Magnetic resonance imaging characteristics of benign and malignant vertebral fractures

Background: Attempts to differentiate benign and malignant vertebral fractures may be difficult, particularly when there is no obvious evidence of malignancy. Since early diagnosis and appropriate management of malignant vertebral fractures are important, a reliable imaging modality is required. Methods: From January 1996 to December 2002, 48 patients with malignant vertebral fractures and 50 patients with benign processes were studied. All patients underwent conventional magnetic resonance imaging (MRI) scanning for acute vertebral compression fractures within 2 months of presenting with the complaint. Seven MRI characteristics were used as criteria, including signal intensity, gadolinium enhancement, epidural compression, multiple compression fractures, associated paraspinal soft tissue mass, pedicle involvement, and posterior element involvement. The predictive value of each MRI characteristic for distinguishing malignant from benign osteoporotic vertebral fractures was tested by statistical analysis. Results: 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 probable malignant characteristics. Among them an associated paraspinal soft tissue mass was found to be significant in predicting the probability of malignancy. Conclusions: Certain MRI characteristics allow early differentiation of benign and malignant vertebral fractures.