Prediction of MRI findings including disc injury and posterior ligamentous complex injury in neurologically intact thoracolumbar burst fractures by the parameters of vertebral body damage on CT scan

Mi, Jie; Sun, Xiaojiang; Zhang, Kai; Zhao, Chang-Qing; Zhao, Jie

doi:10.1016/j.injury.2017.12.011

Cited by 22 publications

(18 citation statements)

References 32 publications

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“…Histology was not available for all patients because only a minority underwent surgical treatment. However, MRI is an accepted modality for evaluating disk abnormalities [30]. Our DECT scanning protocol was optimized for the depiction of bony structures in terms of radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Disk injury in patients with vertebral fractures—a prospective diagnostic accuracy study using dual-energy computed tomography

et al. 2019

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Objectives Using magnetic resonance imaging (MRI) as the standard of reference, we aimed to evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) in assessing disk injuries in patients aged more than 50 years with vertebral fractures. Methods This prospective study was approved by the local ethics committee (EA1/372/14), and all patients gave written informed consent. Patients with suspected fractures underwent spinal DECTs and MRIs. Three readers scored DECT collagen maps for the presence or absence of disk injuries and also scored MR images according to the Sander classification (0–3). Only disks at risk (target disks) were included in the analysis. Sensitivity and specificity were calculated. Fleiss’s κ was used to evaluate interrater agreement. Attenuation, in Hounsfield units, was compared between affected and unaffected disks in DECT. Results Analyzing 295 disks in 67 patients, DECT was both sensitive (0.85) and specific (0.75). Sensitivity varied with the severity of disk damage, as assessed using the Sander scale (grade 1, 0.80; 2, 0.85; and 3, 0.98). Fleiss’s κ was 0.41 for MRI and 0.51 for DECT. In the DECT collagen maps, attenuation was lower in injured disks compared to that in normal disks (80.3 ± 35.2 vs. 97.9 ± 41.0, p < 0.001). Conclusions Compared to conventional CT, DECT collagen maps can yield more diagnostic information, allowing identification of disk injuries in elderly patients with vertebral fractures. Key Points • Dual-energy computed tomography allows vertebral disk injuries to be detected in elderly patients with vertebral fractures. • Dual-energy computed tomography yields more diagnostic information about vertebral disks compared to conventional CT. • Dual-energy computed tomography can be used as an alternative imaging modality for patients unwilling or unable to undergo MRI. Electronic supplementary material The online version of this article (10.1007/s00330-018-5963-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Disk injury in patients with vertebral fractures—a prospective diagnostic accuracy study using dual-energy computed tomography

et al. 2019

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“…Due to its ability to directly reveal soft tissue injuries, MRI is an effective technique for assessing PLC injuries that cannot be directly detected on plain radiography or CT. In most studies that have used MRI as a diagnostic tool, the SSL and LF were categorized as intact or ruptured; however, the ISL and FC were divided into three categories, including intact, indeterminate, or ruptured (2589121617181920212223). The “indeterminate” category included structures that were neither clearly intact nor ruptured.…”

Section: Discussionmentioning

confidence: 99%

“…Almost all previous studies evaluated PLC integrity based on sagittal T1-weighted, T2-weighted, and STIR images as well as axial T2-weighted images (289121617181920212223), which are routine clinical spinal sequences. A few studies also included coronal T2-weighted images; however, the diagnosis still relied on sagittal images (916).…”

Section: Discussionmentioning

confidence: 99%

“…On T2-weighted sequences, the loss of ligamentous continuity or presence of fluid crossing the location of the ligament are specific signs of ligamentous tears. In most previous studies, these exact criteria were used for diagnosing SSL and LF disruption (2589121617181920212223). In these studies, ISL injuries were diagnosed by observation of increased signal intensity (i.e., hyperintensity), and FC injuries were indicated by the presence of articular liquid or diastasis of the facet joint.…”

