Acute vertebral collapse: CT findings in benign and malignant nontraumatic cases.

Abstract

The value of computed tomography (CT) for differentiating benign from malignant causes of nontraumatic acute vertebral collapse (AVC) (associated with pain of less than 3 months duration) was evaluated. The CT findings of 34 benign (osteoporotic) and 32 malignant (metastatic or myelomatous) nontraumatic AVCs were compared. The following CT findings were significantly more frequent in benign AVCs: cortical fractures of the vertebral body without cortical bone destruction, retropulsion of a bone fragment of the posterior cortex of the vertebral body into the spinal canal, fracture lines within the cancellous bone of the vertebral body, an intravertebral vacuum phenomenon, and a thin diffuse paraspinal soft-tissue mass (PSTM). The following CT findings were significantly more frequent in malignant AVCs: destruction of the anterolateral or posterior cortical bone of the vertebral body, destruction of the cancellous bone of the vertebral body, destruction of a vertebral pedicle, a focal PSTM, and an epidural mass. CT can help distinguish benign from malignant causes of nontraumatic AVC.