![]() Differences in the reported SUV measurements may be partly related to the time interval between the fracture event and the PET examination. Based on these data the most reliable threshold for SUV was found to be 4.25, which yielded a sensitivity of 85 % and a specificity of 71 %. The authors reported that the accuracy of FDG-PET in differentiating benign from malignant compression fractures was 92 %. Two retrospective studies with 33 and 96 patients concluded that there is a statistically significant difference in mean standardized uptake value (SUV) between benign and malignant vertebral compression fractures. Theoretically, malignant vertebral fractures must display increased FDG uptake due to the metabolic activity of tumor cells, whereas benign osteoporotic fractures are not expected to significantly accumulate FDG. The role of FDG-PET in the differential diagnosis of benign and malignant VCFs has not been extensively evaluated. All the abovementioned signs are better depicted with thin-collimation MDCT which provides great anatomic detail (e.g., for the evaluation of cortical bone) and allows for the use of sagittal and coronal multiplanar reconstructions. CT findings associated with a malignant VCF are destruction of the cortical bone of the vertebral body, destruction of the cancellous bone of the vertebral body, destruction of a pedicle, a focal paraspinal soft-tissue mass, and an epidural soft-tissue mass (Fig. Despite the ability of CT to demonstrate even very small collections of gas, none of the metastatic VCFs in two CT studies demonstrated the sign, thus confirming its high specificity for benignancy. Occasionally the gas collection may have a transverse (left to right) linear configuration, best appreciated on coronal images (Fig. As with plain radiographs, it is most commonly seen as a linear gas collection adjacent and parallel to the fractured endplate (Fig. Regarding the intravertebral vacuum cleft sign, its detection rate is, as expected, much higher on CT than on plain radiographs. CT findings reported to be associated with a benign VCF are cortical fractures of the vertebral body without cortical bone destruction (the so-called puzzle sign, consisting of small gaps in the cortical bone with all the respective bone fragments still visible and fitting together like a puzzle), retropulsion of a bone fragment into the spinal canal, fracture lines within the cancellous bone, an intravertebral vacuum cleft sign, and a thin (<10 mm), diffuse circumferential (i.e., surrounding the entire anterolateral outer surface of the vertebral body) paraspinal soft-tissue mass (Figs. ![]() Although CT is not considered the examination of choice for the characterization of VCFs, it has been studied in this setting, and multiple valuable signs have been described. ![]()
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