Top

Published in:

01-06-2011 | Review Article

Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review

Authors: Michael M. Y. Khoo, Philippa A. Tyler, Asif Saifuddin, Anwar R. Padhani

Published in: Skeletal Radiology | Issue 6/2011

Abstract

Magnetic resonance imaging (MRI) is the mainstay of diagnosis, staging and follow-up of much musculoskeletal pathology. Diffusion-weighted magnetic resonance imaging (DWI) is a recent addition to the MR sequences conventionally employed. DWI provides qualitative and quantitative functional information concerning the microscopic movements of water at the cellular level. A number of musculoskeletal disorders have been evaluated by DWI, including vertebral fractures, bone marrow infection, bone marrow malignancy, primary bone and soft tissue tumours; post-treatment follow-up has also been assessed. Differentiation between benign and malignant vertebral fractures by DWI and monitoring of therapy response have shown excellent results. However, in other pathologies, such as primary soft tissue tumours, DWI data have been inconclusive in some cases, contributing little additional information beyond that gained from conventional MR sequences. The aim of this article is to critically review the current literature on the contribution of DWI to musculoskeletal MRI.

Schaefer PW, Copen WA, Lev MH, Gonzalez RG. Diffusion-weighted imaging in acute stroke. Magn Reson Imaging Clin N Am. 2006;14(2):141–68.PubMedCrossRef

Karaarslan E, Arslan A. Diffusion weighted MR imaging in non-infarct lesions of the brain. Eur J Radiol. 2008;65(3):402–16.PubMedCrossRef

Baur A, Stäbler A, Brüning R, Bartl R, Krödel A, Reiser M, et al. Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures. Radiology. 1998;207(2):349–56.PubMed

Byun WM, Shin SO, Chang Y, Lee SJ, Finsterbusch J, Frahm J. Diffusion-weighted MR imaging of metastatic disease of the spine: assessment of response to therapy. AJNR Am J Neuroradiol. 2002;23(6):906–12.PubMed

Bley TA, Wieben O, Uhl M. Diffusion-weighted MR imaging in musculoskeletal radiology: applications in trauma, tumors, and inflammation. Magn Reson Imaging Clin N Am. 2009;17(2):263–75.PubMedCrossRef

Turner R, Le Bihan D, Maier J, Vavrek R, Hedges LK, Pekar J. Echo-planar imaging of intravoxel incoherent motion. Radiology. 1990;177(2):407–14.PubMed

Le Bihan D, Turner R, Douek P, Patronas N. Diffusion MR imaging: clinical applications. AJR Am J Roentgenol. 1992;159(3):591–9.PubMed

Raya JG, Dietrich O, Reiser MF, Baur-Melnyk A. Methods and applications of diffusion imaging of vertebral bone marrow. J Magn Reson Imaging. 2006;24(6):1207–20.PubMedCrossRef

Karchevsky M, Babb JS, Schweitzer ME. Can diffusion-weighted imaging be used to differentiate benign from pathologic fractures? A meta-analysis. Skeletal Radiol. 2008;37(9):791–5.PubMedCrossRef

10.

Padhani AR, Liu G, Koh DM, Chenevert TL, Thoeny HC, Takahara T, et al. Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia. 2009;11(2):102–25.PubMed

11.

Nonomura Y, Yasumoto M, Yoshimura R, Haraguchi K, Ito S, Akashi T, et al. Relationship between bone marrow cellularity and apparent diffusion coefficient. J Magn Reson Imaging. 2001;13(5):757–60.PubMedCrossRef

12.

Tang GY, Lv ZW, Tang RB, Liu Y, Peng YF, Li W, et al. Evaluation of MR spectroscopy and diffusion-weighted MRI in detecting bone marrow changes in postmenopausal women with osteoporosis. Clin Radiol. 2010;65(5):377–81.PubMedCrossRef

13.

Galbán CJ, Chenevert TL, Meyer CR, Tsien C, Lawrence TS, Hamstra DA, et al. The parametric response map is an imaging biomarker for early cancer treatment outcome. Nat Med. 2009;15(5):572–6.PubMedCrossRef

14.

Reischauer C, Froehlich JM, Koh D, Graf N, Padevit C, John H, et al. Bone metastases from prostate cancer: assessing treatment response by using diffusion-weighted imaging and functional diffusion maps–initial observations. Radiology. 2010;257(2):523–31.PubMedCrossRef

15.

Fischer MA, Nanz D, Hany T, Reiner CS, Stolzmann P, Donati OF, et al. Diagnostic accuracy of whole-body MRI/DWI image fusion for detection of malignant tumours: a comparison with PET/CT. Eur Radiol [Epub ahead of print]. doi:10.1007/s00330-010-1929-x

16.

Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M. Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med. 2004;22(4):275–82.PubMed

17.

Kwee TC, Takahara T, Ochiai R, Katahira K, Van Cauteren M, Imai Y, et al. Whole-body diffusion-weighted magnetic resonance imaging. Eur J Radiol. 2009;70(3):409–17.PubMedCrossRef

18.

Gutzeit A, Doert A, Froehlich JM, Eckhardt BP, Meili A, Scherr P, et al. Comparison of diffusion-weighted whole body MRI and skeletal scintigraphy for the detection of bone metastases in patients with prostate or breast carcinoma. Skeletal Radiol. 2010;39(4):333–43.PubMedCrossRef

19.

Baur A, Huber A, Ertl-Wagner B, Dürr R, Zysk S, Arbogast S, et al. Diagnostic value of increased diffusion weighting of a steady-state free precession sequence for differentiating acute benign osteoporotic fractures from pathologic vertebral compression fractures. AJNR Am J Neuroradiol. 2001;22(2):366–72.PubMed

20.

Spuentrup E, Buecker A, Adam G, van Vaals JJ, Guenther RW. Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body. Am J Roentgenol. 2001;176(2):351–8.

21.

Byun WM, Jang HW, Kim SW, Jang SH, Ahn SH, Ahn MW. Diffusion-weighted magnetic resonance imaging of sacral insufficiency fractures: comparison with metastases of the sacrum. Spine. 2007;32(26):E820–824.PubMedCrossRef

22.

Castillo M, Arbelaez A, Smith JK, Fisher LL. Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases. AJNR Am J Neuroradiol. 2000;21(5):948–53.PubMed

23.

Baur A, Dietrich O, Reiser M. Diffusion-weighted imaging of the spinal column. Neuroimaging Clin N Am. 2002;12(1):147–60.PubMedCrossRef

24.

Baur A, Dietrich O, Reiser M. Diffusion-weighted imaging of bone marrow: current status. Eur Radiol. 2003;13(7):1699–708.PubMedCrossRef

25.

Chan JHM, Peh WCG, Tsui EYK, Chau LF, Cheung KK, Chan KB, et al. Acute vertebral body compression fractures: discrimination between benign and malignant causes using apparent diffusion coefficients. Br J Radiol. 2002;75(891):207–14.PubMed

26.

Pui MH, Mitha A, Rae WID, Corr P. Diffusion-weighted magnetic resonance imaging of spinal infection and malignancy. J Neuroimaging. 2005;15(2):164–70.PubMed

27.

Baur A, Huber A, Dürr HR, Nikolaou K, Stäbler A, Deimling M, et al. Differentiation of benign osteoporotic and neoplastic vertebral compression fractures with a diffusion-weighted, steady-state free precession sequence. Rofo. 2002;174(1):70–5.PubMed

28.

Bhugaloo A, Abdullah B, Siow Y, Kh N. Diffusion weighted MR imaging in acute vertebral compression fractures: differentiation between malignant and benign causes. Biomed Imaging Interv J. 2006;2(2):e12.

29.

Park S, Lee J, Ehara S, Park Y, Sung SO, Choi J, et al. Single shot fast spin echo diffusion-weighted MR imaging of the spine: is it useful in differentiating malignant metastatic tumor infiltration from benign fracture edema? Clin Imaging. 2004;28(2):102–8.PubMedCrossRef

30.

Jung H, Jee W, McCauley TR, Ha K, Choi K. Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics. 2003;23(1):179–87.PubMedCrossRef

31.

An HS, Andreshak TG, Nguyen C, Williams A, Daniels D. Can we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging? Spine. 1995;20(16):1776–82.PubMedCrossRef

32.

Shih TT, Huang KM, Li YW. Solitary vertebral collapse: distinction between benign and malignant causes using MR patterns. J Magn Reson Imaging. 1999;9(5):635–42.PubMedCrossRef

33.

Frager D, Elkin C, Swerdlow M, Bloch S. Subacute osteoporotic compression fracture: misleading magnetic resonance appearance. Skeletal Radiol. 1988;17(2):123–6.PubMedCrossRef

34.

Cuénod CA, Laredo JD, Chevret S, Hamze B, Naouri JF, Chapaux X, et al. Acute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced and gadolinium-enhanced MR images. Radiology. 1996;199(2):541–9.PubMed

35.

