Intraosseous disease is best delineated on noncontrast MRI sequences (T1-weighted and short tau inversion recovery). Contrast- enhanced MRI is helpful to delineate epidural, foraminal, paraspinal, and intrathecal disease extension, including intramedullary disease, compared to sequences without contrast. It is most beneficial to compare precontrast and postcontrast MRI sequences. With tumor involvement, marrow edema may be difficult to detect on conventional MRI sequences [90]. Diffusion-weighted [88] and MR perfusion techniques [91] may be helpful tools to differentiate benign from pathological fractures and new metastasis from previously treated lesions despite a similar appearance on conventional MRI [92]. MRI is also important for further treatment planning, such as VA, percutaneous ablation, RT (stereotactic body RT [SBRT] or conventional palliative radiation), or systemic chemotherapy [93-96]. Vertebral Compression Fractures CT Myelography Spine Area of Interest Myelography of the spine may be obtained especially to detect epidural tumor extension and spinal cord compression. This modality can also be helpful in patients who have surgical hardware from prior spinal surgical intervention to evaluate the spinal canal at the involved level. Bone Scan Whole Body Tc-99m bone scan (bone scintigraphy) of the whole body is often used for initial detection of metastases as well as the staging of patients with cancer. Hot uptake on a bone scan can persist for 2 years after the fracture [97] and hence is hard to differentiate a subacute from chronic fracture. In patients with osteoporosis, bone scan can show additional fractures in the skeleton and also can be helpful in distinguishing the cause of back pain among fracture, facet joint arthritis, and disc degenerative lesions and can be of help to triage appropriate treatment [98]. Bone scans may be performed based on institutional preference.
Management of Vertebral Compression Fractures PCAs. Intraosseous disease is best delineated on noncontrast MRI sequences (T1-weighted and short tau inversion recovery). Contrast- enhanced MRI is helpful to delineate epidural, foraminal, paraspinal, and intrathecal disease extension, including intramedullary disease, compared to sequences without contrast. It is most beneficial to compare precontrast and postcontrast MRI sequences. With tumor involvement, marrow edema may be difficult to detect on conventional MRI sequences [90]. Diffusion-weighted [88] and MR perfusion techniques [91] may be helpful tools to differentiate benign from pathological fractures and new metastasis from previously treated lesions despite a similar appearance on conventional MRI [92]. MRI is also important for further treatment planning, such as VA, percutaneous ablation, RT (stereotactic body RT [SBRT] or conventional palliative radiation), or systemic chemotherapy [93-96]. Vertebral Compression Fractures CT Myelography Spine Area of Interest Myelography of the spine may be obtained especially to detect epidural tumor extension and spinal cord compression. This modality can also be helpful in patients who have surgical hardware from prior spinal surgical intervention to evaluate the spinal canal at the involved level. Bone Scan Whole Body Tc-99m bone scan (bone scintigraphy) of the whole body is often used for initial detection of metastases as well as the staging of patients with cancer. Hot uptake on a bone scan can persist for 2 years after the fracture [97] and hence is hard to differentiate a subacute from chronic fracture. In patients with osteoporosis, bone scan can show additional fractures in the skeleton and also can be helpful in distinguishing the cause of back pain among fracture, facet joint arthritis, and disc degenerative lesions and can be of help to triage appropriate treatment [98]. Bone scans may be performed based on institutional preference.