Malignant:
Low signal on T1, bright on T2 and STIR
Convex bulge of the posterior cortex
Involvement of pedicle
Epidural mass
Paraspinal soft tisssue mass
Marked, inhomogenous enhancement
Benign:
Band of low signal on T1 adjacent to the endplate
Atleast one area of normal signal within collapsed vertebra
Linear low signal indicative of fracture on non-fat sat T2 sagittal
Low on T1, iso on T2
Partial or complete euql enhancement in relation with adjancent normal vertebra
Fluid signal adjacent to end plate - focal, linear or traingular - on STIR
Retropulsion of posterosuperior aspect into spinal canal - highly specific (100%), sensitivity - 16%
Chronic fracture - normal signal on T1 and T2 with mild enhancement
Intravertebral vacuum cleft - suggestive of AVN - suggests benign
Pitfall:
Multiple myeloma - appear like benign on MR
Acute fracture may mimic malignant fractures on MR
References:
Uetani M et al. Malignant and benign compression fractures: differentiation and diagnostic pitfalls on MRI. Clinical Radiology. Volume 59, Issue 2, February 2004, Pages 124-131
