Osteoporotic or malignant vertebral fracture? This is the question. What can we do about it?

ReviewThe differentiation between benign and malignant vertebral compression fractures is a daily encountered problem particularly in elderly patients. It is important to differentiate between malignant and osteoporotic compression fractures.Aim of the workTo study the different MRI signs allowing to differentiate between benign and malignant vertebral fractures.MethodsA total number of 150 collapsed vertebrae (120 patients) were collected during a period of 40 months. All were subjected to MRI evaluation. For half of patients diffusion weighted imaging was performed. Biopsy was taken from 45 vertebrae.ResultsAverage age of patients was 65 ± 2.3 years. The ratio of men to women was 1:1. Metastases were seen in 70 and osteoporosis in 80 vertebrae.Signs that showed statistically significant value were Water line sign and sharp wedging in favor of osteoporotic fractures and pedicle involvement, non signal drop in out of phase sequence, homogenous T1 hypointensity and restriction in DWI favoring malignancy.ConclusionsSeveral signs are found to favor osteoporotic or malignant vertebral fractures. Chemical shift and DWI are strong allies to morphological signs in differentiating between both entities. Depending on a group of signs rather than one sign alone would increase the diagnostic accuracy.