Mohammad Hossein Daghighi1, Masoud Poureisa1, Mohsen Safarpour1, Razieh Behzadmehr2, Daniel F Fouladi3, Ali Meshkini4, Mojtaba Varshochi5, Ali Kiani Nazarlou1. 1. 1 Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran. 2. 2 Department of Radiology, Zabol University of Medical Sciences, Zabol, Islamic Republic of Iran. 3. 3 Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran. 4. 4 Department of Neurosurgery, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran. 5. 5 Department of Infectious Disease, Sina Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
Abstract
OBJECTIVE: To examine the effect of using different b-values on the utility of diffusion-weighted (DW) MRI in differentiating acute infectious spondylitis from Modic type 1 and the discriminative accuracy of related apparent diffusion coefficient (ADC), claw-sign and amorphous increased signal. METHODS: 43 patients with equivocal diagnosis of acute infectious spondylitis/Modic type 1 by using MR images were prospectively studied. The discriminative accuracy of DW MRI using three b-values of 50, 400, 800 s mm(-2), ADC, claw sign and amorphous increased signal was examined. RESULTS: DW MRI differentiated infectious spondylitis from Modic type 1 change most accurately when a b-value of 800 s mm(-2) was chosen [sensitivity, 91.7%; specificity, 96.8%; positive-predictive value (PPV), 91.7%; negative-predictive value (NPV), 96.8%; and accuracy, 95.3%]. The optimal cut-off ADC value was 1.52 × 10(-3) mm(2) s(-1) (sensitivity, 91.7%; specificity, 100%; PPV, 100%; NPV, 96.9%; and accuracy, 97.7%). Best visualized at a b-value of 50 s mm(-2), claw sign (for degeneration) and amorphous increased signal (for infection) were 100% accurate. CONCLUSION: Should DW MRI be used in differentiating acute infectious spondylitis from degeneration, large b-values are required. With low b-values, however, claw sign and amorphous increased signal are very accurate in this regard. ADVANCES IN KNOWLEDGE: DW MRI using large b-values could be used in differentiating acute infectious spondylitis from Modic type I.
OBJECTIVE: To examine the effect of using different b-values on the utility of diffusion-weighted (DW) MRI in differentiating acute infectious spondylitis from Modic type 1 and the discriminative accuracy of related apparent diffusion coefficient (ADC), claw-sign and amorphous increased signal. METHODS: 43 patients with equivocal diagnosis of acute infectious spondylitis/Modic type 1 by using MR images were prospectively studied. The discriminative accuracy of DW MRI using three b-values of 50, 400, 800 s mm(-2), ADC, claw sign and amorphous increased signal was examined. RESULTS: DW MRI differentiated infectious spondylitis from Modic type 1 change most accurately when a b-value of 800 s mm(-2) was chosen [sensitivity, 91.7%; specificity, 96.8%; positive-predictive value (PPV), 91.7%; negative-predictive value (NPV), 96.8%; and accuracy, 95.3%]. The optimal cut-off ADC value was 1.52 × 10(-3) mm(2) s(-1) (sensitivity, 91.7%; specificity, 100%; PPV, 100%; NPV, 96.9%; and accuracy, 97.7%). Best visualized at a b-value of 50 s mm(-2), claw sign (for degeneration) and amorphous increased signal (for infection) were 100% accurate. CONCLUSION: Should DW MRI be used in differentiating acute infectious spondylitis from degeneration, large b-values are required. With low b-values, however, claw sign and amorphous increased signal are very accurate in this regard. ADVANCES IN KNOWLEDGE: DW MRI using large b-values could be used in differentiating acute infectious spondylitis from Modic type I.
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