High-resolution imaging of the spine using multidetector-row computed tomography: differentiation between benign and malignant vertebral compression fractures.

OBJECTIVE: The purpose of this study was to investigate the ability of high-resolution computed tomography (CT) images to distinguish between benign and malignant vertebral compression fractures.
METHODS: Computed tomography images of 45 benign compression fractures in 40 patients and 33 malignant compression fractures in 33 patients were evaluated. A 16-slice multidetector-row CT scanner was used for data acquisition, and axial images with a slice thickness of 1 mm and sagittal and coronal multiplanar reconstruction images with a slice thickness of 0.7 to 1 mm were used for interpretation.
RESULTS: The following findings were significantly more frequent in malignant fractures: destruction of the anterolateral and/or posterior cortex of the vertebral body, destruction of the cancellous bone of the vertebral body, destruction of the end plate, destruction of the pedicle, a paraspinal soft tissue mass, and an epidural mass. The extremely reliable signs of malignancy were destruction of the anterolateral and/or posterior cortex of vertebral body (100% accuracy) and destruction of the cancellous bone of the vertebral body (97.4% accuracy).
CONCLUSION: High-resolution CT can provide many useful signs for differentiating between benign and malignant vertebral compression fractures, and its diagnostic ability is sufficient for clinical use.