J Korean Neurosurg Soc.  2016 Mar;59(2):137-142. 10.3340/jkns.2016.59.2.137.

Early Bone Marrow Edema Pattern of the Osteoporotic Vertebral Compression Fracture : Can Be Predictor of Vertebral Deformity Types and Prognosis?

• Ahn SE
• Ryu KN
• Park JS
• Jin W
• Park SY
• Kim SB

• KMID: 2192043
• DOI: http://doi.org/10.3340/jkns.2016.59.2.137

Abstract

OBJECTIVE
To evaluate whether an early bone marrow edema pattern predicts vertebral deformity types and prognosis in osteoporotic vertebral compression fracture (OVCF).
METHODS
This retrospective study enrolled 64 patients with 75 acute OVCFs who underwent early MRI and followed up MRI. On early MRI, the low SI pattern of OVCF on T1WI were assessed and classified into 3 types (diffuse, globular or patchy, band-like). On followed up MRI, the vertebral deformity types (anterior wedge, biconcave, crush), degree of vertebral body height loss, incidence of vertebral osteonecrosis and spinal stenosis were assessed for each vertebral fracture types.
RESULTS
According to the early bone marrow edema pattern on T1WI, 26 vertebrae were type 1, 14 vertebrae were type 2 and 35 vertebrae were type 3. On followed up MRI, the crush-type vertebral deformity was most frequent among the type 1 OVCFs, the biconcave-type vertebral deformity was most frequent among the type 2 OVCFs and the anterior wedge-type vertebral deformity was most frequent among the type 3 OVCFs (p<0.001). In addition, type 1 early bone marrow edema pattern of OVCF on T1WI were associated with higher incidence of severe degree vertebral body height loss, vertebral osteonecrosis and spinal stenosis on the follow up MRI.
CONCLUSION
Early bone marrow edema pattern of OVCF on T1WI, significant correlated with vertebral deformity types on the follow up MRI. The severe degree of vertebral height loss, vertebral osteonecrosis, and spinal stenosis were more frequent in patients with diffuse low SI pattern.

Keyword

Vertebral compression fracture; Osteoporosis; MRI; Bone marrow edema

MeSH Terms

Body Height
Bone Marrow*
Congenital Abnormalities*
Edema*
Follow-Up Studies
Fractures, Compression*
Humans
Incidence
Magnetic Resonance Imaging
Osteonecrosis
Osteoporosis
Prognosis*
Retrospective Studies
Spinal Stenosis
Spine

Figure

• 

  Fig. 1 The low SI types of OVCF according to the early bone marrow edema pattern on T1WI. A : Type 1 pattern with diffuse low signal intensity of VCF. B : Type 2 pattern with globular low signal intensity of VCF. C : Type 3 pattern with band-like low signal intensity of VCF. SI : signal intensity, VCF : vertebral compression fracture.

• 

  Fig. 2 The vertebral deformity types of the follow up MRI. A : Anterior wedge deformity which is defined as VB height most decline in the anterior 1/3 portion of VB. B : Biconcave deformity which is defined as VB height most decline in the middle 1/3 portion of VB. C : Crush deformity which is defined as entire VB collapse with diffuse posterior bulging contour. VB : vertebral body.

• 

  Fig. 3 A 77-year-old man with OVCFs at the L3 and L5 vertebral bodies. A : Sagittal T1WI of initial MRI shows band-like low signal intensity (type 3 pattern) of VCF at the L3 vertebral body and diffuse low signal intensity (type 1 pattern) of VCF at the L5 vertebral body. B : Sagittal T1WI of follow up MRI taken after 4 months shows anterior wedge deformity of VCF at the L3 vertebral body and crush deformity of VCF at the L5 vertebral body. L5 vertebral body exhibits severe degree vertebral body height loss (>40%) and posterior bulging with spinal stenosis. He failed conservative management and underwent surgical treatment (laminectomy with posterior instrumentation). OVCFs : osteoporotic vertebral compression fractures, VCF : vertebral compression fracture.

• 

  Fig. 4 67-year-old woman with OVCF of the T12 vertebral body. A : Sagittal T1WI of initial MRI shows acute VCF of the superior T12 endplate with globular low signal intensity (type 2 pattern). B : Sagittal T1WI of follow up MRI taken after 61 months shows chronic VCF of the T12 vertebral body with biconcave deformity. Note the chronic inflammatory changes and fatty infiltration of bone marrow below fractured superior end plate. Note the severe degree vertebral body height loss (>40%). OVCFs : osteoporotic vertebral compression fractures, VCF : vertebral compression fracture.

• 

  Fig. 5 61-year-old woman with OVCF of the L3 vertebral body. A : Sagittal T1WI of initial MRI shows acute VCF of the L3 vertebral body with patchy low signal intensity (type 2 pattern). B : Sagittal T1WI of follow up MRI taken after 5 months shows chronic VCF of the L3 vertebral body with biconcave deformity. Note the mild degree vertebral body height loss. OVCFs : osteoporotic vertebral compression fractures, VCF : vertebral compression fracture.

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