Herneth AM, Friedrich K, Weidekamm C, Schibany N, Krestan C, Czerny C, et al. Diffusion weighted imaging of bone marrow pathologies. Eur J Radiol. 2005;55(1):74–83.PubMedCrossRef

36.

Stäbler A, Baur A, Krüger A, Weiss M, Helmberger T, Reiser M. Differential diagnosis of erosive osteochondrosis and bacterial spondylitis: magnetic resonance tomography (MRT). Rofo. 1998;168(5):421–8.PubMed

37.

Yasumoto M, Nonomura Y, Yoshimura R, Haraguchi K, Ito S, Ohashi I, et al. MR detection of iliac bone marrow involvement by malignant lymphoma with various MR sequences including diffusion-weighted echo-planar imaging. Skeletal Radiol. 2002;31(5):263–9.PubMedCrossRef

38.

Lin C, Itti E, Luciani A, Haioun C, Meignan M, Rahmouni A. Whole-body diffusion-weighted imaging in lymphoma. Cancer Imaging. 2010;10:S172–178.PubMedCrossRef

39.

Ballon D, Dyke J, Schwartz LH, Lis E, Schneider E, Lauto A, et al. Bone marrow segmentation in leukemia using diffusion and T (2) weighted echo planar magnetic resonance imaging. NMR Biomed. 2000;13(6):321–8.PubMedCrossRef

40.

van Rijswijk CSP, Kunz P, Hogendoorn PCW, Taminiau AHM, Doornbos J, Bloem JL. Diffusion-weighted MRI in the characterization of soft-tissue tumors. J Magn Reson Imaging. 2002;15(3):302–7.PubMedCrossRef

41.

Einarsdóttir H, Karlsson M, Wejde J, Bauer H. Diffusion-weighted MRI of soft tissue tumours. Eur Radiol. 2004;14(6):959–63.PubMedCrossRef

42.

Nagata S, Nishimura H, Uchida M, Sakoda J, Tonan T, Hiraoka K, et al. Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis. Radiat Med. 2008;26(5):287–95.PubMedCrossRef

43.

Maeda M, Matsumine A, Kato H, Kusuzaki K, Maier SE, Uchida A, et al. Soft-tissue tumors evaluated by line-scan diffusion-weighted imaging: influence of myxoid matrix on the apparent diffusion coefficient. J Magn Reson Imaging. 2007;25(6):1199–204.PubMedCrossRef

44.

Oka K, Yakushiji T, Sato H, Yorimitsu S, Hayashida Y, Yamashita Y, et al. Ability of diffusion-weighted imaging for the differential diagnosis between chronic expanding hematomas and malignant soft tissue tumors. J Magn Reson Imaging. 2008;28(5):1195–200.PubMedCrossRef

45.

Dudeck O, Zeile M, Pink D, Pech M, Tunn P, Reichardt P, et al. Diffusion-weighted magnetic resonance imaging allows monitoring of anticancer treatment effects in patients with soft-tissue sarcomas. J Magn Reson Imaging. 2008;27(5):1109–13.PubMedCrossRef

46.

Baur A, Huber A, Arbogast S, Dürr HR, Zysk S, Wendtner C, et al. Diffusion-weighted imaging of tumor recurrencies and posttherapeutical soft-tissue changes in humans. Eur Radiol. 2001;11(5):828–33.PubMedCrossRef

47.

Murphey MD, Flemming DJ, Boyea SR, Bojescul JA, Sweet DE, Temple HT. Enchondroma versus chondrosarcoma in the appendicular skeleton: differentiating features. Radiographics. 1998;18(5):1213–37.PubMed

48.

Hayashida Y, Hirai T, Yakushiji T, Katahira K, Shimomura O, Imuta M, et al. Evaluation of diffusion-weighted imaging for the differential diagnosis of poorly contrast-enhanced and T2-prolonged bone masses: initial experience. J Magn Reson Imaging. 2006;23(3):377–82.PubMedCrossRef

49.

Franzius C, Sciuk J, Daldrup-Link HE, Jürgens H, Schober O. FDG-PET for detection of osseous metastases from malignant primary bone tumours: comparison with bone scintigraphy. Eur J Nucl Med. 2000;27(9):1305–11.PubMedCrossRef

50.

Daldrup-Link HE, Franzius C, Link TM, Laukamp D, Sciuk J, Jürgens H, et al. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol. 2001;177(1):229–36.PubMed

51.

Picci P, Bacci G, Campanacci M, Gasparini M, Pilotti S, Cerasoli S, et al. Histologic evaluation of necrosis in osteosarcoma induced by chemotherapy. Regional mapping of viable and nonviable tumor. Cancer. 1985;56(7):1515–21.PubMedCrossRef

52.

