Classification and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI / 中国组织工程研究

ABSTRACT

BACKGROUND; Some scholars have classified osteoporotic vertebral compression fractures based on X-ray and MRI findings. However, little is reported on the morphological types and distribution rules of fracture areas in osteoporotic vertebral compression fractures. OBJECTIVE; To investigate and summarize the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI. METHODS; Clinical data from 352 patients with osteoporotic vertebral compression fractures, 73.07 years of age, including 69 males and 283 females admitted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2011 to June 2017 were retrospectively reviewed. After admission, CT multi-planar reconstruction, MRI and bone mineral density measurements were conducted in each patient. Fresh osteoporotic vertebral compression fractures were confirmed in 477 vertebrae according to clinical manifestations and imaging findings. Fracture areas were defined as shade compact or bright line based on CT multi-planar reconstruction or bone marrow edema on the MRI. Morphological type and distribution of fracture areas were recorded by two experienced spinal surgeons and one senior radiologist independently. The study protocol was approved by the Ethic Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine in China with an approval No. ZYYECKYJ[2017]057. RESULTS AND CONCLUSION: Fracture areas of 472 vertebrae were indicated distinctly on the MRI, whereas the fracture areas of 5 vertebrae were unclear. Meanwhile, fracture areas of 469 vertebrae were shown clearly on the CT multi-planar reconstruction, but the areas of 8 vertebrae were obscure on the CT. Fracture areas of 5 vertebrae were unclear in both CT and MRI. There was no significant difference between CT and MRI in the observation of fracture areas (P=0.402). Finally, fracture areas of 8 vertebrae could not be described accurately on CT, MRI or both. In the sagittal plane of CT and MRI, morphological types of fracture areas of 469 vertebrae were divided into impacted fracture area (n=311, 66.31%) and cleft fracture area (n=158, 33.69%). Of the 158 cleft fracture areas, 26 vertebrae contained gas, 28 vertebrae contained liquid, and 7 vertebrae included both gas and liquid. Of the 469 vertebrae, the location of fracture areas was divided into 5 types Superior (n=238, 50.75%), inferior (n=80,17.06%), anterior (n=21, 4.48%), central (n=110, 23.45%) and mixed (n=20, 4.26%). These findings indicate that the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures can be effectively distinguished by CT multi-planar reconstruction and MRI, which is important for early diagnosis and further treatment of fresh osteoporotic vertebral compression fractures.