Development of vertebral fractures in patients with multiple myeloma: Does MRT enable recognition of vertebrae that will collapse?

Purpose: We assessed the relationship between the presence and size of focal marrow abnormalities detected with MRI in vertebral bodies and the subsequent occurrence of vertebral fractures at follow-up in patients with multiple myeloma (MM), Method: We reviewed 179 follow-up MR examinations of the thoracic and lumbar spine prospectively obtained in 37 patients with Stage 3 MM. For each of 131 vertebral bodies that fractured during follow-up, the status of the vertebral bone marrow was assessed on the last MR study obtained at a mean time interval of 4 months prior to fracture occurrence. When focal lesions were observed before fracture in vertebral bodies that later collapsed, their size was compared with that of the contemporary lesions observed in vertebrae that did not collapse. Results: Of 131 fractures, 82 (63%) appeared in vertebrae previously free of focal bone marrow abnormality at MRI and 49 (37%) appeared in vertebrae in which focal lesions were present on the previous MR study. The size of the lesions that preceded fractures (median 15 mm; range 6-50 mm) was not statistically different from the size of the contemporary lesions (median 15 mm; range 5-60 mm) that did not lead to fracture (p > 0.30). Conclusion: This study in patients with MM suggests a lack of correlation between the preexistence of focal vertebral marrow lesions detected with MRI and the subsequent development of vertebral fractures.