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 mo12,13,15,28	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 mo12,13,15,28
MRI: diffusion	No restricted diffusion18,27,30,32–45	Increased restricted diffusion18,27,30,32–45
MRI: chemical shift	Loss of SI on opposed-phase18,51–53	No change or slight loss of SI on opposed-phase,18,51–53 ratio of opposed-phase to in-phase SI > 0.8–1.018,51–53
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 SUV57–60	SUV of >3–4.7 or 2 SDs above liver SUV57–60
SPECT	Vertebral body and/or facet joint uptake63	Vertebral body with pedicle and/or spinous process uptake,63 marginal uptake in cold lesion63