Department of Radiology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10444, Republic of Korea.
Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
AJR Am J Roentgenol. 2020 Oct;215(4):970-977. doi: 10.2214/AJR.19.22606. Epub 2020 Aug 18.
The purpose of this study was to evaluate whether CT features can predict bone marrow edema (BME) on MRI and fracture age in vertebral fragility fractures. A total of 189 thoracolumbar compression fractures in 103 patients (14 men, 89 women; mean age, 76 years) imaged with both spine CT and MRI were retrospectively included. The presence and extent of BME were assessed on MRI to divide fractures into those with and without BME. The group with BME was then classified for subgroup analysis into fractures with extensive BME (comprising 50% or more of the vertebral body) and those with BME comprising less than 50% of the vertebral body. On CT, five features (presence of cortical or endplate fracture line, presence of trabecular fracture line, presence of condensation band, change in trabecular attenuation, and width of paravertebral soft-tissue change) were analyzed. All five CT findings were predominantly seen in fractures with BME ( < 0.001). Elevated trabecular attenuation, presence of a cortical or endplate fracture line, and paravertebral soft-tissue width showed excellent diagnostic indication for fractures with BME (ROC AUCs: 0.990, 0.976, and 0.950, respectively). In the subgroup with extensive BME, paravertebral soft-tissue width was significantly higher, whereas the change in trabecular attenuation was lower compared with those with BME comprising less than 50% of the vertebral body 0.001). When BME was present, fracture age was not significantly different between the two subgroups, and only greater trabecular attenuation elevation was predictive of older fracture age on linear mixed model analyses ( 0.001). Interobserver agreement was good for the trabecular fracture line factor and excellent for all other factors. CT features accurately correlate with the presence and extent of BME in vertebral fragility fractures. Elevation of trabecular attenuation was the only significant image predictor of fracture age.
本研究旨在评估 CT 特征是否可预测椎体脆性骨折的骨髓水肿（BME）和骨折年龄。回顾性纳入了 103 例（14 名男性，89 名女性；平均年龄 76 岁）共 189 例胸腰椎压缩骨折患者的脊柱 CT 和 MRI 图像。在 MRI 上评估 BME 的存在和程度，将骨折分为有 BME 和无 BME。将有 BME 的组进一步分为 BME 广泛组（占椎体的 50%或以上）和 BME 占椎体不到 50%的组。在 CT 上，分析了 5 种特征（皮质或终板骨折线的存在、小梁骨折线的存在、骨密度带的存在、小梁衰减的变化和椎旁软组织变化的宽度）。所有 5 种 CT 发现均主要见于有 BME 的骨折中（<0.001）。小梁衰减增加、皮质或终板骨折线的存在以及椎旁软组织宽度对有 BME 的骨折具有极好的诊断指示（ROC AUC：0.990、0.976 和 0.950）。在 BME 广泛的亚组中，椎旁软组织宽度显著较高，而小梁衰减变化则较低，与 BME 占椎体不到 50%的骨折相比，差异有统计学意义（<0.001）。当存在 BME 时，两个亚组之间的骨折年龄没有显著差异，仅较大的小梁衰减增加可预测线性混合模型分析中较老的骨折年龄（<0.001）。小梁骨折线因子的观察者间一致性良好，所有其他因子的观察者间一致性均为优秀。CT 特征与椎体脆性骨折中 BME 的存在和程度密切相关。小梁衰减的增加是预测骨折年龄的唯一显著影像学指标。
