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Discrimination of Metastatic from Acute Osteoporotic Compression Spinal Fractures with MR Imaging¹  

¹ From the Departments of Diagnostic Radiology (H.S.J., W.H.J., K.H.C.) and Orthopedic Surgery (K.Y.H.), Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea; and the Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (T.R.M.). Presented as an education exhibit at the 2001 RSNA scientific assembly. Received March 1, 2002; revision requested May 10 and received June 17; accepted July 15. Address correspondence to W.H.J. (e-mail: whjee@cmc.cuk.ac.kr).

View larger version (170K): [in a new window]   Figure 1a.  Typical metastatic compression fracture in a 65-year-old man. (a) Sagittal T1-weighted MR image (400/11) shows a compression fracture with complete replacement of the normal bone marrow of the L1 vertebral body. A convex posterior cortex is present (arrows). There is a rounded metastatic focus within an adjacent noncollapsed vertebral segment at the level above the compression fracture. (b) Sagittal fast spin-echo T2-weighted MR image (3,000/96, echo train length of eight) shows that the L1 vertebral body is heterogeneously hypointense (arrows). (c) Sagittal fat-suppressed contrast material-enhanced T1-weighted MR image (550/11) shows homogeneous enhancement of the L1 vertebral body (arrows). The L1 vertebral body demonstrated heterogeneous enhancement on other sections. Note the enhancement of the metastatic focus at the vertebral level above the compression fracture. (d) Axial fat-suppressed contrast-enhanced T1-weighted MR image (400/14) shows a focal paraspinal mass (long arrows) and an anterior epidural mass (short arrows).

View larger version (165K): [in a new window]   Figure 1b.  Typical metastatic compression fracture in a 65-year-old man. (a) Sagittal T1-weighted MR image (400/11) shows a compression fracture with complete replacement of the normal bone marrow of the L1 vertebral body. A convex posterior cortex is present (arrows). There is a rounded metastatic focus within an adjacent noncollapsed vertebral segment at the level above the compression fracture. (b) Sagittal fast spin-echo T2-weighted MR image (3,000/96, echo train length of eight) shows that the L1 vertebral body is heterogeneously hypointense (arrows). (c) Sagittal fat-suppressed contrast material-enhanced T1-weighted MR image (550/11) shows homogeneous enhancement of the L1 vertebral body (arrows). The L1 vertebral body demonstrated heterogeneous enhancement on other sections. Note the enhancement of the metastatic focus at the vertebral level above the compression fracture. (d) Axial fat-suppressed contrast-enhanced T1-weighted MR image (400/14) shows a focal paraspinal mass (long arrows) and an anterior epidural mass (short arrows).

View larger version (160K): [in a new window]   Figure 1c.  Typical metastatic compression fracture in a 65-year-old man. (a) Sagittal T1-weighted MR image (400/11) shows a compression fracture with complete replacement of the normal bone marrow of the L1 vertebral body. A convex posterior cortex is present (arrows). There is a rounded metastatic focus within an adjacent noncollapsed vertebral segment at the level above the compression fracture. (b) Sagittal fast spin-echo T2-weighted MR image (3,000/96, echo train length of eight) shows that the L1 vertebral body is heterogeneously hypointense (arrows). (c) Sagittal fat-suppressed contrast material-enhanced T1-weighted MR image (550/11) shows homogeneous enhancement of the L1 vertebral body (arrows). The L1 vertebral body demonstrated heterogeneous enhancement on other sections. Note the enhancement of the metastatic focus at the vertebral level above the compression fracture. (d) Axial fat-suppressed contrast-enhanced T1-weighted MR image (400/14) shows a focal paraspinal mass (long arrows) and an anterior epidural mass (short arrows).

View larger version (146K): [in a new window]   Figure 1d.  Typical metastatic compression fracture in a 65-year-old man. (a) Sagittal T1-weighted MR image (400/11) shows a compression fracture with complete replacement of the normal bone marrow of the L1 vertebral body. A convex posterior cortex is present (arrows). There is a rounded metastatic focus within an adjacent noncollapsed vertebral segment at the level above the compression fracture. (b) Sagittal fast spin-echo T2-weighted MR image (3,000/96, echo train length of eight) shows that the L1 vertebral body is heterogeneously hypointense (arrows). (c) Sagittal fat-suppressed contrast material-enhanced T1-weighted MR image (550/11) shows homogeneous enhancement of the L1 vertebral body (arrows). The L1 vertebral body demonstrated heterogeneous enhancement on other sections. Note the enhancement of the metastatic focus at the vertebral level above the compression fracture. (d) Axial fat-suppressed contrast-enhanced T1-weighted MR image (400/14) shows a focal paraspinal mass (long arrows) and an anterior epidural mass (short arrows).

View larger version (155K): [in a new window]   Figure 2a.  Typical acute osteoporotic compression fracture in a 72-year-old woman. (a) Sagittal T1-weighted MR image (400/12) shows compression fractures of T12 and L1 with normal residual bone marrow signal intensity in the vertebral bodies. Retropulsion of a bone fragment (arrow) is present at the posterior portions of the vertebral bodies. (b) Sagittal turbo spin-echo T2-weighted MR image (3,200/99, echo train length of 11) shows that the collapsed vertebral bodies are relatively isointense to adjacent vertebrae. Hypointense bands (arrows) are present in the superior portions of the collapsed vertebrae. (c) Sagittal fat-suppressed contrast-enhanced T1-weighted MR image (432/12) shows heterogeneous enhancement (arrows). The low-signal-intensity bands are nonenhancing, but there is rimlike enhancement around these regions.

View larger version (154K): [in a new window]   Figure 2b.  Typical acute osteoporotic compression fracture in a 72-year-old woman. (a) Sagittal T1-weighted MR image (400/12) shows compression fractures of T12 and L1 with normal residual bone marrow signal intensity in the vertebral bodies. Retropulsion of a bone fragment (arrow) is present at the posterior portions of the vertebral bodies. (b) Sagittal turbo spin-echo T2-weighted MR image (3,200/99, echo train length of 11) shows that the collapsed vertebral bodies are relatively isointense to adjacent vertebrae. Hypointense bands (arrows) are present in the superior portions of the collapsed vertebrae. (c) Sagittal fat-suppressed contrast-enhanced T1-weighted MR image (432/12) shows heterogeneous enhancement (arrows). The low-signal-intensity bands are nonenhancing, but there is rimlike enhancement around these regions.

View larger version (161K): [in a new window]   Figure 2c.  Typical acute osteoporotic compression fracture in a 72-year-old woman. (a) Sagittal T1-weighted MR image (400/12) shows compression fractures of T12 and L1 with normal residual bone marrow signal intensity in the vertebral bodies. Retropulsion of a bone fragment (arrow) is present at the posterior portions of the vertebral bodies. (b) Sagittal turbo spin-echo T2-weighted MR image (3,200/99, echo train length of 11) shows that the collapsed vertebral bodies are relatively isointense to adjacent vertebrae. Hypointense bands (arrows) are present in the superior portions of the collapsed vertebrae. (c) Sagittal fat-suppressed contrast-enhanced T1-weighted MR image (432/12) shows heterogeneous enhancement (arrows). The low-signal-intensity bands are nonenhancing, but there is rimlike enhancement around these regions.

View larger version (141K): [in a new window]   Figure 3.  Unusual acute osteoporotic compression fracture with a convex posterior cortex of the vertebral body in a 77-year-old woman. Sagittal turbo spin-echo T2-weighted MR image (3,200/99, echo train length of 11) shows a convex posterior cortex (arrows) of the L1 vertebral body.

View larger version (144K): [in a new window]   Figure 4.  Unusual acute osteoporotic compression fracture with abnormal signal intensity of the pedicle and posterior element in an 89-year-old man. Axial fat-suppressed contrast-enhanced T1-weighted MR image (600/15) shows abnormal signal intensity of the right pedicle extending to the posterior element (arrows). There is a diffuse thin paraspinal mass.

View larger version (146K): [in a new window]   Figure 5.  Unusual acute osteoporotic compression fracture with an epidural mass in a 58-year-old man. Axial T1-weighted MR image (608/15) shows an anterior epidural mass (arrows).

View larger version (145K): [in a new window]   Figure 6.  Unusual metastatic compression fracture with a hypointense band in an 85-year-old man. Sagittal fast spin-echo T2-weighted MR image (3,000/96, echo train length of eight) shows a hypointense band (arrows) in the collapsed vertebral body of L2.