Radiiollogiicall approach for Diiscriimiinattiion of Beniign from Malliignantt Verttebrall Compressiion Fracttures

Abstract

Differentiating between malignant and benign vertebral compression fractures can represent a diagnostic challenge, particularly when there is no obvious history of primary malignancy. Especially in elderly patients, who are predisposed to senile osteoporosis and malignant disease. Plain radiographs are the initial imaging study obtained for a suspected compression fracture. However, it is limited by its non specificity. MR imaging is the first choice among diagnostic imaging modalities. Reliable MR imaging criteria are based on the changes in the signal intensity and morphological characteristics of the collapsed vertebrae. Such findings as posterior cortical bulging, epidural mass formation, and pedicle enhancement have strong implication for malignancy. Despite the use of these features, there is still considerable overlap in the signal changes from acute to sub-acute fractures from malignant fractures. DWI proved a greatest success in the differentiation between benign and malignant VCF, it shows tendency to hypointensity in benign vertebral fractures and to hyperintensity in malignant fractures. For equivocal vertebral fracture cases, additional DWI data can add to diagnostic confidence. Moreover, ADC measures may be useful if associated to the qualitative analysis of the images. In-phase/opposed-phase imaging is more specific in identifying benign lesion of the spine than DWI or a useful supplement to DWI in assessing problematic vertebral body lesions as SIR (opposed/in) has very high accuracy. 120