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Objective:

To examine the effect of using different b-values on the utility of diffusion-weighted (DW) MRI in differentiating acute infectious spondylitis from Modic type 1 and the discriminative accuracy of related apparent diffusion coefficient (ADC), claw-sign and amorphous increased signal.

Methods:

43 patients with equivocal diagnosis of acute infectious spondylitis/Modic type 1 by using MR images were prospectively studied. The discriminative accuracy of DW MRI using three b-values of 50, 400, 800 s mm−2, ADC, claw sign and amorphous increased signal was examined.

Results:

DW MRI differentiated infectious spondylitis from Modic type 1 change most accurately when a b-value of 800 s mm−2 was chosen [sensitivity, 91.7%; specificity, 96.8%; positive-predictive value (PPV), 91.7%; negative-predictive value (NPV), 96.8%; and accuracy, 95.3%]. The optimal cut-off ADC value was 1.52 × 10−3 mm2 s−1 (sensitivity, 91.7%; specificity, 100%; PPV, 100%; NPV, 96.9%; and accuracy, 97.7%). Best visualized at a b-value of 50 s mm−2, claw sign (for degeneration) and amorphous increased signal (for infection) were 100% accurate.

Conclusion:

Should DW MRI be used in differentiating acute infectious spondylitis from degeneration, large b-values are required. With low b-values, however, claw sign and amorphous increased signal are very accurate in this regard.

Advances in knowledge:

DW MRI using large b-values could be used in differentiating acute infectious spondylitis from Modic type I.

© 2016 The Authors. Published by the British Institute of Radiology
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://dbpia.nl.go.kr/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
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