Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Evaluating Intraosseous Cleft Formation in Patients With Osteoporotic Vertebral Compression Fractures Before Vertebroplasty

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Abstract
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.

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