Sequential magnetic resonance imaging changes in osteoporotic compression fractures: can it be used as a risk predictor for nonunion?
Sequential magnetic resonance imaging changes in osteoporotic compression fractures: can it be used as a risk predictor for nonunion?
复制标题
骨质疏松性压缩骨折的连续磁共振成像变化：它可以用作骨不连的风险预测指标吗？
作者：
Yen;Hui;H. Hsu
致编辑：Re：Tadao Tsujio，Hiroaki Nakamura，Hidetomi Terai等人新鲜骨质疏松性椎体骨折的特征性放射或磁共振图像预测潜在的骨不连风险。脊柱2011；36：1229-35。Tsujio等人报道，新鲜脊椎骨折的T2加权磁共振(MR)图像上的弥漫性低信号可以预测高风险的骨不连。我们对这一发现有一个问题。为了对脊柱疾病作出正确的诊断，我们需要使用MR的几个脉冲序列(T1加权图像、T2加权图像、短tau反转恢复序列和增强后的T1加权图像)的信息来做出诊断，有时我们还需要来自平片的信息。仅凭T2加权图像不能做出诊断。T2加权图像中的低信号代表骨质疏松、空气或骨坏死。2 Sung等3将椎体压缩骨折在MRI上的信号强度分为4型。I型(骨折年龄0~3个月)表现为T1加权像为低信号，T2加权像为高信号。II型在所有脉冲序列上均表现为压缩椎体内局限性低信号。II型骨折年龄约3~5个月。急性椎体骨折的MR成像应在T2加权像上呈高信号。图3中弥漫性低信号图像应为II型，骨折年龄约为3~5个月。T2加权像上的低信号是压缩骨折的晚期结果，不能作为新鲜骨折的预测指标。
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 . Dr. 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 information 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 characterized by hypointensity on T1-weighted image, and hyperintensity on T2-weighted image. Type II was focally hypointense 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.