Malignant Vertebral Fractures Research Articles

Vertebroplasty and Kyphoplasty in the Treatment of Malignant Vertebral Fractures

SummaryThe purpose of this retrospective study was to assess the effectiveness and safety of Percutaneous Vertebroplasty and Kyphoplasty, in the treatment of pain deriving from neoplastic vertebral compression fractures (VCF).We treated 33 oncologic patients with these new techniques (2 pts with aggressive haemangiomas, 8 pts with myelomas and 23 pts with metastases) suffering from severe motion pain in the back, notwithstanding conservative treatment with medication and corset therapy, in the absence of neurological signs.In 3 selected patients we associated radiofrequency heat ablation with vertebroplasty in the treatment of metastases. The aim is to destroy tumor tissue and to thrombose the paravertebral and intravertebral venous plexus before stabilizing the vertebra.

Exploration for the optimal b value in diffusion-weighted MRI scanning for the differentiation between benign and malignant vertebral fractures

目的 探讨应用扩散加权成像(DWI)鉴别良、恶性椎体骨折时的最佳扩散敏感系数值(b值).方法22例椎体压缩性骨折病人分为良性组(10例,因骨质疏松或外伤引起)和恶性组(12例,转移瘤引起),行前瞻性矢状面MR扩散加权成像,用定性评分和定量计算信噪比(SNR)的方法来比较不同b值DWI的质量.二组患者病变椎体的表观扩散系数(ADC)值也做了对比.结果选用的b值越小,DWI的图像质量越清晰,定性评分值越高.在b值为0、100、200、300、400、500、600、700、800s/mm2时,图像SNR分别为22.7±3.4、24.6±3.6、22.2±3.2、19.2±2.6、10.3±2.1、8.8±2.7、6.8±2.7、5.8±1.7和5.8±2.1.各组间差异有非常显著性意义(F=150.13,P＜0.01).良、恶性椎体骨折ADC值的差异也有显著意义(P＜0.05).但在b值为0、100s/mm2的DWI中,4例良性椎体骨折误诊为恶性.结论当DWI应用于鉴别良、恶性椎体骨折时,最佳b值应为300s/mm2左右为宜.b值过大,使噪音本已较明显的DWI质量和SNR进一步降低,影响对病变的分析.b值过小,则降低DWI中水分子的扩散权重,易导致良性椎体骨折假阳性的发生。

Sensitivity and specificity of thallium-201 scintigraphy for the diagnosis of malignant vertebral fractures

Objective: To evaluate the accuracy of thallium-201 ( 201 TI ) scintigraphy in distinguishing a benign from a malignant recent non-traumatic vertebral fracture. Methods: Study design—Single center, prospective study. Participants—Patients hospitalized for a recent non-traumatic vertebral fracture. Evaluation—Usual clinical, laboratory and radiological assessment; 201 TI vertebral scintigraphy: patients were injected with iv 3 mCi 201 TI . Early and delayed images of the fractured vertebra were obtained. Data analysis—(1) Two examinators, unaware of the other findings, rated the images as hyperfixation or not of the fractured vertebra; (2) the ratio (average count per pixel of the fractured vertebra/normal adjacent vertebrae) were calculated. The final diagnosis was established on the result of vertebral biopsy or on follow-up. Results: Twenty-one patients were included. The final diagnosis was a benign vertebral fracture in 14 patients and a malignant vertebral fracture in 7. The sensitivity, specificity, positive and negative predictive values for a malignant fracture on early 201 TI vertebral scintigraphy images were 28.6, 92.9, 66.6, and 72.2%, respectively, and on delayed images were 28.6, 100, 100, and 73.7%, respectively. The ratio of lesioned over normal tissue was not increased in malignant, compared with benign fractures. Conclusion: The weak sensitivity does not support the wide use of 201 TI bone scintigraphy to distinguish a benign from a malignant recent non traumatic vertebral fracture. However, the high specificity suggests that such evaluation might be proposed prior to vertebral biopsy in some difficult cases.

Diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration of the vertebral body.

The aim of this study was to investigate diffusion-weighted MR imaging for differentiation of benign fracture edema and tumor infiltration with and without accompanying fracture. In 10 volunteers, diffusion-weighted spin-echo, fat-suppressed spin-echo, and stimulated-echo sequences were optimized on a clinical 1.5-T scanner. In 34 patients, MR imaging with and without diffusion-sensitizing gradients (b = 598 sec/mm(2) in spin-echo and fat-suppressed spin-echo, b = 360 sec/mm(2) in stimulated-echo) was performed. Thirty-five lesions were analyzed, with 18 caused by acute (< or =10 days old) osteoporotic or traumatic fractures and 17 caused by untreated malignant vertebral infiltration including nine fractures. Signal attenuation in diffusion-weighted images and contrast-to-noise ratio were calculated. The diffusion-weighted images were analyzed by two radiologists. Images from three of 34 patients were excluded because of motion artifact. In osteoporotic and traumatic fractures, a strong signal attenuation of bone marrow edema was seen. In contrast to this, malignant-tumor infiltration caused only minor signal attenuation (p < 0.05), independent of accompanying pathologic fracture. All sequences showed identical changes of signal intensities. In four patients, initial diagnosis was changed by the findings in the diffusion-weighted images. Diffusion-weighted spin-echo, fat-suppressed spin-echo, and stimulated-echo sequences are equally suitable for imaging of the spine. Calculation of signal attenuation and observation of signal characteristics allowed differentiation of benign fracture edema and tumor infiltration and provided excellent distinction between benign and malignant vertebral fractures in our series.

Diffusion-weighted magnetic resonance imaging of spinal bone marrow.

Diffusion-weighted (DW) imaging is an alternative source of image contrast. DW imaging enables to measure the random motion of free water protons on a molecular basis by using different imaging sequences including steady-state free precession imaging, navigated spin-echo DW imaging, and single-shot echo planar imaging. Analysis of intravoxel incoherent motion of water protons is a promising tool that has shown to be of value in the differential diagnosis between benign and malignant spontaneous vertebral fractures. Acute benign osteoporotic fractures show hypo- or isointense signal on DW sequences that reflects persistent free water proton mobility. With increasing diffusion strength a substantial signal loss is found. Metastatic fractures show hyperintensity compared with normal surrounding bone marrow probably due to altered water proton mobility within neoplasm. The ability of the different methods for DW imaging to differentiate other bone marrow alterations needs to be investigated in further studies.