$pathological fracture$

#Pathological fracture full

Therefore a chronic osteoporotic fracture is more easily distinguished from an acute fracture by nearly completely normal marrow signal especially on T1-weighted and STIR images. The time to complete healing is variable especially in the elderly with potentially impeded reparative capacity.

$pathological fracture$

Usually a hyperemic response occurs leading to proliferation of fibroblastic and granulation tissue all of which evolve over time towards restoration of the primarily fat signal of normal marrow with healing. This alters the relaxation time of the marrow leading to hypointensity on T1-weighted images and hyperintensity on T2-weighted or STIR (short inversion-time inversion-recovery) sequences. In acute non-malignant fractures, the bone marrow becomes edematous or fills with fluid. Since one third of vertebral fractures in oncology patients are benign and one quarter of fractures in patients with known osteopenia or osteoporosis are malignant, MRI is commonly performed to assist in the diagnosis 1,2,3,4,5. Different primary tumors tend to spread to different parts of the spine for example breast and lung to the thoracic spine and prostate to the lumbar spine and sacrum. Involvement of the cervical spine or the thoracic spine above T5 is rare. Approximately 70% of spine metastases occur in the thoracic spine. A metastasis to the spine is the initial presentation in up to 20% of cancer patients. Although up to 77% of these cancers have spread to the spine as micrometastases at autopsy, only around 10% become symptomatic. Although any systemic malignancy may involve the spine, common solid organ primary tumors include breast, lung, and prostate, whereas common hematopoietic sources include myeloma and lymphoma. The spine is a very common site for metastases and it has been reported that more than 18,000 patients per year are diagnosed with spinal metastatic disease. Discussionĭeciding whether or not a fracture is benign or pathologic is a common decision confronting a musculoskeletal radiologist. Low signal intradiscal and perhaps intraosseous gas is identified (arrows).īenign L1 compression fracture.

$pathological fracture$

The majority of the remaining marrow does not enhance (asterisks), though enhancement on conventional MR is not a good discriminator between benign and malignant fractures. Enhancement of the compressed anterior aspect of the body (arrowhead) is due to a stress reaction and is also seen in association with the basivertebral vein.

$pathological fracture$

Alkaline phosphatase.A T1-weighted post contrast sagittal with fat saturation. Tissue biopsy for histological examination.Ĭreatinine, Urea, Aluminium, Parathyroid hormone.Īmino acids urine (ethanolamine phosphate). Prostate specific antigen Acid phosphatase is less useful. Prostate needle biopsy for histological examination.īlood or urine examination for abnormal circulating proteins (eg Bence Jones protein urine)īone biopsy for histological examination. Lung biopsy for histological examination.

#Pathological fracture full

Careful clinical assessment and diagnostic imaging may indicate the likely underlying cause.Ĭalcium, Phosphate, Albumin, Protein, Protein electrophoresis, Alkaline phosphatase, Full blood count, Blood film, C-Reactive protein, Bence Jones protein urine.įine needle aspiration biopsy, Tissue biopsy, Bone biopsy (fracture site) or Bone marrow biopsy (aspiration and trephine), as appropriate.īreast biopsy for histological examination.

$pathological fracture$