J Korean Soc Radiol.  2018 Feb;78(2):107-114. 10.3348/jksr.2018.78.2.107.

Importance of Bone Marrow and Soft Tissue Edema to Improve the Diagnostic Accuracy of Lumbosacral MRI for Transverse Process Fractures and Sacral Fractures

• Kwon JA
• Hwang JY
• Kim MJ
• Kwon HY
• Kim DH

• KMID: 2408260
• DOI: http://doi.org/10.3348/jksr.2018.78.2.107

Abstract

PURPOSE
To evaluate the magnetic resonance imaging (MRI) findings to improve the diagnostic accuracy for transverse process fractures and sacral fractures.
MATERIALS AND METHODS
The lumbosacral MRI scans of 214 patients (mean age, 60 years; male-to-female ratio, 85:129), who had spine trauma between January and November 2015 were included. Two radiologists evaluated the presence, number, level, and anatomic site of the fractures on MRI with computed tomography as reference standard. Imaging findings were described as cortical disruption, marrow edema, or soft tissue edema on T1-, T2-, and fat-suppressed T2-weighted images. A statistical analysis was performed to compare the diagnostic accuracy of the MRI pulse sequences for the transverse process and sacral fractures.
RESULTS
Of 168 fractures, 26 (15.5%) and 13 (4.9%) were in the transverse processes and sacra, respectively. A paravertebral soft tissue edema occurred in the transverse process fractures (80.8%) and presacral soft tissue and marrow edemas occurred in the sacral fractures (46.1%). The sensitivity for the transverse process fractures was 88% on the T2-weighted image. It was 92% on fat-suppressed T2- and T1-weighted images for sacral fractures.
CONCLUSION
Bone marrow and soft tissue edemas on the MRI could potentially improve the diagnostic accuracy of an MRI for fractures in the transverse process and sacrum.

MeSH Terms

Bone Marrow*
Edema*
Humans
Lumbosacral Region
Magnetic Resonance Imaging*
Sacrum
Spinal Fractures
Spine

Figure

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  Fig. 1. A 45-year-old man who incurred right L2 and L3 transverse process fractures after falling from a 2m high guardrail. A. Sagittal fat-suppressed T2-weighted MR image showing paravertebral soft tissue edema (arrow). B. Axial T2-weighted MR image showing soft tissue edema in the right psoas and spinal erector muscles (arrows), which reflects a transverse process fracture. C. Axial computed tomography scan showing a fracture at the right L3 transverse process. MR = magnetic resonance

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  Fig. 2. A 67-year-old man who incurred a trauma with a sacral fracture during a car accident. A. Midline sagittal fat-suppressed T2-weighted image showing presacral edema (arrow). B, C. Parasagittal fat-suppressed T2-weighted (B) and T1-weighted (C) images showing bone marrow edema (arrows) in the right sacral ala. D. Axial T2-weighted image showing bone marrow edema (arrow) in right sacral ala. E. Axial CT scan showing a fracture at the right sacral ala.

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  Fig. 3. A false-positive case: a 78-year-old woman who had a low back pain after slipping down. A, B. Sagittal fat-suppressed T2-weighted (A) and T1-weighted (B) images showing presacral edema (arrows). C. No fracture can be observed in the sacrum on the sagittal computed tomography scan.

Reference

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