Dynamic contrast-enhanced magnetic resonance imaging for evaluating intraosseous cleft formation in patients with osteoporotic vertebral compression fractures before vertebroplasty

STUDY DESIGN.: 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. SUMMARY OF BACKGROUND DATA.: 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. MATERIALS.: 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. CONCLUSION.: In patients with osteoporotic VCF before vertebroplasty, decreased bone marrow perfusion, as measured by DCE-MRI, was associated with intraosseous cleft formation.