Malignant compression fractures:
Morhological features:
Convex bulge involving posterior cortex (70% sensitive and 94% specific)
Involvement of pedicles (80% sensitive and 94% specific)
Presence of epidural (80% sensitive and 100% specific) mass
Paraspinal soft tissue
Signal:
T1-diffuse low signal
T2-iso-to-high signal
Enhance post Gd
Benign compression fractures:
Morphological features:
Retropulsion of posterior fragment (often posterosuperior) (100% specific, 16% sensitive)
Signal features:
T1 - focal band of low signal adjacent to end plate
T2 - overall vertebra is iso with adjacent non-fractured bone with focal low signal band of fracture
STIR - 'fluid sign' - linear or traingular area of high signal adjacent to endplate - in acute and subacute compression fractures and rarely seen in malignant fractures
Post Gd - 'return of normal signal', i.e., enhances same as adjacent vertebrae
At least one normal signal area is seen, usually opposite the fractured end plate
Gradually return to normal signal as adjacent vertebrae with aging (after 2-4 months)
Vacuum cleft is suggestive of benign pathology, seen as low signal on T1, low signal (before 10 min of supine) or high signal (after 10 min supine) on T2
References:
Uetani M et al. Malignant and benign compression fractures: differentiation and diagnostic pitfalls on MRI . Clin Rad 2004: 124-131
