Magnetic resonance imaging differentiation of compression spine fractures or vertebral lesions caused by osteoporosis or tumor.

STUDY DESIGN: This study reviewed the magnetic resonance imaging characteristics of atraumatic compression fractures or vertebral lesions caused by osteoporosis of tumor.

OBJECTIVES: The purpose of this study was to evaluate the magnetic resonance imaging characteristics that will allow differentiation of compression fractures or vertebral lesions due to osteoporosis or tumor.

SUMMARY OF BACKGROUND DATA: Previous reports have identified several magnetic resonance imaging characteristics of benign and malignant compression fractures. However, diagnosis has been confirmed primarily by clinical follow-up and not pathologic biopsy specimen.

METHODS: Thirty-four cases of atraumatic compression fractures or vertebral lesions that had undergone magnetic resonance imaging evaluation followed by biopsy were retrospectively reviewed. Conventional magnetic resonance imaging with T1- and T2-weighted images were obtained in all cases and gadolinium was used in 21 cases. Each case was evaluated for magnetic resonance imaging characteristics of the compression fractures or vertebral lesions that included decreased T1 and increased T2 signal, marrow preservation on the T1 image, gadolinium lesion enhancement, multiple level involvement, associated soft tissue mass, posterior vertebral expansion, and pedicle involvement.

RESULTS: Eighteen of the compression fractures or vertebral lesions were confirmed as tumor and 16 were confirmed as osteoporosis by biopsy. Decreased T1- weighted and increased T2-weighted signals are sensitive but not specific for tumor involvement. Normal marrow preservation of the compressed vertebral body on T1 imaging is consistent with an osteoporotic fracture or lesion. Gadolinium enhancement, multiple level involvement, and posterior vertebral expansion are not useful for differentiation of osteoporotic from tumor fractures or lesions. Pedicle involvement or an associated soft tissue mass are specific for a tumor compression fracture or vertebral lesion.

CONCLUSIONS: There are characteristic magnetic resonance imaging findings of compression fractures or vertebral lesions that allow sensitive and specific differentiation of osteoporosis from tumor.