Skip to main content
SpringerLink
Log in

Benign Versus Malignant Vertebral Fractures

  • Chapter
  • First Online:
Bone Marrow MRI

  • 1853 Accesses

Abstract

Establishing whether the cause of an acute vertebral compression fracture (VCF) is benign or malignant has important clinical implications and can often be challenging. This is especially true in elderly patients who are prone to develop osteoporosis-related fractures but are also more likely to carry an undiagnosed malignancy, as well as in cancer patients with no known bone metastases who present with an acute VCF. Traumatic vertebral fractures, which do not pose a differential diagnosis problem, will not be addressed in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mathis JM, Barr JD, Belkoff SM et al (2001) Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol 22:373–381

    CAS  PubMed  Google Scholar 

  2. Thawait SK, Marcus MA, Morrison WB et al (2012) Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Systematic review and meta-analysis. Spine (Phila Pa 1976) 37:E736–E744

    Article  Google Scholar 

  3. Cooper C, Melton LJ (1992) Vertebral fractures. BMJ 304:793–794

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Papaioannou A, Watts NB, Kendler DL et al (2002) Diagnosis and management of vertebral fractures in elderly adults. Am J Med 113:220–228

    Article  PubMed  Google Scholar 

  5. Melton LJ, Kan SH, Frye MA et al (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011

    PubMed  Google Scholar 

  6. Bartalena T, Rinaldi MF, Modolon C et al (2010) Incidental vertebral compression fractures in imaging studies: lessons not learned by radiologists. World J Radiol 2:399–404

    Article  PubMed Central  PubMed  Google Scholar 

  7. Carberry GA, Pooler BD, Binkley N et al (2013) Unreported vertebral body compression fractures at abdominal multidetector CT. Radiology 268:120–126

    Article  PubMed  Google Scholar 

  8. Faciszewski T, McKiernan F (2002) Calling all vertebral fractures classification of vertebral compression fractures: a consensus for comparison of treatment and outcome. J Bone Miner Res 17:185–191

    Article  PubMed  Google Scholar 

  9. Jung HS, Jee WH, McCauley TR (2003) Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics 23:179–187

    Article  PubMed  Google Scholar 

  10. Laredo JD, Lakhdari K, Bellaïche L et al (1995) Acute vertebral collapse: CT findings in benign and malignant nontraumatic cases. Radiology 194:41–48

    Article  CAS  PubMed  Google Scholar 

  11. Uetani M, Hashmi R, Hayashi K (2004) Malignant and benign compression fractures: differentiation and diagnostic pitfalls on MRI. Clin Radiol 59:124–131

    Article  CAS  PubMed  Google Scholar 

  12. Crandall D, Slaughter D, Hankins PJ et al (2004) Acute versus chronic vertebral compression fractures treated with kyphoplasty: early results. Spine J 4:418–424

    Article  PubMed  Google Scholar 

  13. Cuénod CA, Laredo JD, Chevret S et al (1996) Acute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced and gadolinium-enhanced MR images. Radiology 199:541–549

    Article  PubMed  Google Scholar 

  14. Moulopoulos LA, Yoshimitsu K, Johnston DA et al (1996) MR prediction of benign and malignant vertebral compression fractures. J Magn Reson Imaging 6:667–674

    Article  CAS  PubMed  Google Scholar 

  15. Yuh WT, Zachar CK, Barloon TJ et al (1989) Vertebral compression fractures: distinction between benign and malignant causes with MR imaging. Radiology 172:215–218

    Article  CAS  PubMed  Google Scholar 

  16. McNeil BJ (1984) Value of bone scanning in neoplastic disease. Semin Nucl Med 14(4):277–286

    Article  CAS  PubMed  Google Scholar 

  17. Lecouvet FE, Vande Berg BC, Maldague BE et al (1997) Vertebral compression fractures in multiple myeloma. Part I. Distribution and appearance at MR imaging. Radiology 204:195–199

