• Jibin Cao, Sijia Gao, Chenying Zhang, Yinxia Zhang, Wenge Sun, and Lingling Cui.
• Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China.
• Eur Spine J. 2020 Dec 1; 29 (12): 3187-3193.

PurposeSome atypical vertebral hemangiomas (VHs) may mimic metastases on routine MRI and can result in misdiagnosis and ultimately to additional imaging, biopsy and unnecessary costs. The purpose of this study is to assess the utility of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) on account of field-of-view optimized and constrained undistorted single shot (FOCUS) in distinguishing atypical VHs and vertebral metastases.MethodsA total of 25 patients with vertebral metastases and 25 patients with atypical VHs were confirmed by clinical follow-up or pathology. IVIM-DWI imaging was performed at different b values (0, 30, 50, 100, 150, 200, 400, 600, 800, 1000 mm2/s). IVIM parameters [the true diffusion coefficient (D), pseudodiffusion coefficient (D*), standard apparent diffusion coefficient (ADC), and perfusion fraction (f)] were calculated and compared between two groups by using Student's t test. A receiver operating characteristic analysis was performed.ResultsQuantitative analysis of standard ADC and D parameters showed significantly lower values in vertebral metastases when compared to atypical hemangiomas [ADC value: (0.70 ± 0.12) × 10-3 mm2/s vs (1.14 ± 0.28) × 10-3 mm2/s; D value: (0.47 ± 0.07) × 10-3 mm2/s vs (0.76 ± 0.14) × 10-3 mm2/s, all P < 0.01]. The sensitivity and specificity of D value were 93.8% and 92.3%, respectively.ConclusionThe standard ADC value and D value may be used as an indicator to distinguish vertebral metastases from atypical VHs. FOCUS IVIM-derived parameters provide potential value in the quantitatively differentiating vertebral metastases from vertebral atypical hemangiomas.

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