الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Vertebral compression fracture is one of the most common clinical problems, especially encountered in the elderly. Differentiating malignant compression fracture from a benign process using information obtained from clinical findings, plain radiographs, bone scans, and computed tomography may not be totally efficient, in particular for those without a history of obvious trauma or known malignancy.
The aim of this study was to illustrate the role of chemical shift imaging in assessment of vertebral collapse and differentiate between benign and malignant compressions.
This study included 20 patients presented with low back pain.
All patients were subjected to thorough history taking and clinical examination. Informed consent was taken from all patients.
All patients were studied with conventional unenhanced axial and sagittal T1 and T2 weighted imaging,DWI and chemical shift sequence (In phase/ opposed phase IPOP) in sagittal planes .Post contrast axial and sagittal T1 weighted imaging in seven patients, radio isotope bone scan as a part of metastatic work up in known patients with malignancy in six patients and histopathological correlation in four patients.
The results of the current study revealed twenty patients with radiological findings of vertebral collapse have been studied. The twenty patients were 8 males and 12 females. Their age ranged from 5 to 82 years with a mean age of 56.05 years. The largest group of patients was found in the eighth and sixth decades.
The final diagnosis of the 20 patients were; 13 malignant metastases and 7 non-malignant lesions. The primary malignant causes of vertebral collapse included cancer breast (8), prostate cancer (2), Langerhans Histiocytosis (1) and metastasis of unknown origin (2).
Seven patients had non malignant causes of vertebral collapse: trauma (2), osteoporosis (4), and Kummel’s disease (1).
A total of 55 vertebral body collapses were found in these 20 patients: 13 patients with single level collapse and 7 patients with multiple levels of collapse.
Eight patients had chronic disc lesions, five patients had epidural soft tissue component related to the vertebral collapses, two patients had spinal cord compression, and thirteen patients had other metastatic lesions in the spine, iliac bones, and acetabulum. Three patients had deformity, one patient showed sizable pelvic mass and one patient with multiple skin lesions.
Areas that were of abnormal signal intensity on the T1 and T2 sequences were identified on the in-phase/opposed-phase sequences. An elliptical region of interest cursor was placed over the abnormal area on the in-phase as well as on the opposed-phase images. Three measurements of the signal intensity were made and the average recorded.
In this study, the findings were expressed in the form of a ratio, which compared the signal intensity in the abnormal bone marrow on the out-of-phase and in-phase images. This signal intensity ratio was calculated as the mean signal intensity on out-of-phase images divided by the mean signal intensity on the in-phase images.
The results concluded a cut off value of 0.9, with SIR <0.9 denoting benign vertebral compression fractures and SIR > 0.9 denoting malignant compression fractures, with a 92.31% sensitivity , 85.7 % specificity of & accuracy of 90 %.
In phase – Out phase sequence was able to detect 12 out 13 malignant compression fractures and 7 out of 8 benign compression fractures.