“…However, vertebral body edema is not a precise measure of compression fracture age because the duration after an osteoporotic compression fracture is often not known with certainty. Bone marrow edema typically resolves within 1 to 3 months [47,48]. Contrast is not indicated, as it does not add information in the setting of osteoporotic VCF.…”
Section: Discussion Of Procedures By Variant Variant 1: New Symptomatmentioning
confidence: 99%
“…[64,65]. Bone marrow edema associated with acute fractures on MRI typically resolves within 1 to 3 months [47,48].…”
Section: Discussion Of Procedures By Variant Variant 1: New Symptomatmentioning
Vertebral compression fractures (VCFs) have various causes, including osteoporosis, neoplasms, and acute trauma. As painful VCFs may contribute to general physical deconditioning, management of painful VCFs has the potential for improving quality of life and preventing superimposed medical complications. Various imaging modalities can be used to evaluate a VCF to help determine the etiology and guide intervention. The first-line treatment of painful VCFs has been nonoperative or conservative management as most VCFs show gradual improvement in pain over 2 to 12 weeks, with variable return of function. There is evidence that vertebral augmentation (VA) is associated with better pain relief and improved functional outcomes compared to conservative therapy for osteoporotic VCFs. A multidisciplinary approach is necessary for the management of painful pathologic VCFs, with management strategies including medications to affect bone turnover, radiation therapy, and interventions such as VA and percutaneous thermal ablation to alleviate symptoms.
“…However, vertebral body edema is not a precise measure of compression fracture age because the duration after an osteoporotic compression fracture is often not known with certainty. Bone marrow edema typically resolves within 1 to 3 months [47,48]. Contrast is not indicated, as it does not add information in the setting of osteoporotic VCF.…”
Section: Discussion Of Procedures By Variant Variant 1: New Symptomatmentioning
confidence: 99%
“…[64,65]. Bone marrow edema associated with acute fractures on MRI typically resolves within 1 to 3 months [47,48].…”
Section: Discussion Of Procedures By Variant Variant 1: New Symptomatmentioning
Vertebral compression fractures (VCFs) have various causes, including osteoporosis, neoplasms, and acute trauma. As painful VCFs may contribute to general physical deconditioning, management of painful VCFs has the potential for improving quality of life and preventing superimposed medical complications. Various imaging modalities can be used to evaluate a VCF to help determine the etiology and guide intervention. The first-line treatment of painful VCFs has been nonoperative or conservative management as most VCFs show gradual improvement in pain over 2 to 12 weeks, with variable return of function. There is evidence that vertebral augmentation (VA) is associated with better pain relief and improved functional outcomes compared to conservative therapy for osteoporotic VCFs. A multidisciplinary approach is necessary for the management of painful pathologic VCFs, with management strategies including medications to affect bone turnover, radiation therapy, and interventions such as VA and percutaneous thermal ablation to alleviate symptoms.
“…Consolidation was ensured by the absence of bone marrow edema in recent MR imaging. Active, progressive vertebral fractures (with bone marrow edema in MRI or signs of callus formation in CT [21]) were not considered as incidental fractures as they are usually associated with continuous clinical symptoms [22]. Fig.…”
Objectives
To compare opportunistic quantitative CT (QCT) with dual energy X-ray absorptiometry (DXA) in their ability to predict incident vertebral fractures.
Methods
We included 84 patients aged 50 years and older, who had routine CT including the lumbar spine and DXA within a 12-month period (baseline) as well as follow-up imaging after at least 12 months or who sustained an incident vertebral fracture documented earlier. Patients with bone disorders aside from osteoporosis were excluded. Fracture status and trabecular bone mineral density (BMD) were retrospectively evaluated in baseline CT and fracture status was reassessed at follow-up. BMD
QCT
was assessed by opportunistic QCT with asynchronous calibration of multiple MDCT scanners.
Results
Sixteen patients had incident vertebral fractures showing lower mean BMD
QCT
than patients without fracture (
p
= 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMD
QCT
(4.07; 95% CI, 1.98–8.38), as well as after adjusting for age, sex, and prevalent fractures (2.54; 95% CI, 1.09–5.90). For DXA, a statistically significant increase in relative hazard per SD decrease in
T
-score was only observed after age and sex adjustment (1.57; 95% CI, 1.04–2.38). The predictability of incident vertebral fractures was good by BMD
QCT
(AUC = 0.76; 95% CI, 0.64–0.89) and non-significant by
T
-scores. Asynchronously calibrated CT scanners showed good long-term stability (linear drift ranging from − 0.55 to − 2.29 HU per year).
Conclusions
Opportunistic screening of mainly neurosurgical and oncologic patients in CT performed for indications other than densitometry allows for better risk assessment of imminent vertebral fractures than dedicated DXA.
Key Points
• Opportunistic QCT predicts osteoporotic vertebral fractures better than DXA reference standard in mainly neurosurgical and oncologic patients.
• More than every second patient (56%) with an incident vertebral fracture was misdiagnosed not having osteoporosis according to DXA.
• Standard ACR QCT-cutoff values for osteoporosis (< 80 mg/cm
3
) and osteopenia (≤ 120 mg/cm
3
) can also be applied scanner independently in calibrated opportunistic QCT.
“…Up to now, little is known about short-term development of vertebral bone marrow edema in case of acute fractures. In long-term follow-up it is uncertain that the bone marrow edema correlates most with the clinical findings and the outcome (7,8).…”
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