Investig Magn Reson Imaging.  2017 Sep;21(3):148-153. 10.13104/imri.2017.21.3.148.

Magnetic Resonance Enhancement Pattern as a Predictor of Cement Volume in Vertebroplasty Procedures for Osteoporotic Fractures

• Lee KH
• Yoo DS
• Kim YH

• KMID: 2392685
• DOI: http://doi.org/10.13104/imri.2017.21.3.148

Abstract

PURPOSE
To identify the differences between injected cement volumes during vertebroplasty procedures according to the enhancement pattern of pre-procedure magnetic resonance imaging (MRI) findings.
MATERIALS AND METHODS
Thirty-two patients who underwent 52 vertebroplasty procedures as well as pre-procedure contrast-enhanced spine MRI in the authors' institution were reviewed retrospectively. The 52 procedures were divided into two groups according to different enhancement patterns shown by pre-procedure MR imaging [E(+) and E(−)]. The volumes of the enhancing/non-enhancing portions of the fractured vertebral body shown by pre-procedural MR imaging were calculated and compared to the volumes of the injected cement during the vertebroplasty procedures.
RESULTS
The 52 injections included 28 (56%) in Group E(+) and 24 (44%) in Group E(−). The actual volume ratio of the injected cement to the volume of the non-enhanced or enhanced region calculated based on the contrast-enhanced MRI was 0.22 ± 0.11 (cc/cm³) in the E(+) group and 0.93 ± 0.62 (cc/cm³) in the E(−) group. The average amount of injected cement was significantly different between Group E(+) and Group E(−) (P < 0.001). In addition, the ratio of the injected cement amount to the volume of the enhanced or non-enhanced portion based on the contrast-enhanced MRI in Group E(−) was significantly higher than that of Group E(+) (P < 0.001).
CONCLUSION
Different enhancement patterns shown by pre-procedure MRI can predictors of the injected cement volume during vertebroplasty procedures for osteoporotic fractures.

Keyword

Vertebroplasty; Osteoporotic fracture; Cement volume; Enhancement; Magnetic resonance imaging

MeSH Terms

Humans
Magnetic Resonance Imaging
Osteoporotic Fractures*
Retrospective Studies
Spine
Vertebroplasty*

Figure

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  Fig. 1 ROI on each enhanced T1WI sagittal plane in a PACS workstation.

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  Fig. 2 A case from the E(−) group involving an 87-year-old woman with back pain. L1 shows (a) a hyperintensity area on T2WI and (b) low signal intensity on T1WI. (c) On a fat-suppressed contrast-enhanced T1WI, a non-enhanced area is surrounded by well-enhanced bone marrow in the L1 vertebral body. (d) On a lateral spot radiograph during PVP and (e) a post-procedural radiograph, the pattern of cement opacification is the solid pattern. (f) The CT scan done after PVP shows a solid distribution pattern of injected cement.

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  Fig. 3 A case from the E(+) group involving a 72-year-old woman with lower back pain. T11 shows a (a) hypointense area on T1WI and (b) low signal intensity on T2WI. (c) On a fat-suppressed contrast-enhanced T1WI, T11 shows diffuse enhancement. (d) On the anterior-posterior spot radiograph during vertebroplasty and (e) the post-procedural radiograph, the cement opacification is the trabecular pattern. (f) The CT scan done after the procedure shows a trabecular distribution pattern of injected cement.

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  Fig. 4 Ratio of the actual volume of injected cement to the volume of the non-enhanced or enhanced area in Group E(+) and Group E(−).

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