Uhl M, Saueressig U, Koehler G, Kontny U, Niemeyer C, Reichardt W, et al. Evaluation of tumour necrosis during chemotherapy with diffusion-weighted MR imaging: preliminary results in osteosarcomas. Pediatr Radiol. 2006;36(12):1306–11.PubMedCrossRef

53.

Uhl M, Saueressig U, van Buiren M, Kontny U, Niemeyer C, Köhler G, et al. Osteosarcoma: preliminary results of in vivo assessment of tumor necrosis after chemotherapy with diffusion- and perfusion-weighted magnetic resonance imaging. Invest Radiol. 2006;41(8):618–23.PubMedCrossRef

54.

Hayashida Y, Yakushiji T, Awai K, Katahira K, Nakayama Y, Shimomura O, et al. Monitoring therapeutic responses of primary bone tumors by diffusion-weighted image: initial results. Eur Radiol. 2006;16(12):2637–43.PubMedCrossRef

55.

Oka K, Yakushiji T, Sato H, Hirai T, Yamashita Y, Mizuta H. The value of diffusion-weighted imaging for monitoring the chemotherapeutic response of osteosarcoma: a comparison between average apparent diffusion coefficient and minimum apparent diffusion coefficient. Skeletal Radiol. 2010;39(2):141–6.PubMedCrossRef

56.

Fletcher BD, Wall JE, Hanna SL. Effect of hematopoietic growth factors on MR images of bone marrow in children undergoing chemotherapy. Radiology. 1993;189(3):745–51.PubMed

57.

Ballon D, Watts R, Dyke JP, Lis E, Morris MJ, Scher HI, et al. Imaging therapeutic response in human bone marrow using rapid whole-body MRI. Magn Reson Med. 2004;52(6):1234–8.PubMedCrossRef

58.

Oner AY, Tali T, Celikyay F, Celik A, Le Roux P. Diffusion-weighted imaging of the spine with a non-carr-purcell-meiboom-gill single-shot fast spin-echo sequence: initial experience. AJNR Am J Neuroradiol. 2007;28(3):575–80.PubMed

59.

Tang G, Liu Y, Li W, Yao J, Li B, Li P. Optimization of b value in diffusion-weighted MRI for the differential diagnosis of benign and malignant vertebral fractures. Skeletal Radiol. 2007;36(11):1035–41.PubMedCrossRef

60.

Zhou XJ, Leeds NE, McKinnon GC, Kumar AJ. Characterization of benign and metastatic vertebral compression fractures with quantitative diffusion MR imaging. AJNR Am J Neuroradiol. 2002;23(1):165–70.PubMed

61.

Raya JG, Dietrich O, Birkenmaier C, Sommer J, Reiser MF, Baur-Melnyk A. Feasibility of a RARE-based sequence for quantitative diffusion-weighted MRI of the spine. Eur Radiol. 2007;17(11):2872–9.PubMedCrossRef

62.

Herneth AM, Naude J, Philipp M, Beichel R, Trattnig S, Imhof H. The value of diffusion-weighted MRT in assessing the bone marrow changes in vertebral metastases. Radiologe. 2000;40(8):731–6.PubMedCrossRef

63.

Herneth AM, Philipp MO, Naude J, Funovics M, Beichel RR, Bammer R, et al. Vertebral metastases: assessment with apparent diffusion coefficient. Radiology. 2002;225(3):889–94.PubMedCrossRef

64.

Balliu E, Vilanova JC, Peláez I, Puig J, Remollo S, Barceló C, et al. Diagnostic value of apparent diffusion coefficients to differentiate benign from malignant vertebral bone marrow lesions. Eur J Radiol. 2009;69(3):560–6.PubMedCrossRef

Title: Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review
Authors: Michael M. Y. Khoo
Philippa A. Tyler
Asif Saifuddin
Anwar R. Padhani
Publication date: 01-06-2011
Publisher: Springer-Verlag
Published in: Skeletal Radiology / Issue 6/2011
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-011-1106-6

At a glance: The STEP trials

Springer Medicine

Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2011

Meniscal T1rho and T2 measured with 3.0T MRI increases directly after running a marathon

Lumbar spondylolysis: a review

MRI of broken bioabsorbable crosspin fixation in hamstring graft reconstruction of the anterior cruciate ligament

Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears?

Monitoring anti-interleukin 6 receptor antibody treatment for rheumatoid arthritis by quantitative magnetic resonance imaging of the hand and power Doppler ultrasonography of the finger

Browser’s Notes