Summary of imaging features of benign and malignant VCFs

Modality	Benign VCF Features	Malignant VCF Features
MRI: morphology	Normal posterior element signal,²⁰ retropulsed bone fragments,^9,12,14,17 additional benign VCFs¹⁸,¹⁹	Abnormal posterior element signal,^9–19 epidural or paravertebral soft-tissue mass,^{9,10,12–15,17–19} expanded posterior vertebral contour,^{9,11,12,14,18,24} metastasis in other vertebrae⁹,¹⁴,¹⁸
MRI: signal and enhancement patterns	Preserved normal marrow signal,^{9–12,14,15,17} regular margins,¹³,¹⁷,²⁸ linear horizontal hypointense T1/T2 band,^4,9,11,14,18 fluid sign,^9,18,19,26 normal enhancement relative to adjacent vertebrae and at 3 mo^12,13,15,28	Geographic replacement of normal marrow signal,^{11,12,14–18,24,28} irregular margins,¹³,¹⁷,²⁸ increased enhancement relative to adjacent vertebrae and at 3 mo^12,13,15,28
MRI: diffusion	No restricted diffusion^{18,27,30,32–45}	Increased restricted diffusion^{18,27,30,32–45}
MRI: chemical shift	Loss of SI on opposed-phase^18,51–53	No change or slight loss of SI on opposed-phase,^18,51–53 ratio of opposed-phase to in-phase SI > 0.8–1.0^18,51–53
CT	Retropulsed bone,⁵⁴,⁵⁵ puzzle sign,¹⁰,⁵⁴,⁵⁵ sharp fracture lines,¹⁰,⁵⁴,⁵⁵ intravertebral vacuum phenomenenon⁵⁵	Bone destruction,¹⁰,⁵⁴,⁵⁵ epidural or focal paravertebral soft tissue mass⁵⁴,⁵⁵
PET	SUV 2 SDs below liver SUV^57–60	SUV of >3–4.7 or 2 SDs above liver SUV^57–60
SPECT	Vertebral body and/or facet joint uptake⁶³	Vertebral body with pedicle and/or spinous process uptake,⁶³ marginal uptake in cold lesion⁶³