MR Findings Predictive of Intradiscal Leakage of Bone Cement in Vertebroplasty

ABSTRACT

PURPOSE: To evaluate the relation between pre-operative MR findings and intradiscal bone cement leakage. MATERIALS AND METHODS: Pre-operative MR and vertebroplasty were performed in 188 vertebral bodies, 376 superior and inferior cortical endplates and intervertebral discs of 126 patients. We analyzed the relation between endplate cortical injury and intradiscal linear low signal intensity lesions in the pre-operative MR images and measured intradiscal bone cement leakage on post-operative CT and fluoroscopy. RESULTS: Intradiscal bone cement leakage was found in 11.4% (43/376) of the cases. The incidence of endplate cortical injury in T1, T2 weighted MR images were 52.1% and 38.8%, respectively; the incidence of intradiscal linear low signal intensity lesions in T1, T2 weighted images were 11.2% and 24.2%, respectively. In relation with pre-operative MR findings and intradiscal bone cement leakage, the sensitivities of end plate cortical injury in T1 and T2 weighted images and intradiscal low signal intensity lesions in T1 and T2 weighted images were 100%, 95.3%, 39.5%, 86.5%, the specificities were 54.1%, 68.5%, 92.5%, 83.9%, the positive predictive values were 21.9%, 28.1%, 40.5%, 40.7%, the negative predictive values were 100%, 99.1%, 92.2%, 97.9%, and the accuracy were 59.3%, 71.5%, 86.4%, 84.0%. The incidence of intradiscal bone cement leakage was significantly increased when endplate cortical injury and intradiscal linear low signal intensity lesions were observed (p <0.001). CONCLUSION: Endplate cortical injury and intradiscal linear low signal intensity observed in pre-operative MR are useful findings in predicting intradiscal bone cement leakage.