Mri Differential Diagnosis Of Vertebral Compression Fractures Due To Osteoporosis And Metastatic Tumor

Objective To investigate the differential diagnosis between osteoporotic compression fractures and metastatic compression fractures of the spine. Methods MRI films of50cases with osteoporotic compression fractures and50cases with metastatic compression fractures (all showing abnormal signal) confirmed pathologically or clinically were retrospectively reviewed with all MRI features analyzed, recorded and compared. Results In105compressive vertebrae caused by osteoporosis,1was focal-concave,5showed convex bulge of the posterior borders,1displayed enlarged anterior-posterior diameter (>2mm) in the middle part of the vertebral body,10demonstrated angles slightly protruding the posteriosuperior or posterioinferior border,13showed anterior-superior and/or anterior-inferior corners of vertebral body protruding forward,31displayed retropulsion of the posterior-superior and/or posterior-inferior corners into the spinal canal. Ninety-two were type-Ⅰ with abnormal signal in partial vertebral body,13were type-Ⅱ with abnormal signal in the whole vertebral body. On T2WI or fat-suppressed T2WI,32demonstrated abnormal signal line (almost anterior-posterior distrubuted or unlined). Fifteen displayed abnormal signal in unilateral or bilateral pedicles. Nine showed abnormal soft tissue mass beyond the anterior and lateral borders with the thickness less than5mm on axial image. In62compressive vertebrae due to metastatic tumor,6were focal-concave,50showed convex bulge of the posterior borders,38showed convex bulge of the anterior borders,48displayed enlarged anterior-posterior diameter (>2mm) in the middle part of the vertebral body,2showed retropulsion of posterior-superior corners. Eight were type-Ⅰ,54were type-Ⅱ. On T2WI or fat-suppressed T2WI,3showed anterior-posterior distrubuted low signal,15displayed arc-like abnormal signal lines,25revealed multiple scattered patchy higher signal on fat-suppressed T2WI. Unilateral or bilateral pedicles were involved in36,26were accompanied by enlargement of involved pedicles,20showed the involved appendix behind the pars interarticularis. Sixteen demonstrated abnormal soft tissue beyond the anterior and lateral margin, the thickness was more than5mm on axial image,18displayed soft tissue mass located in the juncture of vertebral body and the appendix with the thickness more than10mm. Nine demonstrated crescent-shaped soft tissue mass on neighboring appendix. Significant difference in the above items existed between the two groups (P<0.05). Conclusion: MRI reveals many different signs between osteoporotic compression fractures and metastatic compression fractures, the differential diagnosis can be made in most patients.