Atraumatic vertebral compression fractures: differential diagnosis between benign osteoporotic and malignant fractures by MRI

Abstract

Atraumatic vertebral compression fractures are a common clinical problem, especially in elderly population. Metastases are the most frequent source of bone tumors, and the spine is a common site of metastatic disease; in case of cortical involvement or osteolysis, they may result in pathological compression fractures. Atraumatic compression fractures may result from other primary neoplasms of vertebrae and also from osteomyelitis, Paget's disease, hyperparathyroidism and other metabolic processes. Osteoporosis is a common source of vertebral compression fractures in elderly population, which may be indistinguishable from those of metastatic origin. The differentiation between osteoporotic compression fractures and malignant fracture is necessary to establish an appropriate staging and a therapeutic planning, especially in the acute and subacute stages. Anamnestic data about preexisting disease can be useful to individuate the potential cause of vertebral collapse. Plain radiography shows some difficulties in distinguishing whether the fracture represents a consequence of osteoporosis, a metastatic lesion or some other primary bone neoplasm. Computed tomography is one of the most suitable imaging techniques for the evaluation of bone structure and fragments and to establish the degree of cortical bone destruction; MR imaging (MRI) is the most helpful radiological investigation in order to provide the basis for the distinction between metastatic and acute osteoporotic compression fractures. The most relevant MRI findings to establish a differential diagnosis are described.

Identifying osteoporotic vertebral endplate and cortex fractures

“…Its size remains unchanged for 2-4 months and then can gradually returns to normal. This is an additional sign of osteoporosis and rarely occurs in metastatic fractures (64). Other findings highly suggestive of acute osteoporotic vertebral collapse are ''intravertebral vacuum cleft sign'', features of vertebral osteonecrosis ( Figure 55).…”

Discrimination between Malignant and Benign Vertebral Fractures Using Magnetic Resonance Imaging

“…Spinal fractures must be accurately diagnosed because the clinical course, prognosis, and treatment strategies for malignant and benign fractures are very different. Magnetic resonance imaging (MRI) is reportedly the most sensitive modality to detect and assess the etiology of spinal fractures [123]. However, many published reports have focused on only one or a few discriminators.…”

Imaging of post-surgical treatment and of related complications in spinal trauma

“…Motor vehicle accidents account for about half of reported spinal injury cases. Falls are the next most common cause, followed by acts of violence and sporting activities [1][2][3][4][5]. The rationale of imaging is to diagnose the traumatic abnormalities and characterize the type of injury, to estimate the severity, to evaluate the potential spinal instability [6][7][8][9].…”