NEURORADIOLOGY Iran J Radiol. 2017 April; 14(2):e42016. Published online 2016 December 6. doi: 10.5812/iranjradiol.42016. Research Article Benign Versus Malignant Vertebral Compression, Chemical Shift MR Imaging, Is It Useful? Gulgun Yilmaz Ovali, 1,* Fatih Düzgün, 1 Mustafa Farasat, 2 and Sebnem Orguc 1 1 Department of Radiology, Medicine School, Celal Bayar University, Manisa, Turkey 2 Manisa Merkez Efendi Goverment Hospital Radiology Department, Manisa, Turkey * Corresponding author: Gulgun Yilmaz Ovali, Radiology Department, Medicine School, Celal Bayar University, Manisa, Turkey. Tel: +90-5327989618, Fax: +90-2362349070, E-mail: gulgunyilmaz@hotmail.com Received 2016 September 02; Revised 2016 October 29; Accepted 2016 November 14. Abstract Objectives: The aim of this study was to evaluate the diagnostic accuracy of chemical shift imaging in vertebral compression. Patients and Methods: Forty-nine patients with vertebral compression with suspected malignancy or history of trauma were in- cluded in this study. MR imaging of the spine with standard conventional MR sequences and additional chemical shift imaging was done with 1.5 Tesla MR Unit. Regions of interest (ROI) were placed on the abnormal marrow of compressed vertebrae both on the opposed phase and on the matching in phase images and signal intensity (SI) ratio values (SI out-phase/SI-in phase) were calculated. Results: Forty-nine patients had 68 spine lesions, consisting of 49 benign and 19 malignant fractures. Student t test, receiver operat- ing characteristic (ROC) analysis and interclass correlation test were used statistically. Mean SI ratio of benign vertebral compression (0. 68 ± 0.29, range 0.13 - 1.53) was significantly lower than malignant SI ratio values (1.06 ± 0.10, range 0.96 - 1.35). With student t-test, there was significant difference between benign compressions compared to malignant compressions (P < 0.001). Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut off value in malignant and benign lesion defi- nition. The optimal SI ratio cut off value was found to be 0.96 for separating benign and malignant vertebral compression. The area under the curve (AUC) value was observed as 0.92 (95% confidence interval [CI] = 0.86 - 0.99). According to that cutoff value, sensi- tivity was 100% (95% CI = 82.35% - 100%) and the specificity was 86% (95% CI = 72.76% - 94.06%). Interobserver reliability was studied with intraclass correlation and results were statistically significant with intraclass correlation coefficient (ICC) as 0.85 (P < 0.05). Conclusions: There is significant difference in signal values between benign and malignant compression fractures in chemical shift MR imaging. Chemical shift MR imaging has much additive data to conventional MRI in vertebral compression. Keywords: Vertebral Compression, Chemical Shift Imaging, Spine, MRI 1. Background Both malignant and benign vertebral compressions may show abnormal signal intensity changes in conven- tional MR images that may be similar and cannot be dif- ferentiated from each other. Normal bone marrow consist- ing of mainly fat should be found in benign compression; whereas, bone marrow infiltration in malignant ones leads to loss of fat. Defining fat in terms of signal loss in chemical shift imaging may differentiate these two entities, which have very different treatment algorithms (1). 2. Objectives In this study, we aimed to evaluate the diagnostic accu- racy of chemical shift imaging in vertebral compression. 3. Patients and Methods 3.1. Patients Forty-nine patients with vertebral compression with suspected malignancy were included in this study. None of the patients received radiotherapy before the study. 3.2. MRI Protocol MR imaging of the spine with standard conventional MR sequences and additional chemical shift imaging was done with 1.5 Tesla MR Unit. Standard conventional MR imaging consisted of T1 and T2 weighted fast spin echo im- ages in the sagittal and axial plane with short inversion time inversion recovery (STIR) images in the sagittal plane. Chemical shift imaging parameters in sagittal plane con- sisted of in phase images with repetition time (TR): 200, echo time (TE): 4.2, fractional anisotropy (FA): 30° and out phase images with TR: 200, TE: 2.1, FA: 30°. The duration of this sequence was only 37 seconds. Copyright © 2016, Tehran University of Medical Sciences and Iranian Society of Radiology. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.