Usefulness of MRI in determining the appropriate level of cement augmentation for acute osteoporotic vertebral compression fractures

Study Design: This is a prospective study on consecutive patients with acute osteoporotic vertebral compression fractures (OVCFs). Objectives: To evaluate the usefulness of magnetic resonance imaging (MRI) for diagnosing appropriate acute lesions before a percutaneous cement augmentation technique. Background: Vertebral compression fractures related to osteoporosis are very common in the elderly. Acute OVCFs are usually treated conservatively. In recent years, minimally invasive percutaneous cement augmentation techniques, vertebroplasty and kyphoplasty, have been introduced as alternative treatment options. However, the localization of acute fractures of the spine can be difficult, yet is critical in implementing these treatments. Methods: A total of 168 patients were enrolled in this study. All participants were 50 years of age or older and were admitted via the emergency room because of acute severe back pain with suspected OVCFs with or without a history of trauma. Standard plain radiographs and a computed tomography (CT) scan of the spine were initially obtained in the emergency room. An MRI scan with short-tau inversion recovery (STIR) sequencing of the spine was performed within 3 days of hospitalization. Patients were divided into 2 groups: single group and multiple group. The single group consisted of those with a single fracture, and the multiple group consisted of those with multiple fractures of the vertebral body, as diagnosed using only standard radiographs and CT scans. We compared the level and number of fractures from the initial findings of the standard radiographs and CT scans with the MRI scan results within each group. Results: The mean age of the study participants was 68.9 years. Forty-nine patients were male and 119 were female. In the single group, the concordance rate of diagnosis was 77% (97/125) and the discordance rate was 23% (28/125). In the multiple group, the discordance rate was 65% (28/43). There was a significantly higher rate of misdiagnosis in the multiple group compared with the single group (P<0.01). Conclusions: MRI with STIR sequencing exhibited a multitude of benefits in the exact identification of acute lesions and hidden lesions. Because of the high rate of misdiagnosis using standard plain radiographs and CT scans of the spine for OVCFs, MRI with STIR sequencing should be considered before cement augmentation procedures. Moreover, in cases with multiple lesions or severe osteoporosis, the importance of MRI should be further emphasized.