Summary of imaging features of benign and malignant VCFs
| Modality | Benign VCF Features | Malignant VCF Features |
|---|---|---|
| MRI: morphology | Normal posterior element signal,20 retropulsed bone fragments,9,12,14,17 additional benign VCFs18,19 | Abnormal posterior element signal,9–19 epidural or paravertebral soft-tissue mass,9,10,12–15,17–19 expanded posterior vertebral contour,9,11,12,14,18,24 metastasis in other vertebrae9,14,18 |
| MRI: signal and enhancement patterns | Preserved normal marrow signal,9–12,14,15,17 regular margins,13,17,28 linear horizontal hypointense T1/T2 band,4,9,11,14,18 fluid sign,9,18,19,26 normal enhancement relative to adjacent vertebrae and at 3 mo12,13,15,28 | Geographic replacement of normal marrow signal,11,12,14–18,24,28 irregular margins,13,17,28 increased enhancement relative to adjacent vertebrae and at 3 mo12,13,15,28 |
| MRI: diffusion | No restricted diffusion18,27,30,32–45 | Increased restricted diffusion18,27,30,32–45 |
| MRI: chemical shift | Loss of SI on opposed-phase18,51–53 | No change or slight loss of SI on opposed-phase,18,51–53 ratio of opposed-phase to in-phase SI > 0.8–1.018,51–53 |
| CT | Retropulsed bone,54,55 puzzle sign,10,54,55 sharp fracture lines,10,54,55 intravertebral vacuum phenomenenon55 | Bone destruction,10,54,55 epidural or focal paravertebral soft tissue mass54,55 |
| PET | SUV 2 SDs below liver SUV57–60 | SUV of >3–4.7 or 2 SDs above liver SUV57–60 |
| SPECT | Vertebral body and/or facet joint uptake63 | Vertebral body with pedicle and/or spinous process uptake,63 marginal uptake in cold lesion63 |