    Article  CAS  PubMed  Google Scholar 

  18. Fornasier V, Czitron A (1978) Collapsed vertebrae: a review of 659 autopsies. Clin Orthop 131:261–265

    PubMed  Google Scholar 

  19. Theodorou DJ (2001) The intravertebral vacuum cleft sign. Radiology 221:787–788

    Article  CAS  PubMed  Google Scholar 

  20. Malghem J, Maldague B, Labaisse MA et al (1993) Intravertebral vacuum cleft: changes in content after supine positioning. Radiology 187:483–487

    Article  CAS  PubMed  Google Scholar 

  21. Baur A, Stäbler A, Arbogast S et al (2002) Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging. Radiology 225:730–735

    Article  PubMed  Google Scholar 

  22. Libicher M, Appelt A, Berger I et al (2007) The intravertebral vacuum phenomenon as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol 17:2248–2252

    Article  PubMed  Google Scholar 

  23. Feng SW, Chang MC, Wu HT et al (2011) Are intravertebral vacuum phenomena benign lesions? Eur Spine J 20:1341–1348

    Article  PubMed Central  PubMed  Google Scholar 

  24. Stäbler A, Schneider P, Link TM et al (1999) Intravertebral vacuum phenomenon following fractures: CT study on frequency and etiology. J Comput Assist Tomogr 23:976–980

    Article  PubMed  Google Scholar 

  25. Kubota T, Yamada K, Ito H et al (2005) High-resolution imaging of the spine using multidetector-row computed tomography: differentiation between benign and malignant vertebral compression fractures. J Comput Assist Tomogr 29:712–719

    Article  PubMed  Google Scholar 

  26. Matin P (1979) The appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med 20:1227–1231

    CAS  PubMed  Google Scholar 

  27. Bredella MA, Essary B, Torriani M et al (2008) Use of FDG-PET in differentiating benign from malignant compression fractures. Skeletal Radiol 37:405–413

    Article  PubMed Central  PubMed  Google Scholar 

  28. Cho WI, Chang UK (2011) Comparison of MR imaging and FDG-PET/CT in the differential diagnosis of benign and malignant vertebral compression fractures. J Neurosurg Spine 14:177–183

    Article  PubMed  Google Scholar 

  29. Zhuang H, Sam JW, Chacko TK et al (2003) Rapid normalization of osseous FDG uptake following traumatic or surgical fractures. Eur J Nucl Med Mol Imaging 30:1096–1103

    Article  PubMed  Google Scholar 

  30. An HS, Andreshak TG, Nguyen C et al (1995) Can we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging? Spine (Phila Pa 1976) 20:1776–1782

    Article  CAS  Google Scholar 

  31. Baur A, Stabler A, Bruning R et al (1998) Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures. Radiology 207:349–356

    Article  CAS  PubMed  Google Scholar 

  32. Linn J, Birkenmaier C, Hoffmann RT et al (2009) The intravertebral cleft in acute osteoporotic fractures: fluid in magnetic resonance imaging-vacuum in computed tomography? Spine (Phila Pa 1976) 34(2):E88–E93

    Article  Google Scholar 

  33. Thawait SK, Kim J, Klufas RA et al (2013) Comparison of four prediction models to discriminate benign from malignant vertebral compression fractures according to MRI feature analysis. AJR Am J Roentgenol 200:493–502

    Article  PubMed  Google Scholar 

  34. Shih TT, Huang KM, Li YW (1999) Solitary vertebral collapse: distinction between benign and malignant causes using MR patterns. J Magn Reson Imaging 9:635–642

    Article  CAS  PubMed  Google Scholar 

  35. Ishiyama M, Fuwa S, Numaguchi Y et al (2010) Pedicle involvement on MR imaging is common in osteoporotic compression fractures. AJNR Am J Neuroradiol 31:668–673

    Article  CAS  PubMed  Google Scholar 

  36. Baur A, Huber A, Ertl-Wagner B et al (2001) Diagnostic value of increased diffusion weighting of a steady-state free precession sequence for differentiating acute benign osteoporotic fractures from pathologic vertebral compression fractures. AJNR Am J Neuroradiol 22:366–372

