Abstract
BackgroundVarious types of magnetic resonance imaging (MRI) and computed tomography (CT) findings are used to differentiate malignant vertebral fractures (MVFs) from osteoporotic vertebral fractures (OVFs). The distinguishing ability of any single finding is limited. This study developed a novel scoring system that integrates multiple MRI and CT signs for improved accuracy of differential diagnosis between MVFs and OVFs.MethodsA total of 150 MVFs and 150 OVFs in thoracolumbar vertebrae were analyzed. MRI and CT images were obtained within 2 months of the probable time of fracture. The sensitivity and specificity of 15 MRI and CT image findings were evaluated. A stepwise discriminant analysis using these signs as variables was used to create a scoring system to differentiate MVFs from OVFs.ResultsAll 15 image findings had strong specificity and moderate sensitivity. Seven MRI and three CT image findings were selected and assigned integral values in the final scoring system. A total score of 4 or greater points indicated MVF, whereas a total score of 3 or fewer points indicated OVF. The classification accuracy was 98.3% in the test set.ConclusionsThis novel scoring system using MRI and CT radiologic findings to differentiate MVFs from OVFs in Chinese patients was efficient with high accuracy and good applicability.
Highlights
Various types of magnetic resonance imaging (MRI) and computed tomography (CT) findings are used to differentiate malignant vertebral fractures (MVFs) from osteoporotic vertebral fractures (OVFs)
Multiple-image findings are utilized to distinguish between MVFs and OVFs [1, 3, 4, 9, 10]
All OVF and MVF cases contained in the electronic records archives of the department of spine surgery for the period January 2013 to March 2018 were included in the study
Summary
Various types of magnetic resonance imaging (MRI) and computed tomography (CT) findings are used to differentiate malignant vertebral fractures (MVFs) from osteoporotic vertebral fractures (OVFs). This study developed a novel scoring system that integrates multiple MRI and CT signs for improved accuracy of differential diagnosis between MVFs and OVFs. Vertebral fractures caused by benign or malignant lesions are common among the elderly. Common features of osteoporotic vertebral fracture (OVF) and malignant vertebral fracture (MVF), including age group, clinical symptoms, and history of inadequate trauma, make differential diagnosis challenging. Modern radiological imaging techniques, including magnetic resonance imaging (MRI) and computed tomography (CT), have good predictive value for differential diagnosis. Single-image findings have limited distinguishing ability and are not considered sufficiently sensitive or specific, such as fluid sign and pedicle involvement [1, 11, 12]. Misdiagnosis or delayed diagnosis of MVF is not uncommon in clinical practice, potentially due in part to
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