Early Bone Marrow Edema Pattern of the Osteoporotic Vertebral Compression Fracture : Can Be Predictor of Vertebral Deformity Types and Prognosis?

Abstract

ObjectiveTo evaluate whether an early bone marrow edema pattern predicts vertebral deformity types and prognosis in osteoporotic vertebral compression fracture (OVCF).MethodsThis retrospective study enrolled 64 patients with 75 acute OVCFs who underwent early MRI and followed up MRI. On early MRI, the low SI pattern of OVCF on T1WI were assessed and classified into 3 types (diffuse, globular or patchy, band-like). On followed up MRI, the vertebral deformity types (anterior wedge, biconcave, crush), degree of vertebral body height loss, incidence of vertebral osteonecrosis and spinal stenosis were assessed for each vertebral fracture types.ResultsAccording to the early bone marrow edema pattern on T1WI, 26 vertebrae were type 1, 14 vertebrae were type 2 and 35 vertebrae were type 3. On followed up MRI, the crush-type vertebral deformity was most frequent among the type 1 OVCFs, the biconcave-type vertebral deformity was most frequent among the type 2 OVCFs and the anterior wedge-type vertebral deformity was most frequent among the type 3 OVCFs (p<0.001). In addition, type 1 early bone marrow edema pattern of OVCF on T1WI were associated with higher incidence of severe degree vertebral body height loss, vertebral osteonecrosis and spinal stenosis on the follow up MRI.ConclusionEarly bone marrow edema pattern of OVCF on T1WI, significant correlated with vertebral deformity types on the follow up MRI. The severe degree of vertebral height loss, vertebral osteonecrosis, and spinal stenosis were more frequent in patients with diffuse low SI pattern.

The Evaluation of Different Radiological Measurement Parameters of the Degree of Collapse of the Vertebral Body in Vertebral Compression Fractures

“…In most studies that assessed VBHL, AVH was mostly used to represent the degree of collapse in the entire vertebral body [8, 9]. However, clinical observations showed that vertebral body collapse at the middle region is often the region with the most severe collapse [13]. This may be because the bone at the middle region is softer.…”

Posttraumatic Delayed Vertebral Collapse : Kummell’s Disease

“…MRI is the most useful diagnostic tool for the diagnosis of vertebral compression fracture and IVC, especially T1 weighted image and fat-suppressed T2 weight image 1 , 4 , 13 , 19 , 36) . The affected area shows low SI on T1WI and high SI on T2WI in the acute period, and then changes into iso-signal intensity as the bone marrow edema gradually decreases 1) . However, the signals of MRI differ depending on the diagnosis time, and the reported difference in MRI signals significantly vary by authors.…”

“…Young et al 35) reported that osteonecrotic vertebral collapse shows increased signal intensity in T1 weight image, while decreased signal intensity in T2 weight image. However, most of studies revealed that osteonecrotic vertebral collapse shows decreased signal intensity in T1 weight image, while in T2 weight image, it displays variable signals, such as high in fluid and low in gas, depending on the contents of IVC 1 , 4 , 13 , 19 , 31 , 36) . It was reported that a ‘double line sign’, in which a high signal zone is shown in the center and a low signal zone in the periphery in T2WI at the fractured vertebral body, is associated with IVC ( Fig.…”

“…In addition to IVC, there is another predictive factor in MRI for delayed vertebral collapse. Ahn et al 1) reported that early bone marrow pattern observed on initial MRI was a poor prognostic factor of OVCF if low SI on T1WI. Tsujio et al 32) reported that thoracolumbar junction, middle-column injury, and confined or diffuse low SI on T2WI are the predictive factors of nonunion, and in particular that confined low SI on T2WI means repetitive mechanical compression due to a tensile and shearing force, and thus the confined type can be more nonunion than diffuse low SI on T2WI.…”

Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases

“…In the early stage, Genant et al proposed the Genant semi-quantitative method for fractures with different symptoms [ 8 ]. Smail et al proposed the EVOSG classification and divided the OVCF into three types: wedge type, double concave type and collapse typ, but there is no classification of nerve damage [ 9 ]. Subsequently, Heini et al [ 10 ] further improved and proposed the Heini classification according to clinical and imaging findings, but there was crosses overlap between different types, which was not conducive to clear clinical guidance.…”