    CAS  PubMed  Google Scholar 

  37. Spuentrup E, Buecker A, Adam G et al (2001) Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body. AJR Am J Roentgenol 176:351–358

    Article  CAS  PubMed  Google Scholar 

  38. Chan JH, Peh WC, Tsui EY et al (2002) Acute vertebral body compression fractures: discrimination between benign and malignant causes using apparent diffusion coefficients. Br J Radiol 75:207–214

    Article  CAS  PubMed  Google Scholar 

  39. Zhou XJ, Leeds NE, McKinnon GC et al (2002) Characterization of benign and metastatic vertebral compression fractures with quantitative diffusion MR imaging. AJNR Am J Neuroradiol 23:165–170

    PubMed  Google Scholar 

  40. Maeda M, Sakuma H, Maier SE et al (2003) Quantitative assessment of diffusion abnormalities in benign and malignant vertebral compression fractures by line scan diffusion-weighted imaging. AJR Am J Roentgenol 181:1203–1209

    Article  PubMed  Google Scholar 

  41. Tang G, Liu Y, Li W (2007) Optimization of b value in diffusion-weighted MRI for the differential diagnosis of benign and malignant vertebral fractures. Skeletal Radiol 36:1035–1041

    Article  PubMed  Google Scholar 

  42. Balliu E, Vilanova JC, Peláez I et al (2009) Diagnostic value of apparent diffusion coefficients to differentiate benign from malignant vertebral bone marrow lesions. Eur J Radiol 69:560–566

    Article  CAS  PubMed  Google Scholar 

  43. Geith T, Schmidt G, Biffar A et al (2012) Comparison of qualitative and quantitative evaluation of diffusion-weighted MRI and chemical-shift imaging in the differentiation of benign and malignant vertebral body fractures. AJR Am J Roentgenol 199:1083–1092

    Article  PubMed  Google Scholar 

  44. Castillo M, Arbelaez A, Smith JK et al (2000) Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases. AJNR Am J Neuroradiol 21:948–953

    CAS  PubMed  Google Scholar 

  45. Finelli DA (2001) Diffusion-weighted imaging of acute vertebral compressions: specific diagnosis of benign versus malignant pathologic fractures. AJNR Am J Neuroradiol 22:241–242

    CAS  PubMed  Google Scholar 

  46. Eito K, Waka S, Naoko N et al (2004) Vertebral neoplastic compression fractures: assessment by dual-phase chemical shift imaging. J Magn Reson Imaging 20:1020–1024

    Article  PubMed  Google Scholar 

  47. Erly WK, Oh ES, Outwater EK (2006) The utility of in-phase/opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. AJNR Am J Neuroradiol 27:1183–1188

    CAS  PubMed  Google Scholar 

  48. Ragab Y, Emad Y, Gheita T et al (2009) Differentiation of osteoporotic and neoplastic vertebral fractures by chemical shift {in-phase and out-of phase} MR imaging. Eur J Radiol 72:125–133

    Article  PubMed  Google Scholar 

  49. Yuzawa Y, Ebara S, Kamimura M (2005) Magnetic resonance and computed tomography-based scoring system for the differential diagnosis of vertebral fractures caused by osteoporosis and malignant tumors. J Orthop Sci 10:345–352

    Article  PubMed  Google Scholar 

  50. Baker LL, Goodman SB, Perkash I et al (1990) Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging. Radiology 174:495–502

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 1st Department of Radiology, University of Athens School of Medicine, Athens, Greece

    Lia Angela Moulopoulos (Professor of Radiology and Chair) & Vassilis Koutoulidis (Assistant Professor of Radiology)

Authors
  1. Lia Angela Moulopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vassilis Koutoulidis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lia Angela Moulopoulos .

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Italia

About this chapter

Cite this chapter

Moulopoulos, L.A., Koutoulidis, V. (2015). Benign Versus Malignant Vertebral Fractures. In: Bone Marrow MRI. Springer, Milano. https://doi.org/10.1007/978-88-470-5316-8_8

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-5316-8_8

  • Published:

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5315-1

  • Online ISBN: 978-88-470-5316-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation