[The nuclear magnetic resonance tomographic differentiation of osteoporotic and tumor-related vertebral fractures. The value of subtractive TR gradient-echo sequences, STIR sequences and Gd-DTPA].
42 patients with known malignancy and vertebral compressions underwent MRI. Sagittal T1-weighted spin-echo images pre and post Gd-DTPA, out of phase long TR gradient-echo images (GE) and short T1 inversion recovery images (STIR) were obtained at 1.0 T. The results were confirmed by histology (6/42) or clinical data (28/42) and follow up MRI studies (8/42). In 39 of 42 cases a correct differentiation between osteoporotic and tumorous vertebral compression fractures was possible by quantification and correlation of SE and GE signal intensities. Gd-DTPA did not improve differential diagnosis, since both tumour infiltration and bone marrow oedema in acute compression fracture showed comparable enhancement. STIR-sequences were most sensitive for pathology but unspecific due to a comparable amount of water in tumour tissue and bone marrow oedema. Susceptibility-induced signal reduction in GE images and morphologic criteria proved to be most reliable for differentiation of benign and tumour-related fractures. In the rare cases of single and nearly complete vertebral compressions with complete loss of bone marrow, differentiation with MRI was not possible.
Stäbler
A
A
Radiologische Klinik und Poliklinik, Universität München.
Krimmel
K
K
Seiderer
M
M
Gärtner
C
C
Fritsch
S
S
Raum
W
W
D003287:Contrast Media; D003937:Diagnosis, Differential; D005598:Fractures, Spontaneous / Q000175:diagnosis* / Q000209:etiology; D005682:Gadolinium; D019786:Gadolinium DTPA; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D009942:Organometallic Compounds; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis*; D004369:Pentetic Acid; D016103:Spinal Fractures / Q000175:diagnosis* / Q000209:etiology; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis*; D013904:Thoracic Vertebrae / Q000293:injuries* / Q000473:pathology; D013997:Time Factors
D003287:Contrast Media; D009942:Organometallic Compounds; D004369:Pentetic Acid; D005682:Gadolinium; D019786:Gadolinium DTPA