Learning objectives
1.
To recognize the CT and MRI radiological findings in patients with osteopenia and symptomatic vertebral compression fractures (VCF)
2.
To know the advantages and disadvantages of these techniques in the evaluation of VCF
3.
To know when and how to use CT and MRI depending on the clinical situation
Background
Fractures are the most common complications of osteoporosis,
being vertebral fractures the hallmark of this disorder.
The number of fractures is correlated with the severity of the process and increases the risk of developing more vertebral or hip fractures.
Only one third of the vertebral fractures are symptomatic (1).
They can be caused by a low energy trauma or they can ocurred spontaneously,
as a result of daily activities such us bending,
lifting or caughing.
They are more frequent in woman,
but are ussually more...
Findings and procedure details
The first step in the evaluation of an elderly patient with dorsal or lumbar pain is clinical and radiographic examinations.
Conventional radiography can demostrate osteopenia,
loss of height of one or multiple vertebras,
fractures of the vertebral end plates or vacuum cleft sign.
Sometimes there is no significant abnormalities in the shape of the vertebras.
In addition the sensitivity to asses the severity of the fracture and to identify the acute fracture is limited.
Correlation of the radiographic findings with the clinical symptoms is important...
Conclusion
CT and MRI are advances imaging techniques that are usually required for the assessment of VCF in osteoporotic patients to detect the symptomatic segment and to evaluate stability of the fracture.
MRI is the most sensitive and specific imaging technique to detect the symptomatic fracture,
and to evaluate multilevel involvement.
It is the best to differenciate osteoporotic VCFfrom metastaticfracturesand to evaluate neurological complications.
CT has a better availability and can be used if assessment ofstability is required in case of a severe fracture in an...
References
Sambrook P,
Cooper C.
Osteoporosis.
Lancet 2006; 367(9527):2010-18
Genant H.K.,
Jergas M,
Palermo L,
et al.
Comparision of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis.
J Bone MIner Res 1996;11: 984-96
Briggs AM,
Greig AM,
Wark JD,
Fazzalari NL,
Bennell KL.
A review of anatomical and mechanical factors affecting vertebral body integrity.
Int.
J.
Med.
Sci.
2004; 1: 170-180
Zhao F,
Pollintine P,
Hole BD,
et al.
Vertebral fractures usually affects vertebral end plate because it is thinner...