Differential diagnosis of acute from chronic osteoporotic vertebral fractures / 中国矫形外科杂志

[Objective]To investigate the differentiation of acute from chronic osteoporotic vertebral fractures.[Method]The clinical presentation,X-ray,CT and MRI of patients with osteoporotic vertebral fractures were evaluated in the study.[Result]In 36 cases,64% were identified as acute and 36% with chronic osteoporotic vertebral fractures.The decreased anterior vertebral height was a most important criterium for the diagnosis of osteoporotic vertebral fractures.Degenerative changes on the X-ray film were usually found in chronic fractures.A high intense signal in a specific T2 under eliminating fat tissue was always observed in acute fracture.[Conclusion]The local back pain located at the level of the fractured vertebral body suggests an acute vertebral fracture.Degenerative changes occurred in the edged vertebra is indicative of a chronic fracture.The finding of a specific T2 high intense signal under eliminating fat tissue on MRI is a gold standard for the diagnosis of an acute vertebral fracture.

Differentiation Between Acute and Old Fractures in The Thoracic and Lumbar Spine: Observer Agreement

Differentiation between acute and old fractures in the thoracic and lumbar spine is often difficult. We have evaluated the intraobserver agreement and interobserver variability of interpretations. We have prepared 50 cases from 40 patients with thoracic or lumbar spine fracture for evaluation. At first, two radiologist interpreted each of the 50 cases, Only by using plain roentgenograms. Then, they interpreted the cases again using also spine CT, MRI, bone scintigrams and follow-up roentgenograms. Intraobserver agreement was found to be 78% in Doctor A, and 76% in Doctor B. Interobserver agreement was only 62% at first. It was 88%, when they used CT, MRI, bone scintigrams and follow-up roentgenograms. It was not easy to differentiate the old fractures from acute one only by plain roentgenograms. Differentiation was more difficult, when the patient was female or over 55 years old. Plain roentgenography in hyperextension posture seems to be a simple but useful method for the diagnosis of the acute fracture. MRI was more valuable than CT or bone scintigraphy to differentiate the old fractures from the acute ones.