Section: Introductionmentioning

confidence: 99%

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Coronal Three-Dimensional Magnetic Resonance Imaging for Improving Diagnostic Accuracy for Posterior Ligamentous Complex Disruption In a Goat Spine Injury Model

et al. 2019

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ObjectiveThe purpose of this study was to investigate whether three-dimensional (3D) magnetic resonance imaging could improve diagnostic accuracy for suspected posterior ligamentous complex (PLC) disruption.Materials and MethodsWe used 20 freshly harvested goat spine samples with 60 segments and intact surrounding soft tissue. The animals were aged 1–1.5 years and consisted of 8 males and 12 females, which were sexually mature but had not reached adult weights. We created a paraspinal contusion model by percutaneously injecting 10 mL saline into each side of the interspinous ligament (ISL). All segments underwent T2-weighted sagittal and coronal short inversion time inversion recovery (STIR) scans as well as coronal and sagittal 3D proton density-weighted spectrally selective inversion recovery (3D-PDW-SPIR) scans acquired at 1.5T. Following scanning, some ISLs were cut and then the segments were re-scanned using the same magnetic resonance (MR) techniques. Two radiologists independently assessed the MR images, and the reliability of ISL tear interpretation was assessed using the kappa coefficient. The chi-square test was used to compare the diagnostic accuracy of images obtained using the different MR techniques.ResultsThe interobserver reliability for detecting ISL disruption was high for all imaging techniques (0.776–0.949). The sensitivity, specificity, and diagnostic accuracy of the coronal 3D-PDW-SPIR technique for detecting ISL tears were 100, 96.9, and 97.9%, respectively, which were significantly higher than those of the sagittal STIR (p = 0.000), coronal STIR (p = 0.000), and sagittal 3D-PDW-SPIR (p = 0.001) techniques.ConclusionCompared to other MR methods, coronal 3D-PDW-SPIR provides a more accurate diagnosis of ISL disruption. Adding coronal 3D-PDW-SPIR to a routine MR protocol may help to identify PLC disruptions in cases with nearby contusion.

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“…If a step-off is palpated with increased distance between subsequent spinous processes, a PLC injury is likely [23]. The physical exam should then be completed with a thorough neurological evaluation according to the American Spine Injury Association (ASIA) classification, as neurological deficits increase the likelihood of PLC injury and spinal instability [24].…”

Section: Diagnosis Physical Exammentioning

confidence: 99%

Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications

Bizdikian¹,

Rachkidi²

2021

Cureus

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The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are often dreaded and little attention has been given to them in the management protocols of thoracolumbar trauma. This review aims to summarize and contextualize current concepts in PLC injuries of the thoracolumbar spine with the aim to provide a clear guide for clinical management.Injuries to the PLC may be suspected on the clinical exam but are often missed, leading to serious complications, including instability and neurological compromise. The diagnosis is often made indirectly by spinal radiographs and CT-scanning or by direct visualization of soft tissues via magnetic resonance imaging. The latter remains the standard imaging modality and is mandatory for patients with a high suspicion of PLC injury. PLC injuries are associated with vertebral fractures and follow a progressive pattern of severity, depending on the mechanism of injury and extent of trauma. Surgical management is warranted, as PLC damage renders the spine unstable. Although fusion was once the standard of care and remains applicable for certain patients, recent endeavors of temporary spinal fixation without fusion are increasingly gaining traction in patients with PLC injuries.In conclusion, PLC injuries are challenging as they are often missed, poorly understood, and are not easily managed. Proper diagnosis and management are crucial to avoid long-standing complications such as spinal instability. Considering the paucity of available data on such an important topic in thoracolumbar trauma, this review article aims to contextualize current concepts in PLC injuries in order to demystify this sparsely covered subject.

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Prediction of MRI findings including disc injury and posterior ligamentous complex injury in neurologically intact thoracolumbar burst fractures by the parameters of vertebral body damage on CT scan

Cited by 22 publications

References 32 publications

Disk injury in patients with vertebral fractures—a prospective diagnostic accuracy study using dual-energy computed tomography

Disk injury in patients with vertebral fractures—a prospective diagnostic accuracy study using dual-energy computed tomography

Coronal Three-Dimensional Magnetic Resonance Imaging for Improving Diagnostic Accuracy for Posterior Ligamentous Complex Disruption In a Goat Spine Injury Model

Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications

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