Differentiating Multiple Myeloma and Vertebral Metastases Using T1-Weighted MRI Signal Intensity Ratio

Magnetic resonance imaging (MRI) plays a critical role in identifying vertebral lesions, yet differentiating multiple myeloma from metastases remains challenging. This retrospective study evaluated 100 patients with pathologically confirmed lesions, measuring the signal intensity ratio between spinal lesions and the spinal cord on T1 -weighted MRI. Results revealed a significantly higher signal intensity ratio in multiple myeloma (1.39 0.24) compared to metastases (0.85 0.31), with hepatocellular carcinoma metastases exhibiting a uniquely elevated ratio. The study introduces a practical visual threshold (1) that may be used during image interpretation to differentiate these conditions more effectively. The findings highlight a potentially simple, visual diagnostic aid in distinguishing between these spinal pathologies.