Discrimination of Malignant from Acute Benign Compression Spinal Fractures with Magnetic Resonance imaging

Abstract

Background: Differentiation between malignant and benign vertebral compression fracture is often problematic. This is precisely difficult in elderly who are predisposed to benign compression caused by osteoporosis .Establishing correct diagnosis is of great importance in determining the treatment andprognosis.A study was performed to determine which magnetic resonance imaging findings are useful in discrimination between metastatic and acute osteoporotic compression fractures of the spine. Recently MRI is being increasingly used for evaluation of these fractures.Objectives: The aim of this study is to establish the correct diagnosis of malignant and benign compression vertebral fracture by MRI to determine treatment and prognosis.Methods: MRI of (45 )patients with vertebral compression fracture who underwent MRI of spine during 2 years period ( 2004-2006) in Neuro surgical hospital were retrospectively reviewed by an expedient radiologist , A collapsed vertebra were considered to be acute if there was recent history of back pain of less than 3moths. All MRI sequences needed for spine examination was done( T1WI SE, T2WI GE STIR, and Mylography ) and Gadolinium contrast medium was given to all patients..Results: Of total 45 patients (31male, 14 female, their age range between 18-72years) , The criteria used to differentiate between benign andmalignant collapse spine on MRI was based on the signal intensity, morphology and contrast enhancement for the correct diagnosis. Homogenous and diffuse abnormal signal intensity, posterior convexity and involvement of pedicles are sign that are strongly suggestive of malignant collapse .Conversely, a band like area of low signal intensity adjacent to depressed end plateand preservation of signal intensity of vertebra suggest benign nature of the collapse.Conclusions: We found that MRI features is helpful in differentiation of malignant and benign compression fractures in majority of cases, and if initial MRI finding are equivocal correlation with other images technique, follow up and biopsy in selected cases helpful in arriving correct diagnosis