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

Mauch, Jaclyn T.; Carr, Carrie M.; Cloft, Harry J.; Diehn, Felix E.

doi:10.3174/ajnr.a5528

Cited by 108 publications

(96 citation statements)

References 56 publications

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“…1,15 Therefore, fair interobserver agreement and moderate diagnostic accuracy may be the best that can be realistically expected when using MRI to distinguish MVF versus OVF in routine practice, simply because with current technology, images of MVF and OVF are sometimes indistinguishable. 16,17 For instance, "bulging posterior cortex" was one of the imaging findings with the best interobserver agreement found in this and previous studies, and specifically, expansion of the posterior aspect of the vertebral contour is associated with malignant fractures. 18 However, it can also be observed in benign OVFs, especially in acute posttraumatic fractures.…”

Section: Discussionsupporting

confidence: 67%

“…18 However, it can also be observed in benign OVFs, especially in acute posttraumatic fractures. 16 The low reproducibility of imaging findings challenges the validity of purportedly evidence-based decision support systems based on them. 2 In fact, a decision system based on unreliable findings can be detrimental.…”

Section: Discussionmentioning

confidence: 99%

“…28 No patient was excluded due to sclerotic metastases, previous trauma history, or myeloma, in which vertebral signal intensity changes are misleading. 16,17 Interobserver agreement and diagnostic accuracy may be different for patients showing these findings.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation

Arana

Kovacs

Royuela

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: MRI is assumed to be valid for distinguishing metastatic vertebral fractures (MVFs) from osteoporotic vertebral fractures (OVFs). This study assessed (1) concordance between the imagebased diagnosis of MVF versus OVF and the reference (biopsy or follow-up of .6 months), (2) interobserver and intraobserver agreement on key imaging findings and the diagnosis of MVF versus OVF, and (3) whether disclosing a patient's history of cancer leads to variations in diagnosis, concordance, or agreement. Patients and Methods: This retrospective cohort study included clinical data and imaging from 203 patients with confirmed MVF or OVF provided to 25 clinicians (neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists). From January 2018 through October 2018, the clinicians interpreted images in conditions as close as possible to routine practice. Each specialist assessed data twice, with a minimum 6-week interval, blinded to assessments made by other clinicians and to their own previous assessments. The kappa statistic was used to assess interobserver and intraobserver agreement on key imaging findings, diagnosis (MVF vs OVF), and concordance with the reference. Subgroup analyses were based on clinicians' specialty, years of experience, and complexity of the hospital where they worked. Results: For diagnosis of MVF versus OVF, interobserver agreement was fair, whereas intraobserver agreement was substantial. Only the latter improved to almost perfect when a patient's history of cancer was disclosed. Interobserver agreement for key imaging findings was fair or moderate, whereas intraobserver agreement on key imaging findings was moderate or substantial. Concordance between the diagnosis of MVF versus OVF and the reference was moderate. Results were similar regardless of clinicians' specialty, experience, and hospital category. Conclusions: When MRI is used to distinguish MVF versus OVF, interobserver agreement and concordance with the reference were moderate. These results cast doubt on the reliability of basing such a diagnosis on MRI in routine practice.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation

Arana

Kovacs

Royuela

et al. 2020

Journal of the National Comprehensive Cancer Network

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“…Other features that may suggest pathologic vertebral compression fracture include (a) destruction of cortical or cancellous bone (72,74), (b) absence of a vacuum or fluid cleft (74), (c) convexity or bulging of the posterior vertebral body wall (75), (d) pedicle involvement (75), a focal paravertebral mass measuring greater than 10 mm (72,74,75), and (e) a T1 signal intensity abnormality that persists at 3-6 month follow-up MRI (75)(76)(77) (Table 3). Advanced imaging techniques for evaluation of marrow signal intensity alterations, including dynamic contrast material-enhanced MRI, chemical shift MRI, and diffusion-weighted MRI, have shown promise for discrimination of benign from malignant fractures in the vertebral bodies (76,77). Table 3 summarizes imaging findings with multiple modalities that may be useful to discriminate stress from pathologic fractures (3,17,68,72,74,(76)(77)(78).…”

Section: Pathologic Fracturesmentioning

confidence: 99%

Imaging Features and Management of Stress, Atypical, and Pathologic Fractures

et al. 2018

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■ Describe the radiographic appearance of stress, atypical, and pathologic fractures in the appendicular skeleton, with an emphasis on the imaging features that a multidisciplinary team uses to guide treatment. ■ Identify the imaging features that best allow discrimination of stress fractures from pathologic fractures. ■ Discuss the application of the Mirels criteria for risk stratification of impending fracture of a bony neoplasm.

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“…Specific radiological features have been described in an attempt to differentiate metastatic and osteoporotic fractures ( [61,63]; . In acute vertebral fractures with extensive edema in the bone marrow, the addition of DWI and gradient echo sequences may be beneficial (.…”

Section: Precision Oncology: Targeted Thera-mentioning

confidence: 99%

State-of-the-art imaging for diagnosis of metastatic bone disease

Isaac

Dalili

et al. 2020

Radiologe

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Table 1 Epidemiological indicators: total number of cancer cases in Germany in 2013 (modified according to [21]) New cases Women Men Death Women Men Absolute number 229,920 252,550 Absolute number 101,779 121,314 Mean age at diagnosis 67.2 68.3 Mean age at diagnosis 74.3 73.3 Raw rate 558.4 639.9 Raw rate 247.2 307.7 Age-standardized rate a 351.2 434.1 Age-standardized rate a 126.7 196.5 Current trend +0.8%-0.5% Current trend-0.7%-1.2% Age-standardized rate a 327.9 447.6 Age-standardized rate a 126.8 211.8 Prognosis for 2020 (absolute number) 244,100 274,900 Prognosis for 2020 (absolute number)-0.8%-1.5%

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

Cited by 108 publications

References 56 publications

Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation

Metastatic Versus Osteoporotic Vertebral Fractures on MRI: A Blinded, Multicenter, and Multispecialty Observer Agreement Evaluation

Imaging Features and Management of Stress, Atypical, and Pathologic Fractures

State-of-the-art imaging for diagnosis of metastatic bone disease

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