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Vertebral bone marrow edema in magnetic resonance imaging correlates with bone healing histomorphometry in (sub)acute osteoporotic vertebral compression fracture

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Abstract

Background

BME on MRI has become the gold standard for the diagnosis of acute/subacute OVCF, but the correlation between the quantitative model of BME and histopathological manifestations of OVCF is rarely discussed in the literature.

Objectives

This study aimed to retrospectively investigate the relationship between bone marrow edema (BME) in magnetic resonance imaging (MRI) and bone healing histomorphometry in (sub)acute osteoporotic vertebral compression fracture.

Methods

According to the period since fracture, 125 patients were divided into four stages: stage I (0 to 15 days), stage II (16 to 30 days), stage III (31 to 60 days) and stage IV (61 to 90 days). Bone marrow edema was evaluated by the signal changes and intensity patterns on MRI sagittal images. Decalcified biopsy specimens were obtained from the cancellous bone core in the fractured vertebral body. The histomorphometry study results were analyzed by light microscopy using grid analysis and defined using bone histomorphometry criteria.

Results

There were 70 (56%) patients in stage I, 29 (23.2%) in stage II, 12 (9.6%) in stage III and 14 (11.2%) in stage IV. BME and histomorphometry characteristics differentiated from each other stage: The BME percentage had a significantly negative correlation with the ratio of osteoid volume/bone volume (r =  − 0.539, p = 0.001) and the ratio of woven bone volume/tissue volume (r =  − 0.584, p = 0.001). There was also a positive correlation between the BME percentage and the ratio of fibrous tissue volume/tissue volume (r = 0.488, p = 0.001).

Conclusions

Bone marrow edema significantly correlates with bone morphology parameters after vertebral fracture. The characteristics of histomorphological changes during fracture healing process can be preliminarily determined by observing the edema signal.

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Acknowledgements

We would like to thank Xiaoyang Liu for his help in professional linguistic correction.

Funding

This article did not receive any funding and grants from agencies.

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Author notes

  1. Because Yun Zhang and Haoran Qi contributed equally to this article, Yun Zhang and Haoran Qi are simultaneously co-first authors.

Authors and Affiliations

  1. Department of Geriatrics, Shandong University of Traditional Chinese Medicine, Jinan, 250021, People’s Republic of China

    Yun Zhang & Junning Wang

  2. Department of Spine, Shandong Provincial Hospital Affiliated To Shandong University, Jinan, 250022, People’s Republic of China

    Haoran Qi & Yefeng Zhang

  3. Department of Spine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jingba Road, Jinan, Shandong Province, People’s Republic of China

    Jingcai Xue

Authors
  1. Yun Zhang
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  2. Haoran Qi
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  4. Junning Wang
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  5. Jingcai Xue
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Contributions

YZ, HQ, JS and JW contributed to conceptualization. JX and HQ were involved in data curation. JX, YZ and HQ contributed to formal analysis, investigation and methodology. YZ and HQ were involved in software. JS contributed to supervision. JS and JW were involved in validation. YZ, HQ and JS contributed to visualization. YZ, HQ, JX and JS were involved in writing—original draft. YZ, JX and JS contributed to writing—review and editing.

Corresponding author

Correspondence to Jingcai Xue.

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Conflict of interest

We declare that this article has not been published before in any language, is not being considered for publication elsewhere and has been read and approved by all authors. Each author contributed significantly to one or more aspects of the study. The authors received no specific funding for this work. There are no conflicts of interest around this study. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Ethical approval

The study was approved by the Hospital Institutional Review Board, and informed consent was obtained from all patients. The informed consent provided by participants was written, and they consented to the use of their medical information for research purposes. Prior to access, all patient data were completely anonymous.

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Zhang, Y., Qi, H., Zhang, Y. et al. Vertebral bone marrow edema in magnetic resonance imaging correlates with bone healing histomorphometry in (sub)acute osteoporotic vertebral compression fracture. Eur Spine J 30, 2708–2717 (2021). https://doi.org/10.1007/s00586-021-06814-3

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  • DOI: https://doi.org/10.1007/s00586-021-06814-3

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