Abstract

Background: Discriminating pathological from osteoporotic vertebral compression ‎a fracture is sometimes challenging.‎

Aim: to create scoring system using several MRI signs, trying to correctly ‎differentiate osteoporotic from malignant compression vertebral fractures.‎

Patients and method: a prospective case control analytic study was performed in ‎MRI unite of Al-Imamain Al-Kadhemain Medical City/ Baghdad/Iraq, 68 patients (24 ‎male and 44 female) were included, all were presenting with acute back pain and ‎vertebral compression fracture on x ray. MRI was done within 2 months from ‎symptom onset and follow up for at least 4-6 weeks. A 9 MRI signs were evaluated in ‎terms of sensitivity, specificity and accuracy in diagnosis of malignant fractures. A ‎stepwise analysis was used to create a scoring system to differentiate malignant from ‎osteoporotic vertebral compression fractures.‎

Results: Malignant vertebral fracture was diagnosed in 13 patients and osteoporotic ‎vertebral fracture 55 patients. All used MRI signs had a variable specificity and ‎sensitivity for diagnosis of malignant fractures but all are statistically significant ‎except one. Mean score for patients with MVF was 3.5 (range of 3-6), while Mean ‎score in patients with OVF was 2.1 (range of 0-4). The optimum score cutoff value ‎was 4 with 61.5% sensitivity, 81.8% specificity, 79.4% accuracy and statistically ‎significant (P-value=0.012) for the discrimination of malignant from osteoporotic ‎vertebral compression fractures.‎

Conclusion: Convex posterior vertebral border, asymmetrical diffuse or rounded ‎abnormal bone marrow signal, involvement of the pedicle, and para-vertebral soft ‎tissue mass are highly suggestive MRI sign of malignant fracture. Post contrast ‎enhancement is not a specific sign. Fluid cleft sign is suggestive of osteoporotic ‎fracture. This simple scoring system could be useful tool for the differentiation of ‎malignant and osteoporotic vertebral fractures with the best accurate cutoff value is ‎‎4. ‎

Keywords: Magnetic resonance imaging, malignant vertebral compression fracture, ‎Osteoporotic vertebral compression fracture. ‎