ACCURACY OF MAGNETIC RESONANCE IMAGING IN DIAGNOSIS OF VERTEBRAL LESIONS COMPARED TO PERCUTANEOUS BIOPSY

Objective: To evaluate the accuracy, sensitivity, and specificity of various MRI features in diagnosis of neoplastic and non neoplastic vertebral lesions including vertebral compression fractures caused by malignancy, osteoporosis, or infection, in correlation with true cut biopsy. Methods: Retrospective review of MRI spine images of (28) patients (18 males and 10 females), age ranged 22 to 80 years (mean: 52.8?14.07 years), who had vertebral lesions and compression fractures, sent by their neurosurgeon and musculoskeletal specialists for a diagnostic CT guided per-cutaneous biopsy between January 2013 to September 2013 to be carried out by a specialist expert radiologist. The MRI features are assessed and the sensitivity, specificity, and accuracy for each MRI feature was calculated and compared to histopathological results. Results: Eighteen out of 28 patients had malignant vertebral lesions and 10 patients had benign vertebral lesions 5 patients had osteoporotic compression fracture and 5 had infection. MRI features suggestive of malignant lesions were diffuse replacement of bone marrow signal in the affected vertebra convex posterior border pedicle and posterior neural element involvement an epidural mass a paraspinal mass and multifocal vertebral lesions. MRI features suggestive of osteoporotic fractures are, fluid sign a low signal intensity band retropulsion and spared normal marrow signal intensity. MRI features suggestive of infective lesions are, end plate disruption disc involvement contiguous vertebral involvement paraspinal abscesses and epidural abscesses. The overall sensitivity, specificity, and accuracy of MRI features were (94.4%, 100% and 96.4%) respectively as compared to percutaneous biopsy results. Vertebral morphology as vertebral body expansion is specific but non sensitive for malignant lesions while compression fracture, focal abnormal signal intensity , and contrast enhancement are not useful for differentiation benign from malignant vertebral lesions. Conclusion: Certain MRI features can accurately distinguish malignant from benign vertebral lesions and compression fracture.