: 0.782 to 0.969), respectively. ADC(fast) combined with f showed the highest AUC value of 0.925 (95% CI: 0.858 to 0.992). CONCLUSIONS: IVIM MR imaging might be helpful to differentiate spinal metastasis from tuberculous spondylitis, and provide guidance for clinical treatment.