Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2025; 13(20): 103627
Published online Jul 16, 2025. doi: 10.12998/wjcc.v13.i20.103627
Paravertebral soft tissue swelling on magnetic resonance images helps in differentiation between osteoporotic and malignant vertebral fractures
Xiao-Lin Han, Xiang-Long Shi, Qi-Yuan Li, Ya-Jing Shao, Chuan-Ping Gao
Xiao-Lin Han, Xiang-Long Shi, Ya-Jing Shao, Chuan-Ping Gao, Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Qi-Yuan Li, Department of Radiology, The Cangzhou Central Hospital, Cangzhou 061001, Hebei Province, China
Co-first authors: Xiao-Lin Han and Xiang-Long Shi.
Author contributions: Han XL prepared the original draft; Han XL and Li QY performed the data curation; Shi XL and Shao YJ performed the formal analysis; Gao CP conceptualized the study, reviewed and edited the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: This retrospective study was approved by the Institutional Review Board of the Affiliated hospital of Qingdao University (No. QYFYWZLL29413/dated 5rd September 2023), and all patient requirements for informed consent were waived.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used for the analysis are available from the corresponding authors upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chuan-Ping Gao, MD, Professor, Department of Radiology, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao 266003, Shandong Province, China. gaochuanping2021@163.com
Received: December 3, 2024
Revised: February 23, 2025
Accepted: March 8, 2025
Published online: July 16, 2025
Processing time: 133 Days and 6.1 Hours
Abstract
BACKGROUND

Osteoporotic vertebral fracture (OVF) is one of the most common sequelae of osteoporosis. Differential diagnosis between OVF and malignant vertebral fracture (MVF) is a challenge in clinical practice. Findings on computed tomography and magnetic resonance images (MRI) may help to differentiate between these two types of fracture.

AIM

To determine whether paravertebral soft tissue swelling is useful for differentiation between OVF and MVF.

METHODS

We retrospectively reviewed the MRI for 165 patients diagnosed with a vertebral fracture between May 2021 and July 2022. Three radiologists evaluated the vertebral segments and thickness of soft tissue swelling on sagittal MRI by consensus. The morphology of the soft tissue swelling was also evaluated. The statistical analyses were performed using the χ2 test and analysis of variance.

RESULTS

The study included 117 patients (153 vertebrae) with OVF and 48 patients (63 vertebrae) with MVF. Soft tissue swelling was observed beneath the anterior longitudinal ligament on sagittal MRI and rim-shaped in the paravertebral area on axial MRI in all 153 vertebrae with OVF (100%) and in 12 (19%) of the 63 vertebra with MVF; the difference was statistically significant (P < 0.001), 95%CI: 3.156–8.735. Soft tissue swelling beneath the anterior longitudinal ligament spanned significantly more vertebral segments in patients with OVF than in those with MVF (P < 0.001), 95%CI: 0.932-1.546. The mean thickness of the soft tissue swelling was significantly greater for OVF than for MVF (5.62 mm ± 2.50 mm vs 3.88 mm ± 1.73 mm, P < 0.05, 95%CI: 0.681–0.920). Post-contrast examination was performed in 13 patients; T1-weighted images confirmed OVF in 11 cases and MVF in 2 cases. Soft tissue swelling in OVF and MVF had a fusiform appearance or appeared as a thin line on sagittal MRI and was rim-shaped on axial MRI. The length and diameter of the soft tissue swelling in patients with OVF decreased during follow-up.

CONCLUSION

Paravertebral soft tissue swelling is helpful for differentiating between OVF and MVF.

Keywords: Paravertebral soft tissue swelling; Vertebral compression fracture; Benign; Malignant; Review analysis; Magnetic resonance imaging

Core Tip: Paravertebral soft tissue swelling is helpful for differentiating between osteoporotic and malignant vertebral fractures (MVFs). Soft tissue swelling beneath the anterior longitudinal ligament on sagittal magnetic resonance images (MRI) and rim-shaped soft tissue swelling in the paravertebral area on axial MRI are common in osteoporotic vertebral fractures (OVFs) and decrease during follow-up. Soft tissue swelling is seen in a minority of MVFs, with irregular nodules seen in most cases. Furthermore, soft tissue swelling beneath the anterior longitudinal ligament spans more vertebral segments in patients with OVFs than in those with MVFs.