Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging.

Abstract

Differentiation of benign from pathologic compression fractures of vertebral bodies was evaluated with magnetic resonance imaging in a prospective study of 53 patients. Twenty-six patients had 34 benign posttraumatic compression fractures. Twenty-seven patients had metastatic disease to the vertebral column and seven pathologic fractures. T1- and T2-weighted spin-echo (SE) sequences (1.5 T) were performed in all patients. A presaturation technique was used to obtain "fat" and "water" images to better assess the degree of normal fatty marrow replacement in fractured vertebrae. Short inversion-time inversion-recovery (STIR) images were also obtained. Discrimination between benign and pathologic compression fractures was generally possible with the SE sequences. Chronic benign fractures demonstrated isointense marrow signal intensity (SI), compared with that of normal vertebrae with all sequences. Pathologic fractures showed low SI on T1-weighted images and high SI on T2-weighted images. Fat images revealed complete replacement of normal fatty marrow, shown as absent SI in the involved vertebral body. Water and STIR images showed diffuse high SI in pathologic fractures, with STIR images having the highest contrast between abnormal and normal marrow. Acute benign compression fractures also demonstrated high SI on T2-weighted, water, and STIR images, but the SI was less pronounced and the pattern was generally more inhomogeneous than that of pathologic compressions. In general, fat images showed only partial replacement of normal fatty marrow by low SI, in contrast to the complete absence of marrow SI typical of pathologic fractures.

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

“…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.…”

Treatment of Thoracolumbar Multiple Fractures With Minimally Invasive Surgery

“…The diagnosis was based on a thorough physical exam supported by simple AP and lateral view x-rays, computed axial tomography with three-dimensional image reconstruction, especially in the STIR sequence that clearly shows edema that appears as hyper intense in an acute fracture with compression. 9,10 A decision for surgical treatment was always preceded by failed conservative management where the primary clinical symptom was difficult-to-control pain of long evolution and progressive intensity, exacerbated when in a standing position and hindering the patient's ability to walk, forcing bed rest. An evaluation of pain was conducted in all cases using the Visual Analog Scale (VAS) and of functional quality using the Oswestry scale 11 prior to surgery, immediately following surgery, after one month, six months, and then yearly with support by telephone or in-home visits.…”