Benign and Malignant Vertebral Fractures

Part of the Medical Radiology book series (MEDRAD)


Vertebral compression fractures are a common clinical problem, particularly in elderly patients. Osteoporosis is the most common cause in this age group. However, malignancy can also be a cause of vertebral collapse in the same age group. The diagnostic challenge is even greater when vertebral fractures are detected in patients with a history of cancer. In all these patients, determining the cause of vertebral collapse is crucial for the management, treatment planning and prognosis. The purpose of this chapter is to analyze the imaging features used to differentiate malignant from benign causes.


Vertebral Fracture Compression Fracture Vertebral Compression Fracture Vertebral Collapse Osteoporotic Compression Fracture 


  1. Allen RT, Kum JB, Weidner N, Hulst JB, Garfin SR (2009) Biopsy of osteoporotic vertebral compression fractures during kyphoplasty: unsuspected histologic findings of chronic osteitis without clinical evidence of osteomyelitis. Spine (Phila Pa 1976) 34(14):1486–1491CrossRefGoogle Scholar
  2. Baker LL, Goodman SB, Perkash I, Lane B, Enzmann DR (1990) Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical shift, and STIR MR imaging. Radiology 174(2):495–502PubMedGoogle Scholar
  3. Baur-Melnyk A (2009) Malignant versus benign vertebral collapse: are new imaging techniques useful? Cancer Imagig 9 (Spec No A): S49–S51Google Scholar
  4. Baur-Melnyk A, Reiser M (2004) Staging of multiple myeloma with MRI: comparison to MSCT and conventional radiography. Radiologe 44(9):874–881PubMedCrossRefGoogle Scholar
  5. Baur A, Stäbler A, Brüning R et al (1998) Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures. Radiology 201(2):349–356Google Scholar
  6. Baur A, Stäbler A, Arbogast S, Duerr HR, Bartl R, Reiser M (2002) Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging. Radiology 225(3):730–735PubMedCrossRefGoogle Scholar
  7. Castillo M, Arbelaez A, Smith JK, Fisher LL (2000) Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases. Am J Neuroradiol 21(5):948–953PubMedGoogle Scholar
  8. Chen WT, Shih TT, Chen RC et al (2002) Blood perfusion of vertebral lesions evaluated with gadolinium-enhanced dynamic MRI: in comparison with compression fracture and metastasis. J Magn Reson Imaging 15(3):308–314PubMedCrossRefGoogle Scholar
  9. Cuénod CA, Laredo JD, Chevret S et al (1996) Acute vertebral collapse due to osteoporosis or malignancy: appearance on unenhanced and gadolinium-enhanced MR images. Radiology 199(2):541–549PubMedGoogle Scholar
  10. Erly WK, Oh ES, Outwater EK (2006) The utility of in-phase/opposed-phase imaging in differentiating malignancy from acute benign compression fractures of the spine. Am J Neuroradiol 27(6):1183–1188PubMedGoogle Scholar
  11. Ishiyama M, Fuwa S, Numaguchi Y, Kobayashi N, Saida Y (2010) Am J Neuroradiol 31(4):668–673PubMedCrossRefGoogle Scholar
  12. Jung HS, Jee WH, McCauley TR, Ha KY, Choi KH (2003) Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics 23(1):179–187PubMedCrossRefGoogle Scholar
  13. Kaplan PA, Orton DF, Asleson RJ (1987) Osteoporosis with vertebral compression fractures, retropulsed fragments, and neurologic compromise. Radiology 165(2):533–535PubMedGoogle Scholar
  14. Laredo JD, Lakhdari K, Bellaïche L, Hamze B, Janklewicz P, Tubiana JM (1995) Acute vertebral collapse: CT findings in benign and malignant nontraumatic cases. Radiology 194(1):41–48PubMedGoogle Scholar
