Osteoporotic or malignant vertebral fracture? This is the question. What can we do about it?

Hamimi, Ahmed; Kassab, Farid; Kazkaz, Ghaith

doi:10.1016/j.ejrnm.2014.11.010

Cited by 11 publications

(13 citation statements)

References 29 publications

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“…It has been reported that about 30% of VCFs occurring in patients with known malignant tumours are benign. 14 Thus, it is very important to differentiate the fractures of benign from malignant, particularly in osteoporotic patients with a history of neoplasms, in order to guide therapeutic strategies and for prognosis.…”

Section: Discussionmentioning

confidence: 99%

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

He¹,

Zhao²,

Guo³

et al. 2018

CMAR

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PurposeThe purpose of this study was to evaluate the differential diagnostic value of 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for benign and malignant vertebral compression fractures (VCFs), where the diagnostic accuracy of 18F-FDG PET/CT was compared with magnetic resonance imaging (MRI).Patients and methodsBetween 2015 and 2017, we retrospectively evaluated 87 patients with 116 VCFs. MRI was performed in all the 87 patients, whereas 18F-FDG PET/CT was executed in 51 patients. Three malignant features (convex posterior cortex, epidural mass formation, and pedicle enhancement) from MRI and the maximum standardized uptake value (SUVmax) from 18F-FDG PET/CT were evaluated in benign and malignant VCFs, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of MRI and 18F-FDG PET/CT were compared in the differentiation of malignant from benign VCFs.ResultsThe results of our investigation showed that the sensitivity and specificity for predicting malignant VCFs were 75.6% and 77.3% for convex posterior cortex, 82.9% and 813% for epidural mass formation, and 85.7% and 70.8% for pedicle enhancement. 18F-FDG PET/CT demonstrated higher sensitivity (100%) but lower specificity (38.9%) as compared to MRI with regard to differentiation between benign and malignant VCFs. A significant difference in the SUVmax values was observed between the benign and malignant fractures (2.9 ± 1.0 vs 5.0 ± 1.8, P < 0.01). Besides the value of SUVmax, it has been noticed that the FDG uptake pattern differed in malignant and benign fractures.ConclusionSignificant MRI findings such as convex posterior cortex, epidural mass formation, and pedicle enhancement are highly suggestive of malignancy. 18F-FDG PET/CT reliably differentiated the fractures of malignant from benign based on both SUVmax and 18F-FDG uptake pattern. In a situation where MRI findings are not diagnostic, 18F-FDG PET/CT provides additional information as it has high sensitivity and is semiquantitative.

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Section: Discussionmentioning

confidence: 99%

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

He¹,

Zhao²,

Guo³

et al. 2018

CMAR

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“…Moreover, traumatic fracture showing bone enhancement at fracture margins was observed over 80% patients, although they had varying enhancement degrees. Bone marrow at the acute traumatic fracture site becomes edematous or is replaced by intramedullary hematomas and then shows a hyperemic response, thus altering the marrow relaxation time and showing fracture site enhancement (4811). In our study, the additional use of DWI with conventional MRI demonstrated improved accuracy and specificity, particularly for the less-experienced reader, in cases of absent extra-osseous soft tissue mass and present bone enhancement, i.e., the situations that may make accurate interpretation more challenging on conventional MRI.…”

Section: Discussionmentioning

confidence: 99%

“…Various studies have been published on the utility of DWI in the detection, characterization, and longitudinal evaluation of bone and soft tissue tumors (567). In previous studies, although fractures have been evaluated with DWI, the focus has mostly been on differentiating malignant from osteoporotic vertebral compression fractures through measurement of apparent diffusion coefficient (ADC) values (8910111213). The usefulness of DWI in evaluating suspected pathologic fractures at extremities has not yet been elucidated.…”

Section: Introductionmentioning

confidence: 99%

MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging

et al. 2019

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Objective To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. Materials and Methods Institutional Review Board approved this retrospective study and informed consent was waived. This study included 49 patients each with pathologic and traumatic fractures at extremities. The patients underwent conventional MRI combined with DWI. For qualitative analysis, two radiologists (R1 and R2) independently reviewed three imaging sets with a crossover design using a 5-point scale and a 3-scale confidence level: DWI plus non-enhanced MRI (NEMR; DW set), NEMR plus contrast-enhanced fat-saturated T1-weighted imaging (CEFST1; CE set), and DWI plus NEMR plus CEFST1 (combined set). McNemar's test was used to compare the diagnostic performances among three sets and perform subgroup analyses (single vs. multiple bone abnormality, absence/presence of extra-osseous mass, and bone enhancement at fracture margin). Results Compared to the CE set, the combined set showed improved diagnostic accuracy (R1, 84.7 vs. 95.9%; R2, 91.8 vs. 95.9%, p < 0.05) and specificity (R1, 71.4% vs. 93.9%, p < 0.005; R2, 85.7% vs. 98%, p = 0.07), with no difference in sensitivities ( p > 0.05). In cases of absent extra-osseous soft tissue mass and present fracture site enhancement, the combined set showed improved accuracy (R1, 82.9–84.4% vs. 95.6–96.3%, p < 0.05; R2, 90.2–91.1% vs. 95.1–95.6%, p < 0.05) and specificity (R1, 68.3–72.9% vs. 92.7–95.8%, p < 0.005; R2, 83.0–85.4% vs. 97.6–98.0%, p = 0.07). Conclusion Combining DWI with conventional MRI improved the diagnostic accuracy and specificity while retaining sensitivity for differentiating between pathologic and traumatic fractures from metastasis at extremities.

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“…Seven patients with a previous diagnosis of malignancy had histopathological evidence of a malignant vertebral lesion. However, literature indicates that one-third of patients with co-existing malignancies elsewhere, present with a benign osteoporotic fracture instead of a neoplastic vertebral lesion [ 3 4 ]. It would be interesting to know how many patients with known malignancies in the current series had benign vertebral lesions based on the histopathological diagnosis.…”

mentioning

confidence: 99%

“…Was there any correlation between any of the imaging findings and biopsy results? Magnetic resonance imaging [ 3 ] is considered as an important diagnostic modality to differentiate between malignancies and osteoporotic fractures. Although water-line sign and sharp vertebral wedging favor osteoporotic fractures, a bulging contour of the posterior vertebral body wall, homogenous T1 hypointensity, epidural or paravertebral soft tissue masses, non-signal drop in out-of-phase sequence and restriction in diffusion-weighted imaging strongly favor malignancy.…”

mentioning

confidence: 99%

Letter to the Editor: Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures

Subramanian¹,

Viswanathan²

2017

Asian Spine J

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Osteoporotic or malignant vertebral fracture? This is the question. What can we do about it?

Cited by 11 publications

References 29 publications

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

Differential diagnostic value of <sup>18</sup>F-FDG PET/CT for benign and malignant vertebral compression fractures: comparison with magnetic resonance imaging

MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging

Letter to the Editor: Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures

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