Differentiation Between Osteoporotic and Neoplastic Vertebral Fractures: State of The Art and Future Perspectives

Abstract

: Vertebral fractures are a common condition, occurring in the context of osteoporosis and malignancy. These entities affect a group of patients in the same age range; clinical features may be indistinct and symptoms non-existing, and thus present challenges to diagnosis. In this article, we review the use and accuracy of different imaging modalities available to characterize vertebral fracture etiology, from well-established classical techniques, to the role of new and advanced imaging techniques, and the prospective use of artificial intelligence. We also address the role of imaging on treatment. In the context of osteoporosis, the importance of opportunistic diagnosis is highlighted. In the near future, the use of automated computer-aided diagnostic algorithms applied to different imaging techniques may be really useful to aid on diagnosis.

Effects of Radiation Therapy and Chemotherapy on the Musculoskeletal System

“…This characteristic can be extremely useful in differentiating tumoral tissue from fractures, for example. 8…”

“…This is not seen in the case of metastatic disease or tumor infiltration. 8 Diffusion-weighted imaging (DWI), a functional application on MRI, is well established for the study of bone marrow diseases. The apparent diffusion coefficient (ADC) maps that can be obtained quantitatively reflect the diffusion of water molecules that is very useful to characterize the properties of tissue.…”

“…This characteristic can be extremely useful in differentiating tumoral tissue from fractures, for example. 8 The assessment of diffuse marrow disease with DWI still poses a challenge. Red marrow has an altered diffusion signal compared with yellow marrow, and therefore the detection of marrow disease in younger patients with diffusion techniques can be challenging.…”

“…For example, inflammation is seen in the context of fractures. 8 In the same way, other confounding factors could include lack of avidity of the tumor cells for the tracer and, very importantly, the presence of diffuse changes in the bone marrow inherent to recovery from treatment (hypercellular marrow) (e.g., in the cases of bone marrow transplant and the use of GCSF). These changes may pose a diagnostic challenge to rule out diffuse bone marrow infiltration.…”

Imaging of Bone Marrow: From Science to Practice

“…For example, inflammation is seen in the context of fractures. 14 In the same way, other confounding factors could be lack of avidity of the tumor cells for the tracer, and, very importantly, the presence of diffuse changes in the bone marrow inherent to recovery from treatment (hypercellular marrow), for example in the cases of bone marrow transplant and the use of granulocyte colony-stimulating factors (G-CSFs). These changes may pose a diagnostic challenge to rule out diffuse bone marrow infiltration.…”