ECR 2012 / C-0444
Differentiation of osteoporosis from metastasis in the vertebral fracture using chemical shift and diffusion weighted imaging
Type:
Educational Exhibit
Keywords:
Osteoporosis, Metastases, Imaging sequences, MR, Neuroradiology spine, Musculoskeletal spine
Authors:
H. T. Koay, R. Dutta, M. George; Singapore/SG
DOI:
10.1594/ecr2012/C-0444
Background
- Benign vertebral lesions can occur in cancer patients.
- Metastatic vertebral lesions frequently account for bony metastases in patients with primary neoplasm.
- Differentiation between malignant and benign vertebral compression fracture in acute setting is difficult especially for patients known with or suspected primary neoplasm.
- Routine MRI of the spine typically includes T1-weighted,
T2-weighted and FSEIR sequences,
may provide useful evaluation of the benign and malignant vertebral fracture based on morphological features.
- Lesions with negative gadolinium enhancement were favored as benign fractures.
A uniform signal change in multiple involved vertebra lesions,
round,
smooth margins with marked epidural compression,
a paraspinal soft tissue mass,
and pedicle and posterior element involvement were favored as malignant fractures.
An associated paraspinal soft tissue mass was found to be significant in predicting the probability of malignancy.
(Fu TS,
Chen LH,
Liao JC,
Lai PL,
Niu CC,
Chen WJ.
Magnetic resonance imaging characteristics of benign and malignant vertebral fractures.
Chang Gung Med J. 2004 Nov;27(11):808-15)
- Despite the use of these features,
there may be an overlap between benign fractures from malignant fractures
- Non routine MRI pulse sequences such as chemical shift and diffusion weighted imaging are increasingly used recently for further evaluation.