Vertebral compression fractures: distinction between benign and malignant causes with MR imaging.

Abstract

Magnetic resonance (MR) imaging was performed on 64 patients with 109 vertebral compression fractures, the cause of which could not be determined from plain radiographs. Twenty-five fractures were due to malignancy; 84 were caused by a benign process. In 22 of the 25 fractures caused by malignancy, MR images showed complete replacement of normal bone marrow, whereas 47 of the 61 benign fractures without history of trauma had complete preservation of normal bone marrow. The remaining 14 benign fractures had incompletely preserved bone marrow in a regular pattern. In two of the three remaining malignant fractures, the bone marrow replacement also was incomplete but with an irregular pattern. In cases of recent trauma or primary bone marrow abnormalities, the configuration and signal of remaining bone marrow were not useful in differentiating among malignancy, osteoporosis, and other benign processes. When criteria based on complete loss or preservation of marrow and marrow configuration in cases of incomplete loss were used, the accuracy in differentiating benign from malignant fractures was 94%. MR imaging may be a useful adjunct in differentiating benign from metastatic fractures and may provide information not available with other imaging methods.

Characterizing Hypervascular and Hypovascular Metastases and Normal Bone Marrow of the Spine Using Dynamic Contrast-Enhanced MR Imaging

“…[1][2][3][4] These techniques, though offering valuable insight into gross characteristics, also possess limitations, especially with regard to describing physiologic characteristics of malignant lesions. 1,2,4 For example, static imaging is inadequate in assessing diagnostically challenging spinal lesions, such as those surrounded by abundant fatty bone marrow, predominantly red marrow, or marrow affected by cancerrelated processes such as fibrosis, infarction, edema, and infection. 5 Furthermore, before a malignant bone marrow lesion becomes apparent on conventional imaging, it must replace enough normal marrow cells to cause local alteration of T1, T2, and STIR signal intensities.…”

Pedicle Involvement on MR Imaging Is Common in Osteoporotic Compression Fractures

“…They identified pedicle involvement in 6 vertebrae with benign fractures (28.6%) and 11 vertebrae with malignant fractures (68.8%), showing a clearly higher prevalence of pedicle involvement in benign compression fractures compared with those in the other studies mentioned above. 1,11 This higher rate of pedicle involvement in osteoporotic compression fractures compared with other studies is probably due to the use of fat-suppression techniques. However, a difference from our study is seen in patient selection.…”

“…For many years, various diagnostic signs on CT and MR imaging have been considered useful for such evaluation. [1][2][3][4][5][6][7][8][9][10][11][12] Morphologic changes suggest malignancy when a convex posterior cortex of the vertebral body is seen due to a mass effect or epidural and/or paravertebral masses. [1][2][3][4]8 Among these signs, the presence of an epidural mass has been reported as both specific and sensitive.…”

“…Compression fractures due to malignant tumors have a convex posterior cortex of the vertebral bodies, epidural or paravertebral masses, or infiltration of the posterior elements. [1][2][3][4][5] Of these, pedicle involvement has been described as specific for malignant lesions. 3 Osteoporotic compression fractures usually show retropulsion of a posterior bone fragment or intravertebral fluid.…”

Management of metastatic sacral tumours

“…More accurate visualisation of the tumour may be obtained by means of magnetic resonance imaging (MRI), which remains the optimum method for assessing spinal metastatic disease [12][13][14][15]. This is used to visualise the relationship between the tumour, bone and soft tissues.…”