Conversion of osteoporotic-like vertebral fracture severity score to osteoporosis T-score equivalent status: A framework study for older Chinese men

Objectives@#To define what portion of older community men with what severity of radiographic osteoporotic-like vertebral fracture (OLVF) correspond to what low T-score status. @*Methods@#There were 755 community Chinese men (age: 76.4 ± 6.7 years) with thoracic and lumbar spine radiographs, and hip and lumbar spine bone mineral density measures. For each vertebra in a subject, a score of 0, -0.5, −1, −1.5, −2, −2.5, and −3 was assigned for no OLVF or OLVF of <20%, ≥ 20–25%, ≥ 2 5%–1/3, ≥ 1/3–40%, ≥ 40%–2/3, and ≥ 2/3 vertebral height loss, respectively. OLVFss was defined as the summed score of vertebrae T4 to L5. OLVFss and T-scores were ranked from the smallest to the largest values. @*Results@#OLVFss of −2, −2.5, −3, corresponded to a mean femoral neck T-score of −2.297 (range: -2.355∼-2.247), −2.494 (range: -2.637∼ −2.363), and −2.773 (range: -2.898∼-2.643), a mean hip T-score of-2.311 (range: -2.420∼-2.234), −2.572 (range: -2.708∼-2.432), −2.911 (range: -3.134∼-2.708), a mean lumbar spine T-score of −2.495 (range: -2.656∼-2.403), −2.931 (range: -3.255∼-2.664), and −3.369 (range: -3.525∼-3.258). The Pearson correlation value of OLVFss and T-score of femoral neck, hip and lumbar spine was r = 0.21, 0.26, and 0.22 (all P < 0.0001). @*Conclusions@#A single severe grade radiological OLVF (≥ 40% height loss) or OLVFss ≤ −2.5 suggest the subject is osteoporotic, and a single collapse grade (≥ 2/3 height loss) OLVF or OLVFss ≤ −3 meets osteoporosis diagnosis criterion. The results highlight the difficulty of diagnosing osteoporotic vertebral fractures among Chinese older men.

Radiological features of traumatic vertebral endplate fracture: an analysis of 194 cases with 263 vertebral fractures / 中华医学杂志(英文版)

BACKGROUND@#The importance of identifying osteoporotic vertebral endplate or/and cortex fracture (ECF), which primarily includes endplate fracture (EPF) and vertebral anterior cortex buckling, has been recognized. However, some old traumatic ECFs with healing process in the elderly may be mistaken as osteoporotic. This study analyzes the radiological features of traumatic EPF.@*METHODS@#This was a retrospective analysis of 194 spine trauma patients with 263 vertebral fractures (mean age: 42.11 ± 9.82 years, 118 males and 76 females). All patients had traumatic EPF identified by X-ray/CT/MRI.@*RESULTS@#The involved vertebra was mostly L1 (29.7%), followed by T12 and L2. Except EPFs involved both superior and inferior endplates (12.6%), only 1.9% involved inferior endplate alone, with the majority involved superior endplate. If each endplate was divided into five segments of equal lengths (from anterior to posterior: a1, a2, m, p2, p1), the most depressed point of superior EPFs was mostly at segment-a2 (approximately 45%), followed by segment-a1 (approximately 20%) or segment-m (approximately 20%), and very rarely at segment-p1. The upper 1/3 of anterior vertebral wall was more likely to fracture, followed by middle 1/3 of anterior wall. For posterior vertebral wall fracture, 68.5% broke the bony wall surrounding the basivertebral vain. 58.6%, 30.0%, and 11.4% of vertebral fractures had 1/3 vertebral body height loss. As the extent of vertebral height loss increased, the chance of having both superior and inferior EPFs also increased; however, the chance of having inferior EPF alone did not increase.@*CONCLUSION@#Traumatic EPF features are characterized, which may help the differentiation of traumatic and osteoporotic EPFs.

