J Korean Med Assoc.  2010 Jan;53(1):67-75. 10.5124/jkma.2010.53.1.67.

Imaging Diagnosis of Osteoporotic Fracture

• Yang SO
• Kim S
• Juhng SK

• KMID: 2188241
• DOI: http://doi.org/10.5124/jkma.2010.53.1.67

Abstract

Osteoporotic vertebral fractures suspected at clinical evaluation require radiological confirmation. Most radiologists make the diagnosis of vertebral fracture on the basis of a qualitative impression. However, unlike other fractures, vertebral fractures are commonly found on radiographs obtained for other reasons in patients who do not show signs or symptoms suggestive of fractures. Radiologists qualitatively analyze radiographs of the thoracolumbar spine to identify vertebral fractures in patients whose clinical indications suggest trauma, osteoporosis, malignancy, or acute back pain. The accuracy of decision-making process can be enhanced by additional radiographic projections or by complementary examinations including DXA (Dual Energy X-ray Absorptiometry) morphometry, bone scan, CT, or MRI. The importance of imaging is highlighted by the fact that only about one in four vertebral fractures is recognized on the basis of clinical evaluations without radiographs. Radiographs may include lateral and AP (anterior/posterior) X-rays of the affected spinal segments. The physician may request bone scan and/or CT to help identify the location of the fracture, its status (stable versus unstable). Furthermore, an MRI scan may be performed if neurologic deficit, soft tissue trauma or hematoma are suspected.

Keyword

Osteoporosis; Vertebral fracture; Imaging diagnosis

MeSH Terms

Back Pain
Hematoma
Humans
Magnetic Resonance Imaging
Neurologic Manifestations
Osteoporosis
Osteoporotic Fractures
Spine

Figure

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  Figure 1 Diagram of Saville index (Insurance covered from Grade 3).

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  Figure 2 Various type of vertebral compression fractures: From left, wedge type, biconcave type, and pancake-like crushed vertebral fracture.

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  Figure 3 Semiquantitative method to assess vertebral fractures. (Genant HK, et al. J Bone Mineral Res 1993; 8(9):1137-1148).

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  Figure 4 AP and lateral images of DXA vertebral morphometry.

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  Figure 5 Compression fracture of the 1st lumbar vertebral body by bone scan (left) and sacral insufficiency fracture by bone SPECT (right).

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  Figure 6 CT sagittal reconstructed image and 3 D reformation of L2 vertebral fracture in 62 year-old male.

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  Figure 7 MRI finding of benign vertebral fracture: T2 WI, T1 WI, T1 contrast enhanced image (from left).

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  Figure 8 MRI finding of malignant vertebral fracture: T2 WI, T1 WI, T1 contrast enhanced image (from left). Note the exophytic soft tissue mass and signal changes in the whole spine.

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  Figure 9 MRI finding of sacral insufficiency fracture: Fat suppressed sagittal T2 WI, axial T1 WI, axial fat suppressed T1 WI (from left).

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  Figure 10 Simple radiographs of two cases with multiple myeloma: Heterogenous osteolytic bone loss and biconcave fractures.

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  Figure 11 Simple radiographs of osteomalacia: See the apparent vertebral end-plates with fuzzy appearance.

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