MRI Without Contrast is Sufficient for T12 Compression Fracture Evaluation
For a T12 compression fracture, MRI without contrast is usually appropriate and contrast is not needed unless there is suspicion of malignancy, infection, or inflammation. 1, 2
Imaging Approach for Compression Fractures
Initial Evaluation
- Start with thoracic spine radiographs for initial screening of osseous abnormalities, especially in patients with risk factors for osteoporotic fractures 2
- Follow with MRI without contrast to:
- Assess fracture acuity
- Evaluate posterior ligamentous complex integrity
- Check for spinal cord or nerve root compression
- Identify associated soft tissue injuries 2
When to Use Non-Contrast MRI
- MRI without contrast provides excellent visualization of:
- Bone marrow abnormalities
- Compression fracture morphology
- Soft tissue injuries
- Neurologic compression
- Ligamentous injuries 2
- Non-contrast MRI is specific for identifying benign intravertebral clefts 3
- Non-contrast sequences can effectively differentiate between acute and chronic compression fractures based on signal intensity patterns 4
When to Consider Adding Contrast
Contrast should only be added when:
- Underlying malignancy is clinically suspected
- Infection is a concern
- Inflammatory conditions are being evaluated
- Initial non-contrast MRI shows findings suggestive of infection or tumor 1, 2
Evidence-Based Rationale
The American College of Radiology guidelines clearly state that MRI thoracic spine without IV contrast is useful as an initial study for compression fractures 1. MRI with contrast is not typically performed independently as an initial study, as its interpretation is most informative when correlated with standard non-contrast sequences 1.
MRI without contrast can effectively differentiate between benign and pathologic compression fractures in most cases. Acute benign fractures typically show high signal intensity on T2-weighted images but with a more inhomogeneous pattern compared to pathologic fractures 4.
Common Pitfalls to Avoid
- Don't automatically order contrast for all spine MRIs - it's unnecessary for most compression fractures
- Be aware that CT without contrast may be more appropriate in emergency settings or for presurgical planning when detailed osseous anatomy is needed 2
- Remember that acute benign fractures can sometimes mimic malignant lesions on MRI; correlation with clinical history and laboratory findings is essential
- In pediatric patients, CT demonstrates high sensitivity for compression fractures compared to MRI, and the addition of MRI rarely changes management 5
In summary, for a standard T12 compression fracture evaluation, MRI without contrast provides sufficient diagnostic information. Only add contrast when there are specific concerns about malignancy, infection, or inflammatory conditions.