Using A Quantitative Assessment Tool in Diffusion Weighted Magnetic Resonance Imaging in Patients with Non-Neoplastic Vertebrogenic Low Back Pain

Background: The addition of apparent diffusion coefficient (ADC) measurements and diffusion-weighted imaging (DWI) can address the limitations of conventional MRI by offering complementary quantitative and qualitative diffusion markers. We aimed to evaluate the diagnostic utility of added ADC values and DWI relative to standard MRI, particularly for distinguishing Modic type I changes from early spondylodiscitis, while also enhancing the characterization of various non-neoplastic lumbar vertebral lesions. Methods: In this case–control study, 48 patients with vertebrogenic low back pain and 48 controls underwent lumbar MRI, including DWI at a b-value of 800 s/mm² (In 25 patients with iindeterminate conventional findings (hypointense on T1WI and hyperintense on T2WI), additional DWI acquisitions at b = 50 and 500 s/mm² were performed to compare with b = 800 s/mm²). ADC values were measured using regions of interest, and qualitative DWI signs (claw sign, amorphous increased signal) assessed. Results: Within cases, Modic I changes (37.5%) were most frequent, followed by benign fractures and early infectious endplate changes (14.6% each). Mean ADC was significantly higher in cases (1.10 ± 0.47 ×10⁻³ mm²/s) than controls (0.26 ± 0.08, p < 0.001). Among subgroups,fractures Modic II changes had the highest ADC values, while Modic III the lowest. At b = 800 s/mm², DWI achieved a sensitivity of 85.7%, a specificity of 94.4%, and an accuracy of 92%. ADC cutoff >1.19 ×10⁻³ mm²/s provided 100% specificity but lower sensitivity (79.2%). Conclusion: ADC measurements and DWI substantially enhance the characterization of various benign lumbar vertebral lesions, outperforming conventional MRI alone.