  15. Ledermann HP, Schweitzer ME, Morrison WB, Carrino JA (2003) MR imaging findings in spinal infections: rules or myths? Radiology 228(2):506–514PubMedCrossRefGoogle Scholar
  16. Mulligan M, Chirindel A, Karchevsky M (2011) Characterizing and predicting pathologic spine fractures in myeloma patients with FDG PET/CT and MR imaging. Cancer Invest 29(5):370–376PubMedCrossRefGoogle Scholar
  17. Oka M, Matsusako M, Kobayashi N, Uemura A, Numaguchi Y (2005) Intravertebral cleft sign on fat-suppressed contrast-enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty. Acad Radiol 12(8):992–999PubMedCrossRefGoogle Scholar
  18. Rea JA, Steiger P, Blake GM, Fogelman I (1998) Optimizing data acquisition and analysis of morphometric X-ray absorptiometry. Osteoporos Int 8(2):177–183PubMedCrossRefGoogle Scholar
  19. Resnick DL (1982) Fish vertebrae. Arthritis Rheum 25(9):1073–1077PubMedCrossRefGoogle Scholar
  20. Rupp RE, Ebraheim NA, Coombs RJ (1995) Magnetic resonance imaging differentiation of compression spine fractures or vertebral lesions caused by osteoporosis or tumor. Spine 20(23):2499–2504PubMedCrossRefGoogle Scholar
  21. Schoenfeld AJ, Dinicola NJ, Ehrler DM et al (2008) Retrospective review of biopsy results following percutaneous fixation of vertebral compression fractures. Injury 39(3):327–333PubMedCrossRefGoogle Scholar
  22. Shih TT, Huang KM, Li YW (1999) Solitary vertebral collapse: distinction between benign and malignant causes using MR patterns. J Magn Reson Imaging 9(5):635–642PubMedCrossRefGoogle Scholar
  23. Shindle MK, Tyler W, Edobor-Osula F et al (2006) Unsuspected lymphoma diagnosed with use of biopsy during kyphoplasty. J Bone Joint Surg Am 88(12):2721–2724PubMedCrossRefGoogle Scholar
  24. Stäbler A, Reiser MF (2001) Imaging of spinal infection. Radiol Clin North Am 39(1):115–135PubMedCrossRefGoogle Scholar
  25. Stäbler A, Schneider P, Link TM et al (1999) Intravertebral vacuum phenomenon following fractures: CT study on frequency and etiology. J Comput Assist Tomogr 23(6):976–980PubMedCrossRefGoogle Scholar
  26. Sugimura K, Yamasaki K, Kitagaki H, Tanaka Y, Kono M (1987) Bone marrow diseases of the spine: differentiation with T1 and T2 relaxation times in MR imaging. Radiology 165(2):541–544PubMedGoogle Scholar
  27. Tan SB, Kozak JA, Mawad ME (1991) The limitations of magnetic resonance imaging in the diagnosis of pathologic vertebral fractures. Spine 16(8):919–923PubMedCrossRefGoogle Scholar
  28. Tan DY, Tsou IY, Chee TS (2002) Differentiation of malignant vertebral collapse from osteoporotic and other benign causes using magnetic resonance imaging. Ann Acad Med Singapore 31(1):8–14PubMedGoogle Scholar
  29. Uetani M, Hashmi R, Hayashi K (2004) Malignant and benign compression fractures: differentiation and diagnostic pitfalls on MRI. Clin Radiol 59(2):124–131PubMedCrossRefGoogle Scholar
  30. Yuh WT, Zachar CK, Barloon TJ, Sato Y, Sickels WJ, Hawes DR (1989) Vertebral compression fractures: distinction between benign and malignant causes with MR imaging. Radiology 172(1):215–218PubMedGoogle Scholar
  31. Yuzawa Y, Ebara S, Kamimura M et al (2005) 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(4):345–352PubMedCrossRefGoogle Scholar
  32. Zampa V, Cosottini M, Michelassi C, Ortori S, Bruschini L, Bartolozzi C (2002) Value of opposed-phase gradient-echo technique in distinguishing between benign and malignant vertebral lesions. Eur Radiol 12(7):1811–1818PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg  2013

Authors and Affiliations

  1. 1.Hinchingbrooke Hospital NHS TrustHuntingdonUK

Personalised recommendations