Rapid Increase in Marrow Fat Content and Decrease in Marrow Perfusion in Lumbar Vertebra Following Bilateral Oophorectomy: An MR Imaging-Based Prospective Longitudinal Study

OBJECTIVE: Bilateral oophorectomy leads to reduced bone mineral density (BMD), and reduced BMD is associated with increased marrow fat and reduced marrow perfusion. Purpose of this study was to investigate how soon these changes occur following surgical oophorectomy. MATERIALS AND METHODS: Six patients who underwent hysterectomy and bilateral salpingo-oophorectomy were studied. At baseline, mean patient age was 49.5 years (range: 45-54 years). Third lumbar vertebral body BMD measurement using quantitative CT, marrow fat fraction (FF) using MR spectroscopy and marrow perfusion using dynamic contrast enhanced MRI were conducted immediately prior to surgery and at 3, 9, and 21 months after surgery. RESULTS: Reduced BMD, increased marrow FF, and reduced marrow perfusion occurred synchronously post-oophorectomy. There was a sharp decrease of 12.5 +/- 7.2% in BMD (n = 6), a sharp increase of 92.2 +/- 46.3% (n = 6) in FF, a sharp decrease of 23.6 +/- 3.9% in maximum contrast enhancement (n = 5), and of 45.4 +/- 7.7% for enhancement slope (n = 5) during the initial 3 months post surgery. BMD and marrow perfusion continued to decrease, and marrow FF continued to increase at a slower rate during the following 18 months. Friedman test showed a significant trend for these changes (p < 0.05). CONCLUSION: Bilateral oophorectomy leads to a rapid decrease in lumbar BMD, an increase in marrow fat content, and a decrease in marrow blood perfusion.

Hepatic Sinusoidal Obstruction Syndrome Caused by Herbal Medicine: CT and MRI Features

OBJECTIVE: To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. MATERIALS AND METHODS: The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. RESULTS: Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). CONCLUSION: Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.

Experimental Evaluation of Accelerated T1rho Relaxation Quantification in Human Liver Using Limited Spin-Lock Times

OBJECTIVE: It was reported lately that to obtain consistent liver T1rho measurement, at 3T MRI using six spin-lock times (SLTs), is feasible. In this study, the feasibility of using three or two SLT points to measure liver T1rho relaxation time was explored. MATERIALS AND METHODS: Seventeen healthy volunteers underwent 36 examinations. Three representative axial slices were selected to cut through the upper, middle, and lower liver. A rotary echo spin-lock pulse was implemented in a 2D fast field echo sequence. Spin-lock frequency was 500 Hz and the spin-lock times of 1, 10, 20, 30, 40, and 50 milliseconds (ms) were used for T1rho mapping. T1rho maps were constructed by using all 6 SLT points, three SLT points of 1, 20, and 50 ms, or two SLTs of 1 and 50 ms, respectively. Intra-class correlation coefficient (ICC) and Bland and Altman plot were used to assess the measurement agreement. RESULTS: Two examinations were excluded, due to motion artifact at the SLT of 50 ms. With the remaining 34 examinations, the ICC for 6-SLT vs. 3-SLT T1rho measurements was 0.922, while the ICC for 6-SLT vs. 2-SLT T1rho measurement was 0.756. The Bland and Altman analysis showed a mean difference of 0.19 (95% limits of agreement: -1.34, 1.73) for 6-SLT vs. 3-SLT T1rho measurement, and the mean difference of 0.89 (95% limits of agreement: -1.67, 3.45) for 6-SLT vs. 2-SLT T1rho measurement. The scan re-scan reproducibility ICC (n = 11 subjects) was 0.755, 0.727, and 0.528 for 6-SLT measurement, 3-SLT measurement, and 2-SLT measurement, respectively. CONCLUSION: Adopting 3 SLTs of 1, 20, and 50 ms can be an acceptable alternative for the liver T1rho measurement, while 2 SLTs of 1 and 50 ms do not provide reliable measurement.