Skip to main content

Advertisement

Log in

Magnetic resonance and computed tomography-based scoring system for the differential diagnosis of vertebral fractures caused by osteoporosis and malignant tumors

  • Original article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Previous reports have described magnetic resonance imaging (MRI) findings alleged to be specific for vertebral fractures caused by malignant lesions. Using such findings for differential diagnosis is often difficult, especially during the early phase of the fracture. With the relative inaccuracy of any single imaging finding, a validated scoring system based on a combination of imaging findings might lead to enhanced diagnostic accuracy. The purpose of this study was to establish a diagnostic scoring system for discriminating osteoporotic vertebral fractures from those caused by malignant tumors on the basis of MRI and computed tomography (CT) findings.

Methods

Ten MRI and CT scan findings of 57 osteoporotic vertebral fractures and 43 neoplastic fractures were retrospectively evaluated for their ability to discriminate between malignant and benign vertebral fractures.

Results

The following four MRI and two CT findings were selected as the basis for the scoring system: pedicle or other posterior element involvement; extension into the paravertebral region; preservation of normal bone marrow signal; a continuous black line representing the posterior vertebral body margin on T2-weighted MRI images; osteolytic destruction; and distinct fracture lines on CT.

Conclusion

By combining the findings common to MRI and CT scans of vertebral fractures, a simple scoring system was devised. This scoring system was found to enhance the accuracy of imaging diagnosis of fractures caused by benign or malignant spinal lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. HS An TG Andreshak C Nguyen A Williams D Daniels (1995) ArticleTitleCan we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging? Spine 20 1776–82 Occurrence Handle1:STN:280:DyaK28%2FjsVKitA%3D%3D Occurrence Handle7502133 Occurrence Handle10.1097/00007632-199508150-00005

    Article  CAS  PubMed  Google Scholar 

  2. RE Rupp NA Ebraheim RJ Coombs (1995) ArticleTitleMagnetic resonance imaging differentiation of compression spine fractures or vertebral lesions caused by osteoporosis or tumor Spine 20 2499–503 Occurrence Handle10.1097/00007632-199512000-00007 Occurrence Handle1:STN:280:DyaK287ptlansQ%3D%3D Occurrence Handle8610244

    Article  CAS  PubMed  Google Scholar 

  3. LL Baker SB Goodman I Perkash B Lane DR Enzmanm (1990) ArticleTitleBenign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging Radiology 174 495–502 Occurrence Handle1:STN:280:DyaK3c7hs1CjsQ%3D%3D Occurrence Handle2296658

    CAS  PubMed  Google Scholar 

  4. CA Cuenod JD Laredo S Chevret B Hamze JF Naouri X Chapaux et al. (1996) ArticleTitleAcute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced and gadolinium- enhanced MR images Radiology 199 541–9 Occurrence Handle1:STN:280:DyaK283gt1Oquw%3D%3D Occurrence Handle8668809

    CAS  PubMed  Google Scholar 

  5. TT Shih KM Huang YW Li (1999) ArticleTitleSolitary vertebral collapse: distinction between benign and malignant causes using MR patterns J Magn Reson Imating 9 635–42 10.1002/(SICI)1522-2586(199905)9:5<635::AID-JMRI4>3.0.CO;2-E Occurrence Handle10.1002/(SICI)1522-2586(199905)9:5<635::AID-JMRI4>3.0.CO;2-E Occurrence Handle1:STN:280:DyaK1M3mtVKjsw%3D%3D

    Article  CAS  Google Scholar 

  6. R Ashizawa K Ohtsuka M Kamimura S Ebara K Takaoka (1999) ArticleTitlePercutaneous transpedicular biopsy of thoracic and lumbar vertebrae-method and diagnostic validity Surg Neurol 52 545–51 10.1016/S0090-3019(99)00154-8 Occurrence Handle10.1016/S0090-3019(99)00154-8 Occurrence Handle1:STN:280:DC%2BD3c7itlCitw%3D%3D Occurrence Handle10660019

    Article  CAS  PubMed  Google Scholar 

  7. GJ McLachlan (1992) Discriminant analysis and statistical pattern recognition Wiley-Interscience New York Occurrence Handle10.1002/0471725293

    Book  Google Scholar 

  8. M Yamato G Nishimura E Kuramochi N Saiki M Fujioka (1998) ArticleTitleMR appearance at different ages of osteoporotic compression fractures of the vertebrae Radiat Med 16 329–34 Occurrence Handle1:STN:280:DyaK1M%2Fns12luw%3D%3D Occurrence Handle9862153

    CAS  PubMed  Google Scholar 

  9. LA Moulopoulos K Yoshimitsu DA Johnston NE Leeds HI Libshitz (1996) ArticleTitleMR prediction of benign and malignant vertebral compression fractures J Magn Reson Imaging 6 667–74 Occurrence Handle10.1002/jmri.1880060416 Occurrence Handle1:STN:280:DyaK28vjt12gsQ%3D%3D Occurrence Handle8835961

    Article  CAS  PubMed  Google Scholar 

  10. WT Yuh CK Zachar TJ Barloon Y Sato WJ Sickels DR Hawes (1989) ArticleTitleVertebral compression fractures: distinction between benign and malignant causes with MR imaging Radiology 172 215–8 Occurrence Handle1:STN:280:DyaL1M3psleqsA%3D%3D Occurrence Handle2740506

    CAS  PubMed  Google Scholar 

  11. A Baur A Stabler R Bruning R Bartl A Krodel M Reiser et al. (1998) ArticleTitleDiffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures Radiology 207 349–56 Occurrence Handle1:STN:280:DyaK1c3jvVensg%3D%3D Occurrence Handle9577479

    CAS  PubMed  Google Scholar 

  12. M Castillo A Arbelaez JK Smith LL Fisher (2000) ArticleTitleDiffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases AJNR Am J Neuroradiol 21 948–53 Occurrence Handle1:STN:280:DC%2BD3c3ntlSqtQ%3D%3D Occurrence Handle10815675

    CAS  PubMed  Google Scholar 

  13. M Iwabuchi S Kikuchi K Sato (1997) ArticleTitleAn anatomic study of black line in the lumbar spine on magnetic resonance imaging J Jpn Spine Res Soc 8 152

    Google Scholar 

  14. JD Laredo K Lakhdari L Bellaiche B Hamze P Janklewicz JM Tubiana (1995) ArticleTitleAcute vertebral collapse: CT findings in benign and malignant nontraumatic cases Radiology 194 41–8 Occurrence Handle1:STN:280:DyaK2M%2FptVWgug%3D%3D Occurrence Handle7997579

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Yuzawa, Y., Ebara, S., Kamimura, M. et al. Magnetic resonance and computed tomography-based scoring system for the differential diagnosis of vertebral fractures caused by osteoporosis and malignant tumors. J Orthop Sci 10, 345–352 (2005). https://doi.org/10.1007/s00776-005-0910-z

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-005-0910-z

Keywords

Navigation