Differential Diagnosis Of Primary Osteoporotic Vertebrae Compression Fractures And Metastasis Vertebrae Compression Fractures On Conventional X-ray And MRI

Objective:To investigate the findings and diagnostic value of X-ray,MRI imaging in the diagnosis of primary osteoporotic vertebrae compression fractures and metastasis vertebrae compression fractures.Methods:A total of 100 vertebral compression fractures of 82 patients who underwent X-ray and MRI examinations from 2000 to 2011 were analyzed retrospectively, among which there were 50 osteoporotic vertebrae compression fractures of 40 patients, and 50 metastasis vertebrae compression fractures of 42 patients. The X-ray and MRI characteristics were investigated:(1) The shape and distribution of abnormal compressive vertebral bodies; (2) The shape of poster-border of compressive vertebral bodies; (3) Signal intensity increasing ratio after contrast enhancement; (4) shape of pedicles; (5) Paravertebral soft tissue masses. All statistics were carried out through SPSS 13.0.Results:Among the osteoporotic vertebrae compression fractures on conventional X-ray (50 vertebrae), the wedge-shaped vertebral bodies accounted for 16%(8/50) and the depressed vertebral bodies 66%(33/50). On conventional MRI (50 vertebrae), the retropulsion of superior angles of posterior cortexes of the vertebrae accounted for 98%(49/ 50), the ring-shaped paravertebral soft tissue masses 14%(7/50), the restricted low signals on T1WI 38%(19/50) and the hyper intense signals on T2WI with fat saturation 58%(29/ 50); the pedicle display was normal; the intravertebral fluid sign was present in 2 vertebrae.In the metastasis vertebrae compression fractures on conventional X-ray (20 vertebrae), two out of four types of bone metastasis were found with osteolytic lesions accounting for 80%(16/20), and osteogenic lesions 20%(4/20). On conventional MRI (50 vertebrae), the wedgerear vertebral bodies accounted for 10%(5/50), the bulging posterior edges of the vertebrae 96%(48/50), the anomalnodosity of paravertebral soft tissue masses 74% (37/50), the diffuse low signals on T1WI 82%(41/50) and the hyper intense signals on T2WI with fat saturation 92%(46/50); the signals were enhanced after another injection of Gd DT PA1; the pedicle expansion was displayed with high signal intensity in T2WI.Conclusion:1,X-ray is still the first choice, and MRI examination has important clinic value in diagnosis of bone metastases.2,The most important MRI characteristics for differentiation of primary osteoporotic and metastasis vertebrae compression fractures are the bulging of the posterior edges and the retropulsion of superior angles of posterior cortexes of the vertebrae.3,The routine X-ray film and MRI scan are complementary in the diagnosis of osteoporotic and metastasis compression fracture vertebrae.