The Role of Susceptibility Weighted Magnetic Resonance Imaging in Differentiation between Lytic and Sclerotic Spine Metastatic Bone Lesions

Background: About 30–70% of the diseased patients due to cancer have spinal metastases at postmortem examination and about 14% of the patients with spinal metastases will develop symptomatic lesions during their illness. The morbidity associated with metastatic spinal disease is significant. Aim and objectives: To evaluate the diagnostic performance of susceptibility-weighted magnetic resonance imaging (SWMR) for the differentiation between lytic and sclerotic spine metastatic bone lesions compared to compute tomography (CT). Subjects and methods: A prospective comparative study was conducted at the Diagnostic Radiology department, Suez Canal University hospital, Ismailia, Egypt, including 84 participants. Results: Our study showed a promising diagnostic performance of different MRI techniques including the newly introduced susceptibility weighted MRI sequence for identification of lytic bony lesions with a diagnostic accuracy of 96.43%, sensitivity of 100%, specificity of 92.31%, and positive predictive value of 93.75% and negative predictive value of 100%. The study showed impressive diagnostic performance of different MRI techniques
including the susceptibility weighted sequence for detection of sclerotic bony lesions with a diagnostic accuracy of 89.29%, sensitivity of 90.91%, specificity of 88.24%, and positive predictive value of 83.33% and negative predictive value of 93.75%. We found that using either inverted magnitude MRI sequence alone, phase contrast MRI sequence alone or combining both techniques resulted in similar diagnostic performance with diagnostic accuracy of 89.29%, sensitivity of 90.91%, specificity of 88.24%, positive predictive value of
83.33%, and negative predictive value of 93.75%. Conclusion: we concluded that the susceptibility weighted MRI enables proper differentiation between lytic and sclerotic bony lesions with higher sensitivity and specificity compared to conventional MRI sequences