Collapsed Vertebrae: New Diagnostic Modality for Better Management

Background: Collapsed vertebrae occur when the normal vertebral body of the spine iscompressed to a smaller height. This mostly occurs due to trauma or underlyingvertebral bone disease. Management of collapsed vertebrae is very difficult andchallenging and depends mainly on the cause, but sometimes we couldn t differentiatebetween benign osteoporotic and malignant vertebral compression fractures. Diffusionweighted magnetic resonance image (DWI) is one of the most successful applications ofthe bone marrow for accurate diagnosis of vertebral compression fractures. Objective:The aim of this study is to evaluate the role of diffusion weighed magnetic resonanceimaging in predicting the nature of vertebral collapse. Patients and Methods: Twentypatients presented with vertebral compression fractures were included in this study.There were nine males (45%) and eleven females (55%) and the age ranged from 5-82years with a mean age of 56.05 years. Results: A total of twenty eight vertebral bodycollapses were found in twenty patients: fourteen patients with single level collapse andsix patients with multiple levels of collapse. These vertebral lesions were malignant infive vertebral collapses (in four patients) and twenty three nonmalignant vertebralcollapses (in sixteen patients). The DWI signal intensity of malignant vertebralcompression fractures were hyperintense in all cases (100%) and in nonmalignant casesthe DWI was hyperintense in (8.7%) and iso- or hypointense in (91.3%). The apparentdiffusion coefficient (ADC) value of the malignant vertebral lesions were statisticallysignificant higher than those of the normal vertebral bodies and lower than those ofbenign vertebral lesions, p 0.001 indicated by chi square test. Conclusion: Diffusionweighted magnetic resonance imaging is a promising non-invasive diagnostic imaging todifferentiate between benign and malignant vertebral compression fracture.