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Magnetic Resonance Imaging (MRI) based scoring system to differentiate solitary osteoporotic from malignant vertebral compression fractures | ||
| Iraqi Postgraduate Medical Journal | ||
| Article 13, Volume 24, Issue 3, July 2025, Pages 405-411 PDF (790.06 K) | ||
| Document Type: Research Paper | ||
| DOI: 10.52573/ipmj.2025.148606 | ||
| Authors | ||
| Mohammed Abd kadhim* 1; Haneen Hussain‎ Sahib2 | ||
| 1Iraqi board of medical specilization/ Medical collage/ Al-Nahrain ‎University.‎ Baghdad- Iraq‎ | ||
| 2Radiolkogy department, Al-nrain university, Baghdad/ Iraq | ||
| 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. | ||
| Keywords | ||
| Magnetic resonance imaging; malignant vertebral compression fracture; Osteoporotic vertebral compression fracture&lrm | ||
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