2023, Vol. 27 ›› Issue (18): 2892-2896

Feasibility of vertebral CT value in differentiating fresh and old osteoporotic vertebral compression fractures

Feng Ningning1, Jiang Guozheng1, Yu Xing2, Zhao He2, Yang Yongdong2, Guan Jianbin1, Ma Yukun1, Wang Shuyang1   

Abstract: BACKGROUND: The incidence of osteoporotic vertebral compression fracture is increasing year by year. Clinical differentiation of fresh or old fractures determines the choice of treatment for patients. It is of great clinical significance to find a simple and rapid method to identify the properties of osteoporotic vertebral compression fracture in hospitals without relevant examination facilities and in patients with contraindications to MRI and single photon emission computed tomography whole-body bone scanning.  
OBJECTIVE: To analyze and compare the consistency between vertebral CT values (Hounsfield units value, HU) and MRI in differentiating fresh and old osteoporotic vertebral compression fractures and to explore the feasibility of using vertebral CT values to diagnose fresh osteoporotic vertebral compression fractures.
METHODS: A retrospective analysis was performed on 40 patients, aged 55-89 (74.63±9.71) years, diagnosed as osteoporotic vertebral compression fracture with complete MRI and CT examination in Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine from January 2018 to October 2021. The nature of vertebral fractures was determined based on MRI images: Diagnostic criteria of fresh osteoporotic vertebral compression fracture based on MRI were high signal intensity of bone marrow edema on fat-suppression images, whereas normal signal of MRI on the vertebral body with wedge-shaped was diagnosed as old osteoporotic vertebral compression fracture. The vertebral CT values of target vertebrae with its adjacent level were measured separately. The CT value of target vertebra significantly higher than adjacent vertebra was diagnosed as fresh osteoporotic vertebral compression fracture but similar CT value as old osteoporotic vertebral compression fracture. Wilcoxon rank-sum test was used to compare the consistency of fresh and old vertebral fractures determined by MRI and vertebral CT values.  
RESULTS AND CONCLUSION: (1) A total of 55 vertebral bodies were involved in 40 patients; 42 fresh fractures and 13 old fractures were diagnosed via MRI. (2) The Hu of fresh fractured osteoporotic vertebral compression fracture vertebral body (139.99±49.69 HU) was significantly higher than that of normal adjacent vertebral body (60.44 ±34.74 HU) (P < 0.01). The Hu of old fractured vertebral body (55.65±31.31 HU) was 6.19 HU (1.09-14.51 HU) from that of normal adjacent vertebral body (55.07±29.47 HU), and there was no statistical difference (P > 0.05). (3) The vertebral body CT value was used to diagnose 41 fresh fractured vertebral bodies and 14 old fractured vertebral bodies. (4) Wilcoxon rank-sum test showed that MRI and CT were highly consistent in differentiating fresh and old fractures in osteoporotic vertebral compression fracture (Kappa value=0.951). (5) It is concluded that the CT has high consistency with MRI in differentiating fresh and old fracture of osteoporotic vertebral compression fracture. By comparing the CT values of the target and adjacent vertebrae, fresh or old fractures can be accurately distinguished, which can provide a simple examination method other than MRI for rapid clinical decision making. For fractures that are difficult to determine, the combination of vertebral CT values and MRI can markedly improve the diagnostic accuracy.
Key words: vertebral CT value, osteoporotic vertebral fracture, fresh fracture, old fracture