title: Determination of the painful level in osteoporotic vertebral fractures--Retrospective comparison between plain film, bone scan, and magnetic resonance imaging.
abstract: BACKGROUND
  Determining the actual painful vertebral level is difficult when evaluating osteoporotic vertebral fracture, especially when there are acute and chronic fractures simultaneously. In this study, we retrospectively evaluated and compared the findings between plain film, bone scan, and magnetic resonance imaging (MRI) in the diagnosis of new fracture in osteoporotic vertebral fractures.
  
  
  METHODS
  This is a retrospective clinical study of patients who were diagnosed with osteoporotic vertebral fractures using plain film, bone scan, and MRI within a 1-month interval between February 2008 and December 2012. The findings in plain film, the extent of increased uptake in bone scan, and signal change in MRI were compared to evaluate the actual level of pain. All patients received percutaneous vertebroplasty according to MR finding. Pain scores (visual analog scale) of the study patients were compared prior to and after the procedure.
  
  
  RESULTS
  A total of 52 patients with a mean age of 79.1 years (range 59-92 years) were enrolled in this study, and were treated by vertebroplasty confirmed by MRI. It was observed that patient pain score (visual analog scale) improved from 7.6 to 2.8. Plain film examination revealed 79 vertebrae that were suspected to be compression fractures. Among the suspected vertebrae, 62 showed increased uptake in bone scan, and MRI showed bony edema change in 58 vertebrae. The consistency between bone scan and MRI was 96.9% in patients with single-level suspected fracture on plain film. There was moderate agreement (kappa was 0.56) in patients where multiple levels were noted. Fifteen vertebrae with vacuum cleft sign on plain film showed total concordance in both bone scan and MRI.
  
  
  CONCLUSIONS
  For patients with single-level compression fracture, the painful level in osteoporotic vertebral fractures can be determined by plain film and bone scan testing. Vacuum cleft sign noted on plain film may be enough to localize the level of pain. However, MRI testing is further needed in multiple osteoporotic vertebral fracture patients.
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taiwan, ROC.
authors.forename: Hsi-Hsien
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taiwan, ROC.
authors.forename: Po-Hsin
authors.initials: PH
authors.lastname: Chou
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taiwan, ROC.
authors.forename: Shih-Tien
authors.initials: ST
authors.lastname: Wang
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taiwan, ROC.
authors.forename: Jung-Kuang
authors.initials: JK
authors.lastname: Yu
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taiwan, ROC. Electronic address: bdmcchang@gmail.com.
authors.forename: Ming-Chau
authors.initials: MC
authors.lastname: Chang
authors.affiliation: Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taiwan, ROC.
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D010147:Pain Measurement; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery
keywords: bone scan; magnetic resonance imaging; osteoporosis; vertebral compression fracture