J Korean Soc Radiol.  2013 Jun;68(6):503-510. 10.3348/jksr.2013.68.6.503.

Magnetic Resonance Enhancement Patterns at the Different Ages of Symptomatic Osteoporotic Vertebral Compression Fractures

• You JY
• Lee JW
• Kim JE
• Kang HS

• KMID: 2002903
• DOI: http://doi.org/10.3348/jksr.2013.68.6.503

Abstract

PURPOSE
To investigate the magnetic resonance (MR) enhancement patterns of symptomatic osteoporotic vertebral compression fracture (VCF) according to the fracture age, based on the successful single-level percutaneous vertebroplasty (PVP) cases.
MATERIALS AND METHODS
The study included 135 patients who underwent contrast-enhanced MR imaging and successful PVP from 2005 to 2010 due to a single-level osteoporotic VCF. Two radiologists blinded to the fracture age evaluated the MR enhancement patterns in consensus. The MR enhancement patterns were classified according to the enhancing proportion to the vertebral height and the presence or extent of a non-enhancing cleft within the enhancing area on sagittal plane. The Fisher' exact test, Kruskal-Wallis test and Mann-Whitney U test were performed to assess the differences in the MR enhancement patterns according to the fracture age.
RESULTS
Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. A diffuse enhancing area can be seen in not only the hyperacute and acute VCFs but also the chronic symptomatic VCFs. Symptomatic VCFs having a segmental enhancing area were all included in the hyperacute or acute stage. Most symptomatic osteoporotic VCFs had a non-enhancing cleft in the enhanced vertebral body (128/135, 94.8%). There was no statistical difference of the enhancement pattern according to the fracture age.
CONCLUSION
Symptomatic VCFs show variable MR enhancement patterns in all fracture ages. The most common pattern is a non-enhancing cleft within a diffuse enhanced vertebra.

MeSH Terms

Consensus
Fractures, Compression
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Osteoporosis
Spinal Fractures
Spine
Vertebroplasty

Figure

• 

  Fig. 1 Schematic diagrams and examples of magnetic resonance enhancement patterns. Pattern A shows a large non-enhancing cleft within diffuse enhancing area. Pattern B shows a linear or band-like non-enhancing cleft within diffuse enhancing area. Pattern C shows the absence of or a punctate non-enhancing cleft within diffuse enhancing area. Pattern D shows a linear or band-like non-enhancing cleft within segmental enhancing area. Pattern E shows the absence of non-enhancing cleft within segmental enhancing area.

• 

  Fig. 2 Imaging in a 73-year woman with chronic symptomatic osteoporotic compression fracture. A. Lateral radiography obtained 3 month after trauma shows anterosuperior compression fracture of L1 vertebra. B. T2-weighted image obtained 7 month after lateral radiography (A) due to continuous back pain shows hypointense signal alteration in fractured L1 vertebral body. C. Contrast-enhanced fat-suppressed T1-weighted image shows non-enhancing cleft within diffuse enhanced L1 vertebra (Pattern B). D. After percutaneous vertebroplasty, chronic back pain of the patient was markedly improved.

• 

  Fig. 3 Usefulness of contrast enhanced magnetic resonance (MR) imaging for needle positioning of percutaneous vertebroplasty (PVP). Images in a 63-year-old woman with symptomatic compression fracture of T12 vertebra. A. On T2-weighted image, there is no demonstrable hypointense signal alteration or fluid-filled gap at T12 vertebra. B. However, a contrast-enhanced fat-suppressed T1-weighted image shows a large non-enhancing cleft within diffuse enhanced T12 vertebra (Pattern A). C. On PVP, the vertebroplasty needle tip is placed in the upper third of T12 vertebra, which is well correlated with non-enhancing cleft on contrast enhanced MR image. D. The bone cement is packing at the non-enhancing cleft of T12 vertebra.

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