A novel MRI- and CT-based scoring system to differentiate malignant from osteoporotic vertebral fractures in Chinese patients

Abstract

BackgroundVarious types of magnetic resonance imaging (MRI) and computed tomography (CT) findings are used to differentiate malignant vertebral fractures (MVFs) from osteoporotic vertebral fractures (OVFs). The distinguishing ability of any single finding is limited. This study developed a novel scoring system that integrates multiple MRI and CT signs for improved accuracy of differential diagnosis between MVFs and OVFs.MethodsA total of 150 MVFs and 150 OVFs in thoracolumbar vertebrae were analyzed. MRI and CT images were obtained within 2 months of the probable time of fracture. The sensitivity and specificity of 15 MRI and CT image findings were evaluated. A stepwise discriminant analysis using these signs as variables was used to create a scoring system to differentiate MVFs from OVFs.ResultsAll 15 image findings had strong specificity and moderate sensitivity. Seven MRI and three CT image findings were selected and assigned integral values in the final scoring system. A total score of 4 or greater points indicated MVF, whereas a total score of 3 or fewer points indicated OVF. The classification accuracy was 98.3% in the test set.ConclusionsThis novel scoring system using MRI and CT radiologic findings to differentiate MVFs from OVFs in Chinese patients was efficient with high accuracy and good applicability.

Endplate and intervertebral disc injuries in acute and single level osteoporotic vertebral fractures: is there any association with the process of bone healing?

“…An acute OVF was diagnosed on the basis of back pain or low back pain in a sitting position with MRI findings of low-intensity change on T1 weighted image (WI) and high-intensity change on MR T2 short-TI inversion recovery (STIR) images [17]. OVFs were differentiated from vertebral fractures caused by other pathological conditions such as spondylodiscitis and malignant tumors by their characteristic MRI findings [18, 19], blood test and physical findings.…”

Automated Differentiation Between Osteoporotic Vertebral Fracture and Malignant Vertebral Fracture on MRI Using a Deep Convolutional Neural Network

“…Three previous studies attempted to build scoring systems to differentiate MVFs from OVFs. [14][15][16] Yuzawa et al 15 reported a scoring system using four MRI findings and two CT findings. They optimized the system for available data and did not validate it with external data.…”

Developing a Reliable and Versatile System for the Diagnosis of Metastatic Vertebral Fracture: Challenges and Future Directions

“…Scoring systems have been designed to simulate these experts' integration process. [2][3][4] The virtue of these scoring systems is that they do not require their users to intuitively determine the clinical relevance of each aspect of a radiologic image. For example, if "finding A," which supports MVF, exists in the patient's MRI scan, but "finding B," which strongly negates its possibility, also exists at the same time, the fracture can be concluded to be OVF.…”