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Predicting delayed union in osteoporotic vertebral fractures with consecutive magnetic resonance imaging in the acute phase: a multicenter cohort study

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Abstract

Summary

This study demonstrated the predictive values of radiological findings for delayed union after osteoporotic vertebral fractures (OVFs). High-signal changes on T2WI were useful findings.

Introduction

The purpose of the present study is to determine predictive radiological findings for delayed union by magnetic resonance imaging (MRI) and plain X-rays at two time points in the acute phase of OVFs.

Methods

This multicenter cohort study was performed from 2012 to 2015. A total of 218 consecutive patients with OVFs ≤2 weeks old were enrolled. MRIs and plain X-rays were performed at the time of enrollment and at 1- and 6-month follow-ups. Signal changes on T1-weighted imaging (T1WI) were classified as diffuse low-, confined low-, or no-signal change; those on T2WI were classified as high (similar to the intensity of cerebrospinal fluid), confined low-, diffuse low-, or no-signal change. The angular motion of the fractured vertebral body was measured with X-rays.

Results

A total of 153 patients completed the 6-month follow-up. A high-signal change on T2WI was most useful in predicting delayed union. Sensitivity, specificity, and positive predictive values were 53.3, 87.8, and 51.6 % at enrollment and 65.5, 84.8, and 51.4 % at the 1-month follow-up, respectively. The positive predictive value increased to 62.5 % with observation of high- or diffuse low-signal changes at both enrollment and the 1-month follow-up. The cutoff value of vertebral motion was 5 degrees. Sensitivity and specificity at enrollment were 52.4 and 74.1 %, respectively.

Conclusions

This study demonstrated the radiological factors predicting delayed union after an OVF. T2 high-signal changes showed the strongest association with delayed union. Consecutive MRIs were particularly useful as a differential tool to predict delayed union following OVFs.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    S. Takahashi, M. Hoshino, H. Toyoda & H. Nakamura

  2. Department of Orthopaedic Surgery, Seikeikai Hospital, Saitama, Japan

    K. Takayama

  3. Department of Orthopaedic Surgery, Sato Hospital, Konan, Japan

    K. Iseki

  4. Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan

    R. Sasaoka

  5. Department of Orthopaedic Surgery, Shiraniwa Hospital, Osaka, Japan

    T. Tsujio

  6. Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan

    H. Yasuda

  7. Department of Orthopaedic Surgery, Nishinomiya Watanabe Hospital, Nishinomiya, Japan

    T. Sasaki

  8. Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan

    F. Kanematsu

  9. Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan

    H. Kono

Authors
  1. S. Takahashi
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  2. M. Hoshino
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  3. K. Takayama
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  4. K. Iseki
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  5. R. Sasaoka
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  6. T. Tsujio
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  7. H. Yasuda
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  8. T. Sasaki
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  9. F. Kanematsu
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  10. H. Kono
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  11. H. Toyoda
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  12. H. Nakamura
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Corresponding author

Correspondence to S. Takahashi.

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Conflicts of interest

None.

Funding

This study was funded by the Japan Orthopedics and Traumatology Research Foundation, Inc. (Grant no. 270).

Ethical approval

This study was approved by the Ethics Committee of Osaka City University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

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Takahashi, S., Hoshino, M., Takayama, K. et al. Predicting delayed union in osteoporotic vertebral fractures with consecutive magnetic resonance imaging in the acute phase: a multicenter cohort study. Osteoporos Int 27, 3567–3575 (2016). https://doi.org/10.1007/s00198-016-3687-3

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  • DOI: https://doi.org/10.1007/s00198-016-3687-3

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