Magnetic resonance and computed tomography-based scoring system for the differential diagnosis of vertebral fractures caused by osteoporosis and malignant tumors

Review of the Imaging Features of Benign Osteoporotic and Malignant Vertebral Compression Fractures

“…54,55 The use of various scoring systems and prediction models can be a helpful strategy for delineating benign from malignant VCFs. 10,19,56 Yuzawa et al 10 found that the combination of CT characteristics and MR imaging features enhanced the accuracy of differentiating benign from malignant fractures. The CT findings used in this scoring system included sharp fracture lines without osteolytic destruction in benign VCFs and osteolytic destruction in malignant VCFs.…”

“…9,10,[12][13][14][15][17][18][19] When this is present, it represents direct extension of tumor from the vertebrae into the epidural or paravertebral space . This can occur without fracture or retropulsion.…”

“…According to the literature, abnormal marrow signal involving the pedicles or other posterior elements is a strong indicator of malignancy in VCFs. [9][10][11][12][13][14][15][16][17][18][19] Tumor spread to the posterior elements typically occurs before tumor-associated structural instability leads to fracture within the vertebral body ( Fig 1A). In contradistinction, according to the literature, osteoporotic fractures infrequently have signal change in the posterior elements (Fig 1B).…”

“…17 Therefore, areas of preserved normal high T1 and intermediate T2 SI within the bone marrow of a collapsed vertebral body are more often found in benign VCFs. [9][10][11][12]14,15,17 Unfortunately, some VCFs with areas of spared normal bone marrow signal will also be malignant. Likewise, benign VCFs can also have abnormalities in bone marrow signal characteristics due to edema, which can demonstrate diffuse hypointensity on T1WI and patchy enhancement.…”

“…Both T1-and T2-weighted imaging have characteristic signal intensity patterns that can be used to discern a pathologic entity and differentiate benign and malignant VCFs. [10][11][12][13][14][15][16][17][18]24,[26][27][28] The distinguishing signal intensities arise from 2 different mechanisms of fracture. In malignant VCFs, tumor infiltrates throughout the bone marrow and eventually the trabeculae and cortex, leading to a fracture.…”