Scout CT and MR localizer to detect incidental vertebral fractures

Transcription

1 Scout CT and MR localizer to detect incidental vertebral fractures Poster No.: C-1711 Congress: ECR 2012 Type: Scientific Paper Authors: A. Bazzocchi 1, P. Spinnato 1, C. Acciarri 1, D. Diano 1, G. Garzillo 1, Keywords: DOI: G. Guglielmi 2, C. Rossi 3, G. Battista 1 ; 1 Bologna/IT, 2 San Giovanni Rotondo/IT, 3 Parma/IT Musculoskeletal spine, MR, CT, Diagnostic procedure, Medicolegal issues, Technical aspects, Osteoporosis, Demineralisation- Bone, Forensics /ecr2012/C-1711 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 11

2 Purpose In the past few years literature has firmly demonstrated the importance of vertebral fractures (VFs), as they often represent the most frequent and early manifestation of osteoporosis. More than 50% of osteoporotic VFs are asymptomatic and remain clinically unrecognized, especially for single and mild fractures [1]. As a consequence, patients may ignore their condition and fail to seek therapy to reduce bone density loss and possible subsequent serious fractures [2]. However, imaging studies performed for various clinical indications may lead to an incidental recognition and diagnosis of VFs. Radiologists play a central role in guiding patient management and therapy recognizing these fractures with their clinical consequences [3]. Several techniques and methods have been developed with the goal of VFs detection. In the past many authors investigated VFs unreported especially on lateral chest radiographs and multiplanar sagittal reconstructions of computed tomography (CT) studies when VFs were not the aim of the study [4-6]. Results suggest that the perception and sensibility to VFs are still poor when a VFs assessment is not the purpose of the examination [7, 8]. In recent years, alternative methods such as scout CT lateral radiographs (s-ct) have been evaluated to be suitable in the detection of incidental VFs, and they proved to represent an interesting support in screening VFs during CT examinations performed for different clinical reasons [9-11]. To our knowledge no one considered to investigate magnetic resonance imaging (MRI), with particular reference to localization sequences of MRI (MR-loc), in the detection of VFs. The purpose of this study was to analyze the contribution of s-ct and MR-loc images in the detection of VFs (Fig. 1 on page 2). Images for this section: Page 2 of 11

3 Fig. 1: Scout CT sagittal view (left) vs. MR localizer sagittal view (right) of the spine. Page 3 of 11

4 Methods and Materials We retrospectively reviewed 473 CT (223 whole-body, 113 thoracic, 137 abdominal) and 621 MRI (10 whole-body, 287 on thoracic region, 324 on abdominal region) examinations; the spine was never the original target of exams. A semiquantitative diagnostic approach followed by a morphometric analysis was used to detect VFs on s-ct and MR-loc sagittal images (Fig. 2 on page 4). Afterwards, multiplanar sagittal reconstructions or available sagittal MR images were evaluated to confirm the presence or absence of fractures (Fig. 3 on page 4). When a fracture was detected the radiologist's report was read. Images for this section: Fig. 2: Morphometric analysis performed on both scout CT (left) and MR localizer (right) sagittal images. Page 4 of 11

5 Fig. 3: Multiple vertebral fractures: comparison between scout CT sagittal view (left) and multiplanar sagittal reconstruction CT image (right) of the spine. Page 5 of 11

6 Results We included 290 males and 183 females (64.6±13.5 year-old) for CT and 268 males and 353 females (60.1±12.8 year-old) for MRI. Forty-two out of 473 (8.9%) s-ct and 85/621 (13.7%) MR-loc were considered inadequate for diagnostic purpose (Fig. 4 on page 6). Among patients submitted to CT examination 64/473 (13.5%) had a VF; among those undergoing MRI 41/621 (6.6%) were fractured (Fig. 5 on page 7). S- CT and MR-loc provided the only images showing the fractured segment of the spine in 7/64 (11.0%) affected patients for CT (p=0.016), and in all (100%) affected patients for MRI. Radiologists officially reported only 17/64 (26.6%) and 3/41 (7.3%) patients with detectable VFs in CT and MRI, respectively. Images for this section: Page 6 of 11

7 Fig. 4: "Aliasing" effect in MR localizer images, as an example of exclusion criteria. Page 7 of 11

8 Fig. 5: Mild vertebral fracture (arrow) shown on both MR localizer and conventional X- ray exam. Page 8 of 11

9 Conclusion When VFs diagnosis is not the goal of an imaging examination the detection rate is still too low. S-CT and MR-loc may represent a valid tool in the detection of VFs. Although these two ancillary scans or sequences in imaging acquisition techniques differ in their own features, they both offer some important advantages. S-CT images are similar to radiographic ones and may help physicians with past experience on conventional vertebral morphometry (Fig. 6 on page 9). Moreover s- CT offers the additional advantage of a wider field of view than CT multiplanar sagittal reconstructions. MR-loc combines the potential of the volumetric view, performed on the three planes (axial, coronal and sagittal), with MRI multiparametric analysis (Fig. 6 on page 9). Images for this section: Fig. 6: Fracture of T7 and T8 (arrows), observed on a conventional X-ray thoracic exam (left), and on Scout CT (center) and MR localizer (right). Page 9 of 11

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