Copyrights © 2012 The Korean Society of Radiology Purpose: The purpose of this study was to evaluate the significance of the presence of adjacent rib involvement in osteoporotic compression fractures. Materials and Methods: All the patients with acute osteoporotic compression fractures of the thoracic spine on thoracic spine MRI that presented to our clinic between September 2003 and January 2010 were retrospectively reviewed. All the vertebrae were divided into two groups: those that showed signal-intensity change in the rib adjacent to the compression fracture and those that did not. We compared the results between the two groups to determine if there were differences in the degree of osteoporosis, the compression fracture level and the age of patients between the two groups. We calculated the degree of correlation between the MRI and the bone scan images of these patients. We also reviewed whether percutaneous vertebroplasty relieved symptoms or not. Results: Signal-intensity changes were found in the adjacent rib(s) in 12 of the 60 patients and in 14 of the 94 levels (the total number of levels). The MRI and bone scan showed significant correlation (p < 0.001). There was a statistically significant difference in the incidence of pain at the one-month outpatient follow-up between the two groups (p = 0.0215). Conclusion: The radiologist should comment on the presence or absence of adjacent rib involvement when reporting on the thoracic spine MRI of patients suffering from osteoporotic compression fractures in order to more accurately determine prognosis. Index terms Osteoporosis Compression Fracture Vertebroplasty MRI Thoracic Spine Rib Involvement The Clinical Significance of Adjacent Rib Involvement on MRI in Patients with Acute Osteoporotic Compression Fractures of the Thoracic Spine 급성 골다공증성 흉추압박골절 환자에서 동반된 늑골 침범의 임상적 의의