This prospective study was conducted in the Diagnostic and Interventional Radiology Department in our institution over the last 1.5 years (January 2021–June 2022). Informed written consents were obtained from all patients included in this study. Personal privacy was respected in all levels of this study.
Fifty patients with spinal lesions were included in this study. Inclusion criteria: any patient with spinal lesion detected by conventional MRI.
Exclusion criteria: patients having contraindication to MRI study (as those with cochlear implant, cardiac pace-maker, any metallic stent, claustrophobia and morbid obesity) and operated spinal lesions. Also, patients with vertebral lesions were excluded.
Pre- and post-contrast MRI was done with diffusion-weighted images, apparent diffusion coefficient value (ADC), and perfusion weighted images with analysis of the shape of the curve and the rCBV were analyzed. Pathology of neoplastic lesions was standard of our study.
The images were interpreted by two neuro-radiologists of 10 and 15 years’ experience at the way of conjoint reading.
Examination of all patients was done by 1.5 T MRI (Philips Ingenia and Siemens Magnetom Aera).
Conventional MRI
MRI parameters included: FOV 250 mm, with 0.3 mm gap, 256 × 256 acquisition matrix and slice thickness of 1 mm. The sequences were as follow: For each sequence T2 spin echo (axial and sagittal) with 3500 ms TR, 88 ms TE, and acquisition time was 2 min 35 s. T1 spin echo (pre- and post-contrast sagittal imaging) with 640 ms TR, 10 ms TE, and acquisition time was 3 min 23 s.
Perfusion images
A single shot, gradient-echo, echo-planar imaging sequence was used to get dynamic T2* perfusion. During the first pass of contrast, FOV was 250 mm; TR/TE is 1520/32 ms; flip angle of 80°; matrix was 96 × 128; 10 mm thickness mid-sagittal slice; 50 scans. The contrast dose was calculated at 0.1 mmol/kg for 20 ml maximum. The total contrast was delivered with 5 ml/s rate.
A specific software package is used to assess the results of the post-processing (syngo neuro perfusion evaluation). The lesions and normal cord were used to produce perfusion mean curves in distinct regions of interest (ROIs). After that, comparison curves were created.
Diffusion-weighted imaging and ADC value
A single shot spin echo sequence which is multi-section with diffusion sensitivities of 0, 500, and 1000 s/mm2 was used to acquire DW-MRI. The gradient of diffusion was done in three orthogonal directions consecutively (TR/TE was 1600/95 ms), and the matrix was (176 256), (6 mm) thickness, (1 mm) gap, (40 20) FOV, and a conventional spinal surface coil was used.
The ADC maps were generated automatically, and circular ROIs of 10 mm diameter were put in the lesion's center to produce ADC values with B values of 1000 s/mm2.
Statistical analysis
The collected data were coded, processed, and analyzed using the SPSS (Statistical Package for Social Sciences) version 15 for Windows® (SPSS Inc, Chicago, IL, USA). Qualitative data was presented as number and percent. Comparison between groups was done by Chi-Square test. Quantitative data was tested for normality by Kolmogorov–Smirnov test. Normally distributed data was presented as mean ± SD. Nonparametric data was presented as min–max and median. Mann–Whitney test was used for comparison between groups. P < 0.05 was statistically significant.