Comparative evaluation of Dixon fat fraction imaging and diffusion-weighted MRI in differentiating malignant from osteoporotic vertebral fracture

Background Quantitative parameters such as fat fraction (FF) derived from Dixon MRI and apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) have emerged as promising imaging biomarkers for differentiating among various types of vertebral fractures. Aim In this study, we sought to compare quantitative MRI parameters—specifically FF and ADC—to determine their utility in differentiating malignant from osteoporotic vertebral fractures. Patient and methods This case-control study was conducted on 35 cases (10 controls and 25 patients), 25 patients aged between 32 and 70 years, all presenting with pathological vertebral fractures. Patients were referred from the oncology and orthopaedic departments to the Radiodiagnosis Department at University Hospitals over a period extending from January 2024 to April 2025. Results The FF derived from Dixon MRI demonstrated superior diagnostic performance compared with the ADC obtained from diffusion-weighted imaging. FF achieved a sensitivity of 85.7% and an overall accuracy of 84%, whereas ADC yielded a sensitivity of 64.3% and an accuracy of 76%. These results suggest that FF is a more reliable imaging biomarker than ADC. Conclusion Both FF and ADC enhance diagnostic specificity in differentiating malignant from osteoporotic vertebral fractures, particularly in cases with indeterminate fracture morphology. Among the two parameters, FF demonstrated superior discriminatory power compared with ADC when used as a standalone marker.