OBJECTIVES We sought to determine the added value of diffusion-weighted magnetic resonance imaging (DWI) in the differentiation of pelvic insufficiency fracture (PIF) from bone metastasis after radiotherapy in cervical cancer patients. METHODS In the present study, 42 cervical cancer patients after radiotherapy with 61 bone lesions (n = 40, PIFs; n = 21, bone metastasis) were included. Conventional MRI and DWI were performed in all patients. For qualitative imaging diagnosis, two sets of images were reviewed independently by three observers, including a conventional MRI set (unenhanced T1-weighted, T2-weighted, and enhanced T1-weighted images) and a DWI set (conventional MRIs, DW images, and ADC maps). The mean ADC value of each lesson was measured on ADC maps. The diagnostic performance was assessed by using the area under the receiver operating characteristic curve (Az), and sensitivity and specificity were determined. RESULTS For all observers, the Az value and sensitivity of the DWI set showed improvement compared with the conventional MRI set. The observer who had the least experience (3 years) demonstrated significant improvement in diagnostic performance with the addition of DWI; Az value increased from 0.804 to 0.915 (p = 0.042) and sensitivity increased from 75.0 to 92.5% (p = 0.035). The mean ADCs of the PIFs were significantly higher than the bone metastases (p < 0.001); ADC values > 0.97 × 10-3 mm2/s yielded an Az of 0.887, a sensitivity of 92.5%, and a specificity of 76.2%. CONCLUSIONS The addition of DWI to conventional MRI improved the differentiation of PIF from bone metastasis after RT in patients with cervical cancer. KEY POINTS • DWI showed additive value to conventional MRI in the differentiation of PIF from bone metastasis after RT. • For qualitative diagnosis, the addition of DWI can improve diagnostic performance compared with conventional MRI alone and can particularly improve the sensitivity. • Quantitative ADC assessment showed potential value for identifying PIF from bone metastasis.

中文翻译：

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宫颈癌放疗后骨盆不全骨折或骨转移？DWI 用于表征的附加值。

目的 我们试图确定弥散加权磁共振成像 (DWI) 在鉴别宫颈癌患者放疗后骨盆功能不全骨折 (PIF) 与骨转移方面的附加值。方法 在本研究中，纳入了 42 例放疗后有 61 个骨病变的宫颈癌患者（n = 40，PIFs；n = 21，骨转移）。所有患者均进行常规 MRI 和 DWI。对于定性成像诊断，三名观察者独立审查了两组图像，包括常规 MRI 集（未增强的 T1 加权、T2 加权和增强的 T1 加权图像）和 DWI 集（常规 MRI、DW 图像和ADC 地图）。每节课的平均 ADC 值是在 ADC 地图上测量的。通过使用接受者操作特征曲线 (Az) 下的面积评估诊断性能，并确定灵敏度和特异性。结果 对于所有观察者而言，与传统 MRI 装置相比，DWI 装置的 Az 值和灵敏度均有所改善。经验最少（3 年）的观察者在添加 DWI 后表现出显着的诊断性能改善；Az 值从 0.804 增加到 0.915 (p = 0.042)，灵敏度从 75.0 增加到 92.5% (p = 0.035)。PIF 的平均 ADC 显着高于骨转移 (p < 0.001)；ADC 值 > 0.97 × 10-3 mm2/s 产生的 Az 为 0.887，灵敏度为 92.5%，特异性为 76.2%。结论 在常规 MRI 基础上增加 DWI 改善了宫颈癌患者放疗后 PIF 与骨转移的鉴别。要点 • DWI 在区分 PIF 和 RT 后骨转移方面显示了常规 MRI 的附加值。• 对于定性诊断，与单独使用常规MRI 相比，增加DWI 可以提高诊断性能，尤其可以提高灵敏度。• 定量ADC 评估显示了从骨转移中识别PIF 的潜在价值。与单独使用常规 MRI 相比，增加 DWI 可以提高诊断性能，特别是可以提高灵敏度。• 定量ADC 评估显示了从骨转移中识别PIF 的潜在价值。与单独使用常规 MRI 相比，增加 DWI 可以提高诊断性能，特别是可以提高灵敏度。• 定量ADC 评估显示了从骨转移中识别PIF 的潜在价值。