Investig Magn Reson Imaging.  2017 Sep;21(3):148-153. 10.13104/imri.2017.21.3.148.

Magnetic Resonance Enhancement Pattern as a Predictor of Cement Volume in Vertebroplasty Procedures for Osteoporotic Fractures

Affiliations
  • 1Department of Radiology, Dankook University Hospital, Cheonan, Korea. sun0255@hanmail.net

Abstract

PURPOSE
To identify the differences between injected cement volumes during vertebroplasty procedures according to the enhancement pattern of pre-procedure magnetic resonance imaging (MRI) findings.
MATERIALS AND METHODS
Thirty-two patients who underwent 52 vertebroplasty procedures as well as pre-procedure contrast-enhanced spine MRI in the authors' institution were reviewed retrospectively. The 52 procedures were divided into two groups according to different enhancement patterns shown by pre-procedure MR imaging [E(+) and E(−)]. The volumes of the enhancing/non-enhancing portions of the fractured vertebral body shown by pre-procedural MR imaging were calculated and compared to the volumes of the injected cement during the vertebroplasty procedures.
RESULTS
The 52 injections included 28 (56%) in Group E(+) and 24 (44%) in Group E(−). The actual volume ratio of the injected cement to the volume of the non-enhanced or enhanced region calculated based on the contrast-enhanced MRI was 0.22 ± 0.11 (cc/cm³) in the E(+) group and 0.93 ± 0.62 (cc/cm³) in the E(−) group. The average amount of injected cement was significantly different between Group E(+) and Group E(−) (P < 0.001). In addition, the ratio of the injected cement amount to the volume of the enhanced or non-enhanced portion based on the contrast-enhanced MRI in Group E(−) was significantly higher than that of Group E(+) (P < 0.001).
CONCLUSION
Different enhancement patterns shown by pre-procedure MRI can predictors of the injected cement volume during vertebroplasty procedures for osteoporotic fractures.

Keyword

Vertebroplasty; Osteoporotic fracture; Cement volume; Enhancement; Magnetic resonance imaging

MeSH Terms

Humans
Magnetic Resonance Imaging
Osteoporotic Fractures*
Retrospective Studies
Spine
Vertebroplasty*

Figure

  • Fig. 1 ROI on each enhanced T1WI sagittal plane in a PACS workstation.

  • Fig. 2 A case from the E(−) group involving an 87-year-old woman with back pain. L1 shows (a) a hyperintensity area on T2WI and (b) low signal intensity on T1WI. (c) On a fat-suppressed contrast-enhanced T1WI, a non-enhanced area is surrounded by well-enhanced bone marrow in the L1 vertebral body. (d) On a lateral spot radiograph during PVP and (e) a post-procedural radiograph, the pattern of cement opacification is the solid pattern. (f) The CT scan done after PVP shows a solid distribution pattern of injected cement.

  • Fig. 3 A case from the E(+) group involving a 72-year-old woman with lower back pain. T11 shows a (a) hypointense area on T1WI and (b) low signal intensity on T2WI. (c) On a fat-suppressed contrast-enhanced T1WI, T11 shows diffuse enhancement. (d) On the anterior-posterior spot radiograph during vertebroplasty and (e) the post-procedural radiograph, the cement opacification is the trabecular pattern. (f) The CT scan done after the procedure shows a trabecular distribution pattern of injected cement.

  • Fig. 4 Ratio of the actual volume of injected cement to the volume of the non-enhanced or enhanced area in Group E(+) and Group E(−).


Reference

1. Mehbod A, Aunoble S, Le Huec JC. Vertebroplasty for osteoporotic spine fracture: prevention and treatment. Eur Spine J. 2003; 12:Suppl 2. S155–S162.
2. Blasco J, Martinez-Ferrer A, Macho J, et al. Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: a 12-month randomized follow-up, controlled trial. J Bone Miner Res. 2012; 27:1159–1166.
3. Provenzano MJ, Murphy KP, Riley LH 3rd. Bone cements: review of their physiochemical and biochemical properties in percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2004; 25:1286–1290.
4. Mathis JM. Percutaneous vertebroplasty: complication avoidance and technique optimization. AJNR Am J Neuroradiol. 2003; 24:1697–1706.
5. Kaufmann TJ, Trout AT, Kallmes DF. The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol. 2006; 27:1933–1937.
6. Molloy S, Riley LH 3rd, Belkoff SM. Effect of cement volume and placement on mechanical-property restoration resulting from vertebroplasty. AJNR Am J Neuroradiol. 2005; 26:401–404.
7. Ryu KS, Park CK, Kim MC, Kang JK. Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg. 2002; 96:56–61.
8. Tanigawa N, Komemushi A, Kariya S, et al. Relationship between cement distribution pattern and new compression fracture after percutaneous vertebroplasty. AJR Am J Roentgenol. 2007; 189:W348–W352.
9. Oka M, Matsusako M, Kobayashi N, Uemura A, Numaguchi Y. Intravertebral cleft sign on fat-suppressed contrast-enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty. Acad Radiol. 2005; 12:992–999.
Full Text Links
  • IMRI
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr