Percutaneous vertebroplasty: relationship between vertebral body bone marrow edema pattern on MR images and initial clinical response.
OBJECTIVE
To prospectively investigate the relationship between initial clinical response and bone marrow edema pattern on preprocedural magnetic resonance (MR) images in vertebral bodies selected for percutaneous vertebroplasty (PVP).


METHODS
Institutional review board approval and written informed consent were obtained. PVP was performed for osteoporotic compression fractures in 80 consecutive patients (mean age, 72.4 years; range, 44-85 years; 67 women and 14 men; 157 vertebrae). Patients were divided into three groups according to the proportion of the vertebra in which the bone marrow edema pattern was observed on sagittal MR images: group 1, 50% or more of the vertebra; group 2, less than 50%; group 3, no edema pattern observed. By using Wilcoxon rank sum test, Fisher exact test, and Wilcoxon signed rank test, groups were examined for differences in treatment efficacy, which was defined as the difference between preprocedural and postprocedural pain as assessed by means of visual analog scale (VAS) score at 1-3 days after PVP.


RESULTS
Forty-four patients were assigned to group 1, 14 to group 2, and 22 to group 3. No significant difference was seen between the groups with respect to age, sex, number of treated vertebrae, or preprocedural VAS score. In group 1, VAS score decreased from 7.5 before the procedure to 2.9 after (improvement of 4.6). In group 2, the score decreased from 6.8 to 3.1 (improvement of 3.7). In group 3, the score decreased from 7.0 to 4.3 (improvement of 2.7). Improvement was significantly greater in group 1 than in group 3 (P < .005).


CONCLUSIONS
PVP resulted in significantly greater clinical improvement in patients with an extensive bone marrow edema pattern than in those without this pattern. (c) RSNA, 2006.
Tanigawa
Noboru
N
Department of Radiology, Kansai Medical University, 10-15 Fumizono, Moriguchi, Osaka 570-8507, Japan. tanigano@takii.kmu.ac.jp
Komemushi
Atsushi
A
Kariya
Shuji
S
Kojima
Hiroyuki
H
Shomura
Yuzo
Y
Ikeda
Koshi
K
Omura
Naoto
N
Murakami
Takamichi
T
Sawada
Satoshi
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004487:Edema / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011446:Prospective Studies; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000209:etiology; D013124:Spinal Injuries / Q000175:diagnosis* / Q000601:surgery*