title: Dynamic contrast-enhanced magnetic resonance imaging for evaluating intraosseous cleft formation in patients with osteoporotic vertebral compression fractures before vertebroplasty.
abstract: METHODS
  A prospective trial of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in patients with osteoporotic vertebral compression fracture (VCF).
  
  
  OBJECTIVE
  To investigate the relationship between intraosseous clefts and bone marrow perfusion using DCE-MRI in patients with osteoporotic VCF before vertebroplasty.
  
  
  BACKGROUND
  The nonhealing cleft may be responsible for persistent pain and progressive vertebral collapse after acute injury. If localized kyphosis increased, there is risk of neuropathy appearing as a complication. Even after receiving vertebroplasty, it was reported to be at increased risk for subsequent cemented vertebral refracture and new adjacent vertebral fractures. DCE -MRI has been used for the evaluation of bone marrow perfusion. However, there are few reports on the evaluation of osteoporotic VCF and intraosseous cleft formation.
  
  
  METHODS
  Forty subjects referred for evaluation of VCF underwent DCE-MRI. Bone marrow perfusion, as measured using the DCE-MRI time-intensity curve from a noninjured vertebrae was developed using two distinct parameters including peak enhancement ratio and enhancement slope. The ratio of the well-enhanced and the poorly enhanced zone of each injured vertebra were calculated. Multiple logistic regression analysis was used to evaluate the relationships between baseline clinical factors, parameters of DCE-MRI and presence or absence of intraosseous clefts.
  
  
  RESULTS
  Twenty-nine injured vertebrae (72%) had intraosseous clefts. Lower PER of the noninjured vertebrae was associated with higher poorly enhanced zone ratio of the injured vertebrae (γ = -0.362, P = 0.017). Multivariate logistic regression analysis identified only lower PER (hazard ratio, 0.000; 95% confidence interval, 0.000-0.096; P = 0.009) was associated with the presence of intraosseous clefts. A peak enhancement ratio value less than 0.57 had a sensitivity of 80% and specificity of 90% for predicting intraosseous clefts.
  
  
  CONCLUSIONS
  In patients with osteoporotic VCF before vertebroplasty, decreased bone marrow perfusion, as measured by DCE-MRI, was associated with intraosseous cleft formation.
authors.affiliation: Department of Diagnostic Radiology Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Lin
authors.forename: Hsiu-Ling
authors.initials: HL
authors.lastname: Chen
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
authors.forename: Hung-Chen
authors.initials: HC
authors.lastname: Wang
authors.forename: Re-Wen
authors.initials: RW
authors.lastname: Wu
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Lui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001853:Bone Marrow / Q000473:pathology; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015999:Multivariate Analysis; D010020:Osteonecrosis / Q000473:pathology*; D010024:Osteoporosis / Q000150:complications*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D015203:Reproducibility of Results; D016103:Spinal Fractures / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D013997:Time Factors; D054854:Vertebroplasty
chemical_list: D003287:Contrast Media