Enhancing Injury Diagnosis in Athletes: The Role of DWI in Differentiating Vertebral Fractures

Abstract

Objective: To evaluate the utility of Diffusion-Weighted Imaging (DWI) using a 1.5T MRI in differentiating benign from malignant vertebral fractures in athletes, providing a reliable diagnostic tool that enhances decision-making in sports medicine. Methods: This study analyzed 106 fractured vertebral bodies imaged by conventional magnetic resonance and diffusion-weighted sequences. The cohort included 44 benign fractures, typically seen in sports-related injuries, and 62 malignant fractures. We compared the signal intensity (SI), bone marrow contrast ratio (R), and Apparent Diffusion Coefficient (ADC) values between the groups, utilizing Receiver Operating Characteristic (ROC) analysis to determine the diagnostic efficacy. Results: The ADC value calculated with b-values of 50 and 400 s/mm ² (ADC50-400) demonstrated the highest Area Under the Curve (AUC) of 0.956, suggesting superior diagnostic performance. A threshold of ADC50-400 ≤1.337×10^-3 mm²/s achieved high diagnostic accuracy for differentiating malignant from benign vertebral fractures, with a sensitivity of 96.8% and a specificity of 86.4%. Benign fractures showed significantly higher ADC50-400 values (1.928×10^-3 mm²/s) compared to malignant fractures (0.832×10^-3 mm²/s, p<0.05). SI and R values at 800 ms delay (SIA800 and R800) also exhibited high diagnostic value (AUCs of 0.894 and 0.858, respectively). Conclusion: DWI, particularly the ADC50-400 measurement, provides a highly effective means of differentiating between benign and malignant vertebral fractures. This capability is crucial in sports medicine, where accurate and rapid diagnosis of spinal injuries can dictate treatment strategies and impact an athlete’s return-to-play decisions. The findings support the incorporation of DWI in routine evaluations of athletes with suspected vertebral fractures to ensure optimal management and rehabilitation planning.