Sensitivity, Specificity and Accuracy of Magnetic Resonance Imaging for Differentiating Vertebral Compression Fractures Caused by Malignancy, Osteoporosis, and Infections

Abdel-Wanis, ME; Solyman, Mohamed Tharwat Mahmoud; Hasan, Nahla Mohamed Ali

doi:10.1177/230949901101900203

Cited by 41 publications

(36 citation statements)

References 14 publications

(20 reference statements)

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“…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).…”

Section: Mr Imagingmentioning

confidence: 99%

“…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.…”

Section: Mr Imagingmentioning

confidence: 99%

“…13 A convex vertebral contour, specifically expansion of the posterior aspect of the vertebral contour, is an imaging feature strongly suggestive of malignant fracture. 9,11,12,14,18,24 Because tumor infiltrates and destroys the cortex, an axial load causes bulging of the mass into the ventral epidural space. The bulge extends beyond the normal posterior margin of the vertebral body, resulting in a convexity, rather than the normal anatomic concavity of the vertebral body ( Figs 3A, 4, and 5).…”

Section: Mr Imagingmentioning

confidence: 99%

“…15,17 Retropulsion of bone fragments from the posterior aspect of the vertebral body, rather than an expansile, convex contour, is characteristic of benign VCFs (Fig 6). 9,12,14,17 This is typical with axial loading from traumatic compression fractures, especially burst-type fractures. 20 The location of a VCF within the spinal column has been reported to indicate the likelihood of benignity or malig- Vertebral body with pedicle and/or spinous process uptake, 63 marginal uptake in cold lesion 63 nancy, 11,14,[17][18][19]25 but this feature is of limited clinical utility.…”

Section: Mr Imagingmentioning

confidence: 99%

“…18,19 Likewise, known spinal metastasis within other segments or indeterminate vertebral lesions suggest malignancy as the cause of new fractures. 9,14,18 A potential pitfall would be that it is possible to have both malignant and benign VCFs in the same patient.…”

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confidence: 99%

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

Mauch

Carr

Cloft

et al. 2018

AJNR Am J Neuroradiol

108

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SUMMARY: Vertebral compression fractures are very common, especially in the elderly. Benign osteoporotic and malignant vertebral compression fractures have extremely different management and prognostic implications. Although there is an overlap in appearances, characteristic imaging features can aid in the distinction between these 2 types of compression fractures. The aim of this review is to characterize the imaging features of benign and malignant vertebral compression fractures seen with CT, PET, SPECT, and MR imaging.ABBREVIATIONS: SI ϭ signal intensity; SUV ϭ standard uptake value; VCF ϭ vertebral compression fracture

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Section: Mr Imagingmentioning

confidence: 99%

Section: Mr Imagingmentioning

confidence: 99%

Section: Mr Imagingmentioning

confidence: 99%

Section: Mr Imagingmentioning

confidence: 99%

mentioning

confidence: 99%

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

Mauch

Carr

Cloft

et al. 2018

AJNR Am J Neuroradiol

108

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Back Pain-Inducing Test, a Novel and Sensitive Screening Test for Painful Osteoporotic Vertebral Fractures: A Prospective Clinical Study

Jin

Liu

et al. 2019

Journal of Bone and Mineral Research

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To detect painful vertebral fractures (VFs) in back pain populations at risk of osteoporosis, we designed a physical examination test (the Back Pain‐Inducing Test [BPIT]) that included three movements: lying supine, rolling over, and sitting up. If back pain is induced during any of these movements, the result is defined as positive, thereby establishing a presumptive diagnosis of painful VFs. Pain severity is quantified using a self‐reported numerical rating scale (NRS). The presence or absence of painful VFs is verified by whole‐spine magnetic resonance imaging (MRI), the gold standard for final diagnosis. According to the standards for reporting diagnostic accuracy, a real‐world, prospective, and observational study was performed on 510 back pain patients (enrolled from a single institute) at risk of osteoporosis. The sensitivity, specificity, and accuracy of the BPIT for identifying painful VFs were 99.1% (95% CI, 97.5% to 99.8%), 67.9% (95% CI, 60.4% to 74.5%), and 89.0%, respectively. The positive and negative predictive values were 86.6% (95% CI, 82.9% to 89.6%) and 97.4% (95% CI, 92.6% to 99.3%), respectively. Cutoff NRS scores for lying supine, rolling over, and sitting up were 3, 0, and 2, respectively. The corresponding area under the receiver operating characteristic curves (AUROCs) of each movement was 0.898 (95% CI, 0.868 to 0.922), 0.884 (95% CI, 0.854 to 0.911), and 0.910 (95% CI, 0.882 to 0.933), respectively. Although the high prevalence of VFs in the enrolled cohort partially limits the external validity of the predictive value in the general population, we conclude that the BPIT is potentially effective for detecting painful VFs in back pain populations at risk of osteoporosis. This test may be used as a stratification tool in decision‐making on subsequent imaging procedures: a negative BPIT rules out painful VFs and indicates that an MRI should be spared, whereas a positive BPIT means that an MRI is necessary and is likely to identify painful VFs. © 2019 American Society for Bone and Mineral Research.

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Vertebral Fracture Identification

Cafarelli,

Guglielmi,

Manuela

2023

Endocrinology

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Sensitivity, Specificity and Accuracy of Magnetic Resonance Imaging for Differentiating Vertebral Compression Fractures Caused by Malignancy, Osteoporosis, and Infections

Abstract: Combination of several MRI features can provide clues to differentiate between malignant, osteoporotic, and infective vertebral compression fractures.

Cited by 41 publications

References 14 publications

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

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

Back Pain-Inducing Test, a Novel and Sensitive Screening Test for Painful Osteoporotic Vertebral Fractures: A Prospective Clinical Study

Vertebral Fracture Identification

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