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Acute Osteoporotic and Neoplastic Vertebral Compression Fractures: Fluid Sign at MR Imaging¹

¹ From the Departments of Clinical Radiology (A.B., A.S., M.R.), Pathology (S.A.), Orthopedic Surgery (H.R.D.), and Internal Medicine (R.B.), University of Munich–Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. Received August 20, 2001; revision requested September 24; final revision received April 29, 2002; accepted May 16. Address correspondence to A.B. (e-mail: andrea.baur@ikra.med.uni-muenchen.de).

PURPOSE: To evaluate the occurrence, location, and shape of the fluid sign in acute osteoporotic and neoplastic vertebral compression fractures at magnetic resonance (MR) imaging.

MATERIALS AND METHODS: The study group comprised 87 consecutive patients with acute vertebral compression fractures due to osteoporotic (n = 52) or neoplastic (n = 35) infiltration. The MR imaging protocol included nonenhanced T1-weighted spin-echo and short inversion time inversion-recovery sequences and a 1.5-T system. Readers blinded to the outcome documented the occurrence, shape, and location of the fluid sign with consensus. The fluid sign was correlated with the cause, age, and severity of the fracture. The diagnosis was confirmed with surgery, follow-up MR imaging, clinical follow-up, or unequivocal imaging findings. Wilcoxon and ² tests were used to assess significance.

RESULTS: In fractured vertebral bodies, the fluid sign was adjacent to the fractured end plates and exhibited signal intensity isointense to that of cerebrospinal fluid. The fluid sign was linear (n = 16), triangular (n = 5), or focal (n = 2) and was significantly associated with osteoporotic fractures (21 [40%] of 52; P < .001). The fluid sign occurred in two (6%) of 35 neoplastic compression fractures. Histologic examination demonstrated osteonecrosis, edema, and fibrosis at the site of the fluid sign. There was a tendency toward older fractures exhibiting the fluid sign, but this relationship was not significant (P > .05). In osteoporotic fractures, the fluid sign was significantly associated with fracture severity (P < .05).

CONCLUSION: The fluid sign is featured in acute vertebral compression fractures that show bone marrow edema. It can be an additional sign of osteoporosis and rarely occurs in metastatic fractures.

© RSNA, 2002

Index terms: Osteoporosis, 30.56 • Spine, fractures, 30.411 • Spine, MR, 30.121411, 30.121413 • Spine, secondary neoplasms, 30.33

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