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Radiographic assessment of acute vs chronic vertebral compression fractures

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Abstract

Purpose

Distinguishing between acute and chronic vertebral compression fractures typically requires advanced imaging techniques such as magnetic resonance imaging (MRI). Recognizing specific radiographic findings associated with fracture acuity may improve the accuracy of radiographic assessment.

Methods

Patients with compression fractures that had both radiographic and MRI studies of the lumbar spine within a 30-day time frame were retrospectively reviewed. MRI studies were used to determine compression fracture acuity. Radiographs were interpreted by a separate group of radiologists blinded to the MRI results. Radiographic findings of endplate osteophyte, subendplate density, subendplate cleft, and subendplate cyst were recorded as was the overall impression of fracture acuity.

Results

Sensitivity and specificity for radiographic reporting of acute fracture were 0.52 (95% CI: 0.42, 0.61) and 0.95 (95% CI: 0.93, 0.97) respectively. For chronic fractures, the sensitivity and specificity were 0.52 (95% CI: 0.41, 0.63) and 0.94 (95% CI: 0.92, 0.96).

The radiographic presence of a subendplate cleft increased the odds of a fracture being acute by a factor of 1.75 (95% CI: 1.09, 2.81; P = 0.0202). The radiographic presence of subendplate density increased the odds of a fracture being acute by a factor of 1.78 (95% CI: 1.21, 2.63; P = 0.0037). The presence of an endplate osteophyte or subendplate cyst was not significantly associated with fracture acuity.

Conclusion

Radiographs are relatively insensitive in distinguishing between acute and chronic lumbar compression fractures but the presence of a subendplate cleft or subendplate density increases the likelihood that a given fracture is acute.

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References

  1. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301(5):513–521

    Article  CAS  Google Scholar 

  2. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475

    Article  Google Scholar 

  3. Marongiu G, Congia S, Verona M, Lombardo M, Podda D, Capone A (2018) The impact of magnetic resonance imaging in the diagnostic and classification process of osteoporotic vertebral fractures. Injury 49:S26-31

    Article  Google Scholar 

  4. Mao H, Zou J, Geng D, Zhu X, Zhu M, Jiang W et al (2012) Osteoporotic vertebral fractures without compression: key factors of diagnosis and initial outcome of treatment with cement augmentation. Neuroradiology 54(10):1137–1143

    Article  Google Scholar 

  5. Spiegl UJA, Beisse R, Hauck S, Grillhösl A, Bühren V (2009) Value of MRI imaging prior to a kyphoplasty for osteoporotic insufficiency fractures. Eur Spine J 18(9):1287–92

    Article  Google Scholar 

  6. Urrutia J, Besa P, Piza C (2019) Incidental identification of vertebral compression fractures in patients over 60 years old using computed tomography scans showing the entire thoraco-lumbar spine. Arch Orthop Trauma Surg 139(11):1497–1503

    Article  Google Scholar 

  7. Link TM, Guglielmi G, van Kuijk C, Adams JE (2005) Radiologic assessment of osteoporotic vertebral fractures: Diagnostic and prognostic implications. Eur Radiol 15(8):1521–32

    Article  Google Scholar 

  8. Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K et al (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128(10):793–800

    Article  CAS  Google Scholar 

  9. Kim AY et al (2022) Prediction of the acuity of vertebral compression fractures on CT using radiologic and radiomic features. Acad Radiol 29(10):1512–1520

    Article  Google Scholar 

  10. Gerling MC, Eubanks JD, Patel R, Whang PG, Bohlman HH, Ahn NU (2011) Cement augmentation of refractory osteoporotic vertebral compression fractures: survivorship analysis. Spine 36(19):E1266–E1269

    Article  Google Scholar 

  11. Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ III (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137(9):1001–1005

    Article  CAS  Google Scholar 

  12. Genant HK, Wu CY, Van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148

    Article  CAS  Google Scholar 

  13. Chen W, Liu X, Li K, Luo Y, Bai S, Wu J, Chen W, Dong M, Guo D (2022) A deep-learning model for identifying fresh vertebral compression fractures on digital radiography. Eur Radiol 32(3):1496–1505

    Article  Google Scholar 

  14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  Google Scholar 

  15. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L et al (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95:103208

    Article  Google Scholar 

  16. Zhao Q, Gu X, Liu Z, Cheng L (2016) The value of radionuclide bone imaging in defining fresh fractures among osteoporotic vertebral compression fractures. Journal of Craniofacial Surgery 27(3):745–748

    Article  Google Scholar 

  17. Piazzolla A, Solarino G, Lamartina C, De Giorgi S, Bizzoca D, Berjano P et al (2015) Vertebral bone marrow edema (VBME) in conservatively treated acute vertebral compression fractures (VCFs). Spine 40(14):E842–E848

    Article  Google Scholar 

  18. Hedderich DM, Maegerlein C, Baum T, Hapfelmeier A, Ryang Y-M, Zimmer C et al (2019) Differentiation of acute/subacute versus old vertebral fractures in multislice detector computed tomography: is magnetic resonance imaging always needed? World Neurosurg 122:e676–e683

    Article  Google Scholar 

  19. Henes FO et al (2014) Detection of occult vertebral fractures by quantitative assessment of bone marrow attenuation values at MDCT. Eur J Radiol 83(1):167–172

    Article  Google Scholar 

  20. Ryoo CH et al (2021) CT Hounsfield unit and histogram analysis for differentiation of recent versus remote vertebral compression fractures. Br J Radiol 94(1128):20210941

    Article  Google Scholar 

  21. Chang MY et al (2020) Predicting bone marrow edema and fracture age in vertebral fragility fractures using MDCT. AJR Am J Roentgenol 215(4):970–977

    Article  Google Scholar 

  22. Petritsch B et al (2017) Vertebral compression fractures: third-generation dual-energy CT for detection of bone marrow edema at visual and quantitative analyses. Radiology 284(1):161–168

    Article  Google Scholar 

  23. Schwaiger BJ et al (2018) Three-material decomposition with dual-layer spectral CT compared to MRI for the detection of bone marrow edema in patients with acute vertebral fractures. Skeletal Radiol 47(11):1533–1540

    Article  Google Scholar 

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Acknowledgements

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 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA

    Colin D. Strickland, Mary K. Jesse, Michael J. Durst & James A. Korf

  2. Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA

    Peter E. DeWitt

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  1. Colin D. Strickland
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  2. Peter E. DeWitt
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Correspondence to Colin D. Strickland.

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Strickland, C.D., DeWitt, P.E., Jesse, M.K. et al. Radiographic assessment of acute vs chronic vertebral compression fractures. Emerg Radiol 30, 11–18 (2023). https://doi.org/10.1007/s10140-022-02092-8

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  • DOI: https://doi.org/10.1007/s10140-022-02092-8

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