Solitary vertebral collapse: Distinction between benign and malignant causes using MR patterns

Abstract

Differentiation of benign from malignant causes of vertebral compression fracture can be difficult at a single location. We studied 37 patients with solitary vertebral collapse (SVC) in the spine using magnetic resonance imaging (MRI). Sixteen of them were found to have a benign cause of SVC, while the remaining 21 were found to have malignancy. The following four MRI characteristics were investigated: ill‐ or well‐defined margin of the intravertebral lesion (P < 0.005); pedicle involvement (P < 0.05); MR enhancement pattern (P < 0.005); and paravertebral soft tissue lesion (PSL) (P < 0.025). It was found that cases of malignant SVC tended to have an ill‐defined margin, abnormal signal involvement of the pedicle, a marked and heterogenous MR enhancement pattern, and irregular nodular‐type PSL. Pedicle change with expansile lesion totally excluded a benign cause. By using these criteria, we were able to differentiate benign or malignant causes of SVC accurately.J. Magn. Reson. Imaging 1999;9:635–642. © 1999 Wiley‐Liss, Inc.

SPECT-CT: applications in musculoskeletal radiology

“…However, the sensitivity of MDCT remains significantly lower than that of MRI in the detection of vertebral metastases [17], mainly owing to the ability of MRI to detect bone marrow signal changes. It should be noted that MRI is regarded less sensitive than CT in demonstrating cortical destruction [18,19]. In cases where the SPECT component of the study shows focal uptake suggestive of malignancy and no bony abnormality is evident on the CT images, further correlation with MRI may be required.…”

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.…”

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.…”

“…Compression fractures due to malignant tumors have a convex posterior cortex of the vertebral bodies, epidural or paravertebral masses, or infiltration of the posterior elements. [1][2][3][4][5] Of these, pedicle involvement has been described as specific for malignant lesions. 3 Osteoporotic compression fractures usually show retropulsion of a posterior bone fragment or intravertebral fluid.…”