E1439. Back to "Back": A Multimodality Approach for Vertebral Fractures
Mercy Catholic Medical Center
Mercy Catholic Medical Center
Vertebral fractures (VFs) are one of the most common types of fractures, accounting for over 1 million cases in men and women over 50 years of age worldwide. In the United States, studies have recorded an estimate of 700,000 cases per year. Additionally, VFs have demonstrated an increase in mortality risk independently and as a comorbid condition. Despite their high prevalence and clear association with a decline in daily functionality, they remain underdiagnosed by clinicians and radiologists. The purpose of this exhibit is to educate radiology trainees about the current diagnostic and therapeutic modalities available for VFs, as well as, to illustrate classic and common radiologic findings that would help to make a confident diagnosis and provide further recommendations for additional workup, follow-up and treatment.
Educational Goals / Teaching Points
We present a trainee-focused pictorial review of common findings in plain radiograph, Dual-energy X-ray Absorptiometry (DXA), Conventional computerized tomography (CT), dual-energy CT (DECT) and magnetic resonance imaging (MRI), as well as, pathological characterization of benign and malignant vertebral fractures. Finally, we review indications and benefits of interventional techniques for treatment of osteoporotic and pathologic VFs.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We present examples of classic findings that help accurately identify VFs in different imaging modalities and the most common treatment for this pathology. A plain radiograph can reveal findings associated with normal vertebral variants such as limbus vertebra, schmorls’ node, and butterfly vertebra that can be easily misinterpreted as fractures. DXA can reveal focal sclerotic changes in old fractures that falsely increase bone marrow density in an otherwise osteoporotic spine. Conventional CT helps to characterize common signs that can differentiate benign from malignant etiology with findings that include vertebral involvements, tumor infiltration, displacement of the affected fragment, and presence of adjacent masses. New technologies such as DECT reveal the presence of bone marrow edema through colormap processing, demonstrating promising data in the differentiation of compression fractures and metastatic disease. MRI, as a gold standard for spine evaluation, shows classic signs of spinal cord compression, bone marrow edema, contrast enhancement, as well as, morphology changes between benign and malignant and reveals tumor extension through tools like diffuse weighted images and chemical shift. Finally, vertebral augmentation demonstrates mortality benefits and should be considered for benign and pathologic VFs.
VFs comprise considerable morbidity and mortality in the population, causing chronic pain, severe functional limitation, and overall impairment in patient’s quality of life. Accurate identification of common signs for vertebral fractures in different imaging modalities is an important skill that radiologists should acquire early in training to help guide a multidisciplinary approach for definite diagnosis and treatment.