Spine imaging: benign versus malignant vertebral collapse: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Spine imaging: benign versus malignant vertebral collapse

Sample item

An elderly woman has an acute vertebral compression fracture. Which MRI finding favours a malignant cause over osteoporosis?

AMultiple fractures with a normal marrow signalBConvex posterior vertebral border, pedicle involvement and an epidural soft tissue massCRetropulsion of a bone fragment with a low signal bandDFluid sign with preserved normal marrow elsewhere in the vertebra

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Convex posterior vertebral border, pedicle involvement and an epidural soft tissue mass

Malignant collapse often shows a convex posterior cortex, pedicle and posterior element infiltration, an epidural or paraspinal mass and abnormal marrow. Osteoporotic fractures keep some normal marrow, show a fluid sign and a low signal band.

Option by option

A. Multiple fractures with a normal marrow signal
Normal marrow signal favours osteoporosis.
B. Convex posterior vertebral border, pedicle involvement and an epidural soft tissue mass (correct)
Correct. Convex bulging, pedicle involvement and soft tissue mass favour malignancy.
C. Retropulsion of a bone fragment with a low signal band
A low signal fracture line with bone retropulsion favours a benign fracture.
D. Fluid sign with preserved normal marrow elsewhere in the vertebra
Fluid sign with preserved marrow favours benign collapse.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, Convex posterior vertebral border, pedicle involvement and an epidural soft tissue mass. Malignant collapse often shows a convex posterior cortex, pedicle and posterior element infiltration, an epidural or paraspinal mass and abnormal marrow.

Why is "Multiple fractures with a normal marrow signal" not the answer?

Normal marrow signal favours osteoporosis.

Why is "Retropulsion of a bone fragment with a low signal band" not the answer?

A low signal fracture line with bone retropulsion favours a benign fracture.

Why is "Fluid sign with preserved normal marrow elsewhere in the vertebra" not the answer?

Fluid sign with preserved marrow favours benign collapse.

What concept does this question test?

It tests Spine imaging: benign versus malignant vertebral collapse in Radiology. Osteoporotic fractures keep some normal marrow, show a fluid sign and a low signal band.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine imaging: benign versus malignant vertebral collapse?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.