Accuracy of diffusion-weighted imaging in discriminating atypical vertebral haemangiomas from malignant masses in patients with vertebral lesions: a cross-sectional study

Purpose
Vertebral haemangiomas are incidental findings in imaging modalities. Atypical haemangiomas are haeman­giomas rich in vascular tissue, and they are found to be hypointense in T1 sequences and hyperintense in T2 sequences, mimicking the findings of metastatic lesions. In the present study we aim to evaluate the ability of diffusion- weighted imaging to differentiate these two groups of vertebral lesions.

Material and methods
In the present cross-sectional study, a total of 23 lesions were included, including 10 haemangiomas and 13 malignant lesions. Diffusion-weighted imaging was used to compare atypical haemangiomas and metastatic lesions. The apparent diffusion co-efficient was determined for each lesion, and then the mean of each group was calculated. The means were then compared. Receiver operating characteristic analysis was used to determine a cut-off ADC value to differentiate these lesions.

Results
The difference between the mean age of the two groups was not significant. The mean ADC value for atypical haemangiomas was 1884 ± 74 × 10-6 mm²/s and 1008 ± 81 × 10-6 mm²/s for the malignant lesions. The difference between the two groups was statistically significant (p < 10-3). ROC curve analysis determined an ADC value of 958 × 10-6 mm²/s to be able to differentiate between atypical haemangiomas and malignant lesions.

Conclusions
Diffusion-weighted MRI could be used to differentiate between atypical haemangiomas and malignant metastatic lesions.