Contrast-enhanced MRI of healed pathologic vertebral compression fracture mimicking active disease in a patient treated for lymphoma

Despite the valuable contribution of MRI, the distinction between benign and malignant compression fractures of the spine is sometimes difficult, and cannot with certainty be based on T1- and T2-weighted signal criteria alone, or on the configuration of the compression fracture. This case report demonstrates that in certain instances neither can gadolinium enhancement specifically make this determination in cases of treated malignancy of the spinal column. Because treated neoplasia having benign histologic characteristics may continue to enhance with IV gadolinium, biopsy evaluation must be undertaken in this setting in order to prove the diagnosis.