The first article to describe the use of DW imaging for differentiating benign from malignant vertebral compression fractures was written by Baur et al (4) in 1998 and elicited controversy. In that article, 22 benign and 17 pathologic fractures were correctly diagnosed and showed low and high signal intensity on DW images, respectively, when compared with other vertebrae that were assumed to be normal. The authors used a steady-state free precession (SSFP) sequence with a low b value (165 s/mm2), because it resulted in optimal signal-to-noise ratio and because they believed that increasing the b value resulted in a drop of signal intensity and provided no greater diffusion-related information. The authors concluded that the tumor packing present in pathologic fractures led to restriction of water diffusion and thus high signal intensity on DW images.
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