Spine www.spinejournal.com 2363
LETTERS
SPINE Volume 36, Number 26, p 2363
©2011, Lippincott Williams & Wilkins
TO THE EDITOR:
Re: Tadao Tsujio, Hiroaki Nakamura, Hidetomi Terai, et al.
Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion. Spine 2011;36:1229–35 .
D
r. Tsujio et al 1 reported that diffuse low intensity on T2-weighted magnetic resonance (MR) images of fresh vertebral fractures can predict a high risk of nonunion. We have a question about this fi nding.To make a correct diagnosis of spinal disease, we need to use the information from several pulse sequences (T1-weighted image, T2-weighted image, short-tau inversion recovery sequence, and contrast-enhanced T1-weighted image) of MR to make the diagnosis; sometimes we also need the informa- tion from plain radiographs. Only T2-weighted image alone cannot make the diagnosis.
Low-intensity signal in T2-weighted image represents fi brosis, air, or osteonecrosis. 2 Sung et al 3 classifi ed the signal intensity of vertebral compression fracture on MR imaging into 4 types. Type I (fracture age about 0–3 months) was char- acterized by hypointensity on T1-weighted image, and hyper- intensity on T2-weighted image. Type II was focally hypoin- tense in the compressed vertebral body on all pulse sequences.
The fracture age at type II was about 3 to 5 months. The MR imaging of acute vertebral fracture should be hyperintensity on T2-weighted image. The image of diffuse low intensity in Figure 3 should be the type II pattern, and the fracture age is about 3 to 5 months. The low intensity in T2-weighted image is a late result of compression fracture, and should not be used as a predictor in fresh fracture.
Acknowledgment date: August 6, 2011. Acceptance date: September 26, 2011.
The manuscript submitted does not contain information about medical device(s)/drug(s).
No funds were received in support of this work. No benefi ts in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
Yen-Jen Chen, MD Orthopedic Department China Medical University Hospital Taichung, Taiwan Department of Orthopedic Surgery School of Medicine China Medical University Taichung, Taiwan Hui-Yi Chen, MD Radiologic Department China Medical University Hospital Taichung, Taiwan Horng-Chaung Hsu, MD
Orthopedic Department China Medical University Hospital Taichung, Taiwan Department of Orthopedic Surgery School of Medicine China Medical University Taichung, Taiwan
DOI: 10.1097/BRS.0b013e318239b3cd
References
1. Tsujio T , Nakamura H , Terai H , et al. Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral frac- tures predicting potential risk for nonunion: a prospective multi- center study . Spine (Phila Pa 1976) 36 : 1229 – 35 .
2. Yu CW , Hsu CY , Shih TT , et al. Vertebral osteonecrosis: MR imag- ing fi ndings and related changes on adjacent levels . AJNR Am J Neuroradiol 2007 ; 28 : 42 – 7 .
3. Sung MS , Park SH , Lee JM , et al. Sequential changes of traumatic vertebral compression fracture on MR imaging . J Korean Med Sci 1995 ; 10 : 189 – 94 .
Sequential Magnetic Resonance Imaging Changes in Osteoporotic Compression Fractures: Can It Be Used as a Risk Predictor for Nonunion?
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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