European Radiology

, Volume 28, Issue 7, pp 2890–2902 | Cite as

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
  • Wook Jin
  • Sun Hwa Lee
  • So Young Park
  • Chang-Woo Ryu



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)


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 differentiating 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.


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%).


Quantitative assessment of ADC is a useful diagnostic tool for differentiating benign and malignant vertebral BMLs and CFs.

Key Points

• 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.


Meta-analysis Diffusion-weighted MRI Spine Bone marrow neoplasm Compression fracture 



Apparent diffusion coefficient


Bone marrow lesion


Best value comparator


Compression fracture


Diffusion-weighted imaging


Hierarchical summary receiver operating characteristic


Quality Assessment of Diagnostic Accuracy Studies-2



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Seong Jong Yun, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Chong Hyun Suh, MD) has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because the nature of our study was a systemic review and meta-analysis.

Ethical approval

Institutional review board approval was not required because the nature of our study was a systemic review and meta-analysis.


• Meta-analysis performed at one institution

Supplementary material

330_2018_5330_MOESM1_ESM.doc (1.5 mb)
ESM 1 (DOC 1520 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Radiology, Kyung Hee University Hospital at GangdongKyung Hee University School of MedicineSeoulRepublic of Korea
  3. 3.Department of Emergency Medicine, Sanggye Paik HospitalInje University College of MedicineSeoulRepublic of Korea

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