A novel MRI- and CT-based scoring system to differentiate malignant from osteoporotic vertebral fractures in Chinese patients

Background: Various types of magnetic resonance imaging (MRI) and computed tomography (CT) findings are used to differentiate malignant vertebral fractures (MVFs) from osteoporotic vertebral fractures (OVFs). The distinguishing ability of any single finding is limited. This study developed a novel scoring system that integrates multiple MRI and CT signs for improved accuracy of differential diagnosis between MVFs and OVFs. Methods: A total of 150 MVFs and 150 OVFs in thoracolumbar vertebrae were analyzed. MRI and CT images were obtained within 2 months of the probable time of fracture. The sensitivity and specificity of 15 MRI and CT image findings were evaluated. A stepwise discriminant analysis using these signs as variables was used to create a scoring system to differentiate MVFs from OVFs. Results: All 15 image findings had strong specificity and moderate sensitivity. Seven MRI and three CT image findings were selected and assigned integral values in the final scoring system. A total score of 4 or greater points indicated MVF, whereas a total score of 3 or fewer points indicated OVF. The classification accuracy was 98.3% in the test set. Conclusions: This novel scoring system using MRI and CT radiologic findings to differentiate MVFs from OVFs in Chinese patients was efficient with high accuracy and good applicability.