ADC as a useful diagnostic tool for differentiating benign and malignant
vertebral bone marrow lesions and compression fractures: a systematic
review and meta-analysis
Chong Hyun Suh
Seong Jong Yun
Sun Hwa Lee
So Young Park
Received: 6 December 2017 /Revised: 10 January 2018 /Accepted: 12 January 2018 / Published online: 15 February 2018
European Society of Radiology 2018
Objectives To assess the sensitivity and specificity of quantitative assessment of the apparent diffusion coefficient (ADC) for
differentiating benign and malignant vertebral bone marrow lesions (BMLs) and compression fractures (CFs)
Methods An electronic literature search of MEDLINE and EMBASE was conducted. Bivariate modelling and hierarchical
summary receiver operating characteristic modelling were performed to evaluate the diagnostic performance of ADC for differ-
entiating vertebral BMLs. Subgroup analysis was performed for differentiating benign and malignant vertebral CFs. Meta-
regression analyses according to subject, study and diffusion-weighted imaging (DWI) characteristics were performed.
Results Twelve eligible studies (748 lesions, 661 patients) were included. The ADC exhibited a pooled sensitivity of 0.89 (95%
confidence interval [CI] 0.80–0.94) and a pooled specificity of 0.87 (95% CI 0.78–0.93) for differentiating benign and malignant
vertebral BMLs. In addition, the pooled sensitivity and specificity for differentiating benign and malignant CFs were 0.92 (95%
CI 0.82–0.97) and 0.91 (95% CI 0.87–0.94), respectively. In the meta-regression analysis, the DWI slice thickness was a
significant factor affecting heterogeneity (p < 0.01); thinner slice thickness (< 5 mm) showed higher specificity (95%) than
thicker slice thickness (81%).
Conclusions Quantitative assessment of ADC is a useful diagnostic tool for differentiating benign and malignant vertebral BMLs
• Quantitative assessment of ADC is useful in differentiating vertebral BMLs.
• Quantitative ADC assessment for BMLs had sensitivity of 89%, specificity of 87%.
• Quantitative ADC assessment for CFs had sensitivity of 92%, specificity of 91%.
• The specificity is highest (95%) with thinner (< 5 mm) DWI slice thickness.
Bone marrow neoplasm
ADC Apparent diffusion coefficient
BML Bone marrow lesion
BVC Best value comparator
CF Compression fracture
DWI Diffusion-weighted imaging
HSROC Hierarchical summary receiver
QUADAS-2 Quality Assessment of Diagnostic
Differentiating between benign and malignant vertebral mar-
row pathologies is challenging because fractures of both
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00330-018-5330-5) contains supplementary
material, which is available to authorized users.
* Seong Jong Yun
Department of Radiology and Research Institute of Radiology, Asan
Medical Center, University of Ulsan College of Medicine, 88
Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
Department of Radiology, Kyung Hee University Hospital at
Gangdong, Kyung Hee University School of Medicine, 891
Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
Department of Emergency Medicine, Sanggye Paik Hospital, Inje
University College of Medicine, 1342 Dongil-ro, Nowon-gu,
Seoul 01757, Republic of Korea
European Radiology (2018) 28:2890–2902