Acute vertebral collapse: CT findings in benign and malignant nontraumatic cases.

PURPOSE: The value of computed tomography (CT) for differentiating benign from malignant causes of nontraumatic acute vertebral collapse (AVC) (associated with pain of less than 3 months duration) was evaluated. MATERIALS AND METHODS: The CT findings of 34 benign (osteoporotic) and 32 malignant (metastatic or myelomatous) nontraumatic AVCs were compared. RESULTS: The following CT findings were significantly more frequent in benign AVCs: cortical fractures of the vertebral body without cortical bone destruction, retropulsion of a bone fragment of the posterior cortex of the vertebral body into the spinal canal, fracture lines within the cancellous bone of the vertebral body, an intravertebral vacuum phenomenon, and a thin diffuse paraspinal soft-tissue mass (PSTM). The following CT findings were significantly more frequent in malignant AVCs: destruction of the anterolateral or posterior cortical bone of the vertebral body, destruction of the cancellous bone of the vertebral body, destruction of a vertebral pedicle, a focal PSTM, and an epidural mass. CONCLUSION: CT can help distinguish benign from malignant causes of nontraumatic AVC.