Papers

International journal
Jun, 2017

Discrimination between Malignant and Benign Vertebral Fractures Using Magnetic Resonance Imaging.

Asian spine journal
  • Tomoyuki Takigawa
  • ,
  • Masato Tanaka
  • ,
  • Yoshihisa Sugimoto
  • ,
  • Tomoko Tetsunaga
  • ,
  • Keiichiro Nishida
  • ,
  • Toshifumi Ozaki

Volume
11
Number
3
First page
478
Last page
483
Language
English
Publishing type
Research paper (scientific journal)
DOI
10.4184/asj.2017.11.3.478

STUDY DESIGN: Retrospective analysis using magnetic resonance imaging (MRI). PURPOSE: To identify MRI features that could discriminate benign from malignant vertebral fractures. OVERVIEW OF LITERATURE: Discrimination between benign and malignant vertebral fractures remains challenging, particularly in patients with osteoporosis and cancer. Presently, the most sensitive means of detecting and assessing fracture etiology is MRI. However, published reports have focused on only one or a few discriminators. METHODS: Totally, 106 patients were assessed by MRI within six weeks of sustaining 114 thoracic and/or lumbar vertebral fractures (benign, n=65; malignant, n=49). The fractures were pathologically confirmed if malignant or clinically diagnosed if benign and were followed up for a minimum of six months. Seventeen features were analyzed in all fractures' magnetic resonance images. Single parameters were analyzed using the chi-square test; a logit model was established using multivariate logistic regression analysis. RESULTS: The chi-square test revealed 11 malignant and 4 benign parameters. Multivariate logistic regression analysis selected (i) posterior wall diffuse protrusion (odds ratio [OR], 48; 95% confidence interval [CI], 4.2-548; p=0.002), (ii) pedicle involvement (OR, 21; 95% CI, 2.0-229; p=0.01), (iii) posterior involvement (OR, 21; 95% CI, 1.5-21; p=0.02), and (iv) band pattern (OR, 0.047; 95% CI, 0.0005-4.7; p=0.19). The logit model was expressed as P=1/[1+exp (x)], x=-3.88×(i)-3.05×(ii)-3.02×(iii)+3.05×(iv)+5.00, where P is the probability of malignancy. The total predictive value was 97.3%. The only exception was multiple myeloma with features of a benign fracture. CONCLUSIONS: Although each MRI feature had a different meaning with a variable differentiation power, combining them led to an accurate diagnosis. This study identified the most relevant MRI features that would be helpful in discriminating benign from malignant vertebral fractures.

Link information
DOI
https://doi.org/10.4184/asj.2017.11.3.478
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/28670417
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481604
ID information
  • DOI : 10.4184/asj.2017.11.3.478
  • Pubmed ID : 28670417
  • Pubmed Central ID : PMC5481604

Export
BibTeX RIS