Park Si Young, Lee Soon Hyuck, Suh Seung Woo, Park Jong Hoon, Kim Tae Gwon
Department of Orthopaedic Surgery, College of Medicine, Korea University, Seoul, Korea.
J Spinal Disord Tech. 2013 May;26(3):E80-5. doi: 10.1097/BSD.0b013e318261f438.
This is a prospective study on consecutive patients with acute osteoporotic vertebral compression fractures (OVCFs).
To evaluate the usefulness of magnetic resonance imaging (MRI) for diagnosing appropriate acute lesions before a percutaneous cement augmentation technique.
Vertebral compression fractures related to osteoporosis are very common in the elderly. Acute OVCFs are usually treated conservatively. In recent years, minimally invasive percutaneous cement augmentation techniques, vertebroplasty and kyphoplasty, have been introduced as alternative treatment options. However, the localization of acute fractures of the spine can be difficult, yet is critical in implementing these treatments.
A total of 168 patients were enrolled in this study. All participants were 50 years of age or older and were admitted via the emergency room because of acute severe back pain with suspected OVCFs with or without a history of trauma. Standard plain radiographs and a computed tomography (CT) scan of the spine were initially obtained in the emergency room. An MRI scan with short-tau inversion recovery (STIR) sequencing of the spine was performed within 3 days of hospitalization. Patients were divided into 2 groups: single group and multiple group. The single group consisted of those with a single fracture, and the multiple group consisted of those with multiple fractures of the vertebral body, as diagnosed using only standard radiographs and CT scans. We compared the level and number of fractures from the initial findings of the standard radiographs and CT scans with the MRI scan results within each group.
The mean age of the study participants was 68.9 years. Forty-nine patients were male and 119 were female. In the single group, the concordance rate of diagnosis was 77% (97/125) and the discordance rate was 23% (28/125). In the multiple group, the discordance rate was 65% (28/43). There was a significantly higher rate of misdiagnosis in the multiple group compared with the single group (P < 0.01).
MRI with STIR sequencing exhibited a multitude of benefits in the exact identification of acute lesions and hidden lesions. Because of the high rate of misdiagnosis using standard plain radiographs and CT scans of the spine for OVCFs, MRI with STIR sequencing should be considered before cement augmentation procedures. Moreover, in cases with multiple lesions or severe osteoporosis, the importance of MRI should be further emphasized.
这是一项针对连续性急性骨质疏松性椎体压缩骨折（OVCF）患者的前瞻性研究。
评估磁共振成像（MRI）在经皮骨水泥强化技术前诊断合适急性病变的实用性。
与骨质疏松相关的椎体压缩骨折在老年人中非常常见。急性OVCF通常采用保守治疗。近年来，微创经皮骨水泥强化技术，椎体成形术和后凸成形术，已作为替代治疗选择被引入。然而，脊柱急性骨折的定位可能困难，但在实施这些治疗中至关重要。
本研究共纳入168例患者。所有参与者年龄在50岁及以上，因疑似OVCF伴或不伴有创伤史的急性严重背痛通过急诊室入院。最初在急诊室获得标准脊柱X线平片和计算机断层扫描（CT）。住院3天内对脊柱进行短tau反转恢复（STIR）序列的MRI扫描。患者分为2组：单发病例组和多发病例组。单发病例组由单发骨折患者组成，多发病例组由椎体多发骨折患者组成，仅使用标准X线平片和CT扫描进行诊断。我们将标准X线平片和CT扫描的初始检查结果中的骨折部位和数量与每组内的MRI扫描结果进行比较。
研究参与者的平均年龄为68.9岁。男性49例，女性119例。在单发病例组中，诊断符合率为77%（97/125），不符合率为23%（28/125）。在多发病例组中，不符合率为65%（28/43）。多发病例组的误诊率明显高于单发病例组（P < 0.01）。
STIR序列的MRI在准确识别急性病变和隐匿性病变方面显示出诸多益处。由于使用标准脊柱X线平片和CT扫描诊断OVCF的误诊率较高，在骨水泥强化手术前应考虑使用STIR序列的MRI。此外，在多节段病变或严重骨质疏松的病例中，应进一步强调MRI的重要性。
