目的 探讨MRI中同反相位成 相、表观扩散系数以及DWI序列在诊断椎 体良恶性疾病中的应用价值。方法 分析 病理诊断或随访确认为恶性肿瘤椎体压 缩骨折患者65例，良性疾病导致的椎体 压缩性骨折45例，其中65例恶性患者共 计80个椎体，良性疾病共计50个椎体。 均行MRI常规序列及DWI扫描并采用双回 波技术在3D快速扰相梯度回波序列中采 集IP/OP图像；对比良恶性疾病的椎体 DWI信号特点测定2组椎体的ADC值、SIR 值和SAR值，应用ROC曲线确定最佳诊断 指标以及诊断界值。结果 良性组与恶 性组常规DWI序列信号并无规律可言； 良性组ADC值(2.35±0.42)×10-3mm2 /s高 于恶性组(1.89±0.53)×10-3mm2 /s，差 异有统计学意义(t=4.859，P<0.001)； 良性组SIR值为(0.65±0.23)，恶性组 为(1.38±0.21)，差异有统计学意义 (t=-17.238，P<0.001)，良性组SAR值为 (0.52±0.42)，恶性组为(0.19±0.12)， 差异有统计学意义(t=6.001，P<0.001)。 SAR值、SIR值以及ADC的ROC曲线下面积分 别为65.1%、72.4%和96.5%， ADC的最佳 诊断界值为0.837。结论 DWI信号不能用 于准确诊断椎体良恶性病变，而ADC值和 SIR值、SAR值具有重要的鉴别诊断价值， 其中以ADC的诊断价值最高。

Objective To compare the clinical value of in-phase and opposed-phase, apparent diffusion coefficient and diffusion-weighted imaging in diagnosis benign and malignant spinal lesion. Methods Patients with vertebral compression fractures caused by malignant tumor or benign lesion were selected, with 125 and 130 cases respectively. Routine sequence of MRI, DWI scan and double echo technique in the 3 D fast interference phase gradient echo was performed to acquire sequence IP/OP images. The DWI signal characteristic were also analyzed and the ADC value, SIR and SAR values were recorded and analyzed. Receiver operating characteristic curve (ROC) was performed to identify the optimal diagnosis indicator and value. Results DWI sequence in each groups is irregular, the ADC value in benign group is (2.35±0.42)×10-3mm2 / s and is (1.89±0.53)×10-3mm2 /s in malignant group, the difference is significant difference(t=4.859, P<0.001). The value of SIR in benign group is (0.65±0.23) and is (1.38±0.21) in malignant group, the difference is significant difference(t=-17.238, P<0.001). The value of SAR in benign group is (0.52±0.42) and is (0.19±0.12) in malignant group, the difference is significant difference (t=6.001, P<0.001). The ROC area for SAR, SIR and ADC is 65.1%, 72.4% and 96.5%, and the best diagnose value for ADC is 0.837. Conclusion DWI signal cannot be used for accurately diagnosis benign and malignant lesions of vertebral bodies, and ADC values and SIR and SAR values is of important value in diagnosis. ADC is the best diagnose value for benign and malignant lesions.