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Discriminating imaging findings of acute osteoporotic vertebral fracture: a prospective multicenter cohort study.

Qasem KM, Suzuki A, Yamada K, Hoshino M, Tsujio T, Takahashi S, Nakamura H - J Orthop Surg Res (2014)

Bottom Line: Average AVHR fell from 84.6% at initial visit to 63.7% at 6 months.On MRI, 83.5% of fractured vertebrae showed intensity change in the posterior wall in the acute stage, which fell to 41.7% of vertebrae after 6 months.This study suggests that vertebral fracture rarely shows significant collapse on X-ray in the first 2 weeks after injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. a-suzuki@msic.med.osaka-cu.ac.jp.

ABSTRACT

Background: Appropriate treatment of osteoporotic vertebral fractures (OVF) requires knowledge of the age of the fracture. Although diagnostic imaging has made remarkable progress in recent years, it remains difficult to differentiate acute fractures from old. Our purpose was to investigate chronological changes in radiological findings after OVF and to identify discriminators of acute versus older injuries.

Methods: We evaluated 139 vertebrae in 136 patients. All patients underwent X-ray and magnetic resonance imaging (MRI) examination within 2 weeks of injury and again after 6 months. The anterior vertebral height ratio (AVHR) was calculated on lateral X-ray, and the intensity change of the posterior wall of the fractured vertebra was evaluated on T1-weighted MRI. The cutoff AVHR value to diagnose acute fracture was determined by receiver operating characteristic (ROC) curve analysis.

Results: Average AVHR fell from 84.6% at initial visit to 63.7% at 6 months. When acute fracture was defined as AVHR >75%, sensitivity was 85.6%, specificity was 67.6%, and positive predictive value was 72.6%. On MRI, 83.5% of fractured vertebrae showed intensity change in the posterior wall in the acute stage, which fell to 41.7% of vertebrae after 6 months. When intensity change in the posterior wall and AVHR >75% were both present, the specificity and positive predictive value for diagnosing acute fracture improved to 87.1% and 84.7%, respectively.

Conclusions: This study suggests that vertebral fracture rarely shows significant collapse on X-ray in the first 2 weeks after injury. The combination of intensity change in the posterior wall on MRI and AVHR >75% on X-ray indicates a high probability of acute fracture.

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Representative image of chronological intensity change at posterior wall on T1-weighted magnetic resonance image. Intensity change at posterior wall was observed in the acute stage (left), but the intensity change was disappeared at 6 months (right).
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Fig2: Representative image of chronological intensity change at posterior wall on T1-weighted magnetic resonance image. Intensity change at posterior wall was observed in the acute stage (left), but the intensity change was disappeared at 6 months (right).

Mentions: Three experienced orthopedic surgeons who were not provided with patient information evaluated the MRI images. Change in signal intensity at the posterior wall of fractured vertebrae was evaluated on T1-weighted images (Figure 2a, b) and recorded as positive or negative. The three surgeons initially evaluated all MRI images independently. The evaluations were consistent for 201 of 278 images (72.3%). For the remaining images without consensus, the three doctors discussed the cases and together determined the final evaluation. In this study, we did not include the evaluation of T2-weighted images because intensity on these images varies too much between patients to achieve agreement on the evaluation [12].Figure 2


Discriminating imaging findings of acute osteoporotic vertebral fracture: a prospective multicenter cohort study.

Qasem KM, Suzuki A, Yamada K, Hoshino M, Tsujio T, Takahashi S, Nakamura H - J Orthop Surg Res (2014)

Representative image of chronological intensity change at posterior wall on T1-weighted magnetic resonance image. Intensity change at posterior wall was observed in the acute stage (left), but the intensity change was disappeared at 6 months (right).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4195983&req=5

Fig2: Representative image of chronological intensity change at posterior wall on T1-weighted magnetic resonance image. Intensity change at posterior wall was observed in the acute stage (left), but the intensity change was disappeared at 6 months (right).
Mentions: Three experienced orthopedic surgeons who were not provided with patient information evaluated the MRI images. Change in signal intensity at the posterior wall of fractured vertebrae was evaluated on T1-weighted images (Figure 2a, b) and recorded as positive or negative. The three surgeons initially evaluated all MRI images independently. The evaluations were consistent for 201 of 278 images (72.3%). For the remaining images without consensus, the three doctors discussed the cases and together determined the final evaluation. In this study, we did not include the evaluation of T2-weighted images because intensity on these images varies too much between patients to achieve agreement on the evaluation [12].Figure 2

Bottom Line: Average AVHR fell from 84.6% at initial visit to 63.7% at 6 months.On MRI, 83.5% of fractured vertebrae showed intensity change in the posterior wall in the acute stage, which fell to 41.7% of vertebrae after 6 months.This study suggests that vertebral fracture rarely shows significant collapse on X-ray in the first 2 weeks after injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. a-suzuki@msic.med.osaka-cu.ac.jp.

ABSTRACT

Background: Appropriate treatment of osteoporotic vertebral fractures (OVF) requires knowledge of the age of the fracture. Although diagnostic imaging has made remarkable progress in recent years, it remains difficult to differentiate acute fractures from old. Our purpose was to investigate chronological changes in radiological findings after OVF and to identify discriminators of acute versus older injuries.

Methods: We evaluated 139 vertebrae in 136 patients. All patients underwent X-ray and magnetic resonance imaging (MRI) examination within 2 weeks of injury and again after 6 months. The anterior vertebral height ratio (AVHR) was calculated on lateral X-ray, and the intensity change of the posterior wall of the fractured vertebra was evaluated on T1-weighted MRI. The cutoff AVHR value to diagnose acute fracture was determined by receiver operating characteristic (ROC) curve analysis.

Results: Average AVHR fell from 84.6% at initial visit to 63.7% at 6 months. When acute fracture was defined as AVHR >75%, sensitivity was 85.6%, specificity was 67.6%, and positive predictive value was 72.6%. On MRI, 83.5% of fractured vertebrae showed intensity change in the posterior wall in the acute stage, which fell to 41.7% of vertebrae after 6 months. When intensity change in the posterior wall and AVHR >75% were both present, the specificity and positive predictive value for diagnosing acute fracture improved to 87.1% and 84.7%, respectively.

Conclusions: This study suggests that vertebral fracture rarely shows significant collapse on X-ray in the first 2 weeks after injury. The combination of intensity change in the posterior wall on MRI and AVHR >75% on X-ray indicates a high probability of acute fracture.

Show MeSH
Related in: MedlinePlus