Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Department of Radiology, College of Medicine, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Tongil-ro, Eunpyeong-gu, Seoul, 1021, Korea.
Neuroradiology. 2022 Aug;64(8):1681-1688. doi: 10.1007/s00234-022-02976-z. Epub 2022 May 17.
The diagnostic tool for Kümmell's disease (KD), including the intravertebral vacuum cavity on imaging, is still limited. The purpose of this study was to find other magnetic resonance imaging (MRI) findings that could help the diagnosis of KD.
A total of 289 patients (103 males and 186 females with a mean age of 69 ± 15 years) with thoracolumbar compression fracture were included. Medical records were reviewed to note symptom duration. MRIs were analyzed for intraosseous cavities (IOC), prevertebral soft-tissue changes (PreSC), posterior wall fracture (PoF), and posterior ligamentous complex tear (PLCT). KD was diagnosed based on surgical findings or clinical report. MRI findings and symptom duration in the presence or absence of KD were compared with chi-squared test, logistic regression, and Student's t-test and area under the curve (AUC) analyses.
KD was diagnosed in 55 cases. IOC was noted in 33 (60%) cases in the KD group and 82 (35%) cases in non-KD group. Definite PreSC was noted in 44 (80%) cases in the KD group and 94 (40%) cases in the non-KD group. PoF was seen in 36 (65%) and 140 (60%) cases, and PLCT was seen in 7 (13%) and 26 (11%) cases in KD and non-KD groups, respectively. The IOC and PreSC MRI findings were significantly correlated with KD (p < 0.001), but not with PoF (p = 0.539) or PLCT (p = 0.814). AUC of combined IOC and PreSC was 0.72, higher than that of IOC alone (0.63) or PreSC alone (0.69) (both p < 0.001). The average duration of symptom was 64 days in the KD group and 14 days in the non-KD group (p < 0.001). Positive IOC and PreSC findings were associated with longer symptom duration (p < 0.001).
Prevertebral soft-tissue changes and intraosseous cavity are associated with KD. Combined findings of prevertebral soft-tissue changes and intraosseous cavity can help the diagnosis of KD.
用于诊断 Kuemmell 病（KD）的诊断工具，包括影像学上的椎体内真空腔，仍然存在局限性。本研究的目的是寻找其他磁共振成像（MRI）表现，以帮助诊断 KD。
共纳入 289 例胸腰椎压缩性骨折患者（男 103 例，女 186 例，平均年龄 69±15 岁）。回顾病历以记录症状持续时间。对 MRI 进行分析，以确定是否存在骨内空腔（IOC）、椎体前方软组织变化（PreSC）、后纵韧带复合体撕裂（PLCT）和后柱骨折（PoF）。根据手术发现或临床报告诊断 KD。比较 KD 组和非 KD 组 MRI 表现与症状持续时间，采用卡方检验、logistic 回归、Student's t 检验和曲线下面积（AUC）分析。
55 例诊断为 KD。KD 组 33 例（60%）和非 KD 组 82 例（35%）有明确的 IOC。KD 组 44 例（80%）和非 KD 组 94 例（40%）存在明确的 PreSC。PoF 在 KD 组和非 KD 组分别为 36 例（65%）和 140 例（60%），PLCT 在 KD 组和非 KD 组分别为 7 例（13%）和 26 例（11%）。IOC 和 PreSC 的 MRI 表现与 KD 显著相关（p<0.001），但与 PoF（p=0.539）或 PLCT（p=0.814）无关。IOC 和 PreSC 联合的 AUC 为 0.72，高于单独 IOC（0.63）或单独 PreSC（0.69）（均 p<0.001）。KD 组的平均症状持续时间为 64 天，非 KD 组为 14 天（p<0.001）。阳性 IOC 和 PreSC 表现与较长的症状持续时间相关（p<0.001）。
椎体前方软组织改变和骨内空腔与 KD 相关。椎体前方软组织改变和骨内空腔的联合表现有助于 KD 的诊断。
