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Abstract
Differentiation between malignant and benign vertebral compression fractures is often problematic. This is particularly difficult in the elderly patients who are predisposed to benign compression fractures caused by osteoporosis, especially if there is a known primary malignancy elsewhere. Conventional MRI has been used to differentiate between benign and malignant compression fractures in many studies and reliable MRI criteria based on changes in the signal intensity, morphology and pattern of enhancement of the collapsed vertebra has been established. Homogeneous and diffuse abnormal signal intensity, posterior convexity, and involvement of pedicles are signs that are strongly suggestive of malignant compression fracture. Conversely, a band-like area of low signal intensity adjacent to the depressed endplate or preservation of signal intensity of the vertebra suggests benign nature of the collapse. When the findings are not completely conclusive, the use of additional MRI techniques such as diffusion, chemical shift, pattern of contrast enhancement may be helpful. The recent advent of multidetector-row computed tomography (MDCT) has provided extremely high-resolution images, including sagittal and coronal multiplanar reconstructions, and such images represent a conceivably promising tool for the evaluation of vertebral fractures. A malignant compression fracture on CT frequently shows destruction of the anterolateral or posterior cortical bone, cancellous bone and/or pedicle. Additionally, paraspinal and epidural masses, which are highly specific for malignant fractures, are well depicted on CT. Conversely, bone destruction is rare in benign compression fractures.