Discrimination between Malignant and Benign Vertebral Fractures Using Magnetic Resonance Imaging

Abstract

Study DesignRetrospective analysis using magnetic resonance imaging (MRI).PurposeTo identify MRI features that could discriminate benign from malignant vertebral fractures.Overview of LiteratureDiscrimination between benign and malignant vertebral fractures remains challenging, particularly in patients with osteoporosis and cancer. Presently, the most sensitive means of detecting and assessing fracture etiology is MRI. However, published reports have focused on only one or a few discriminators.MethodsTotally, 106 patients were assessed by MRI within six weeks of sustaining 114 thoracic and/or lumbar vertebral fractures (benign, n=65; malignant, n=49). The fractures were pathologically confirmed if malignant or clinically diagnosed if benign and were followed up for a minimum of six months. Seventeen features were analyzed in all fractures' magnetic resonance images. Single parameters were analyzed using the chi-square test; a logit model was established using multivariate logistic regression analysis.ResultsThe chi-square test revealed 11 malignant and 4 benign parameters. Multivariate logistic regression analysis selected (i) posterior wall diffuse protrusion (odds ratio [OR], 48; 95% confidence interval [CI], 4.2–548; p=0.002), (ii) pedicle involvement (OR, 21; 95% CI, 2.0–229; p=0.01), (iii) posterior involvement (OR, 21; 95% CI, 1.5–21; p=0.02), and (iv) band pattern (OR, 0.047; 95% CI, 0.0005–4.7; p=0.19). The logit model was expressed as P=1/[1+exp (x)], x=−3.88×(i)−3.05×(ii)−3.02×(iii)+3.05×(iv)+5.00, where P is the probability of malignancy. The total predictive value was 97.3%. The only exception was multiple myeloma with features of a benign fracture.ConclusionsAlthough each MRI feature had a different meaning with a variable differentiation power, combining them led to an accurate diagnosis. This study identified the most relevant MRI features that would be helpful in discriminating benign from malignant vertebral fractures.

ACR Appropriateness Criteria® Management of Vertebral Compression Fractures

“…MRI is imperative for assessing VCFs in patients with a history of malignancy or atypical clinical features. In addition to detecting early metastases that are localized completely in the bone marrow cavity, MRI can be used to differentiate benign from malignant fractures, as osteoporotic VCFs can occur in patients with malignancy [81,[101][102][103][104]. MRI allows assessment of the degree of thecal sac or cord compression, epidural extension [13], paraspinal extension, presence of other lesions, and vascularity.…”

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

“…Vertebral fractures caused by benign or malignant lesions are common among the elderly. Identifying the etiology of spinal fractures at an early stage is critical to determine the clinical course, treatment, and prognosis [ 1 – 4 ]. Common features of osteoporotic vertebral fracture (OVF) and malignant vertebral fracture (MVF), including age group, clinical symptoms, and history of inadequate trauma, make differential diagnosis challenging.…”

“…Modern radiological imaging techniques, including magnetic resonance imaging (MRI) and computed tomography (CT), have good predictive value for differential diagnosis. Multiple-image findings are utilized to distinguish between MVFs and OVFs [ 1 , 3 , 4 , 9 , 10 ]. Single-image findings have limited distinguishing ability and are not considered sufficiently sensitive or specific, such as fluid sign and pedicle involvement [ 1 , 11 , 12 ].…”

Differential diagnosis of benign and malignant vertebral compression fractures using conventional and advanced MRI techniques

“…A typical MRI feature suggestive of malignancy is the presence of abnormal bone marrow signal intensity involving the pedicles or other posterior vertebral elements. 1 Malignant VCFs often have total replacement of the high T 1 bone marrow signal intensity resulting in diffuse homogeneous low signal and showing heterogeneous enhancement after contrast administration ( Figure 1 ). However, osteoporotic fractures may commonly show similar signal changes in the acute phase due to marrow edema extension ( Figure 2 ), while a malignant vertebral fracture may have preserved pedicles signal intensity if there is no tumor infiltration at that level.…”