Metastatic compression fracture


  • A 69 years old lady
  • Underlying hypertension
  • Presented with back pain and bilateral limb weakness
  • No history of trauma
  • No constitutional symptoms
MRI spine in sagittal planes


MRI spine in axial planes; in T1WI, T2WI and T1-post contrast.


MRI spine in axial planes; T1WI, T2WI and T1+contrast.

MRI findings:

  • There is reduction in vertebral body height with abnormal signal intensity seen of T5 vertebra appearing as low signal on T1, high signal on T2 and TIRM images, with non-homogeneous enhancement (white arrows).
  • There is similar but more severe changes seen at T3 vertebra. Almost total collapsed of this vertebra is seen (white arrows).
  • There is  posterior vertebral surface convexity bulging into the spinal canal.
  • Associated surrounding soft tissue mass with intraspinal extension (yellow arrows).
  • Incidental finding of thyroid mass also noted (star-shape)

Diagnosis: Metastastic compression fractures.


  • Vertebral compression fractures are very common, especially in the elderly.
  • It is important to differentiate benign from malignant vertebral collapse because their management and outcome are substantially different.
  • The spine represents the most frequent site of skeletal metastasis predominating in the thoracic and lumbar spine.
  • Features supporting malignant collapse include
    • Convex posterior border of the vertebral body
    • Abnormal signal intensity of the pedicle
    • Epidural mass
    • Focal paraspinal mass
    • involvement of the posterior half of the vertebral body
    • contrast enhancement and
    • multi-segmental involvement of vertebrae.

Progress of patient:

  • Further work-up confirms diagnosis of thyroid carcinoma with multiple skeletal metastasis
CT scan neck shows large left thyroid mass compressing the trachea
Author: radhianahassan