Dr karen billington Consultant Radiologist Te whetu ORA Auckland Musculoskeletal Radiologist Auckland Radiology Group Outline Anatomy Terminology Imaging modalities Measuring fracture height loss ID: 1043494
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1. Classification of Vertebral Body FracturesDr karen billingtonConsultant Radiologist, Te whetu ORA AucklandMusculoskeletal Radiologist, Auckland Radiology Group
2. OutlineAnatomyTerminologyImaging modalitiesMeasuring fracture height lossCase examples
3. Anatomy of the Spine
4. Anatomy of the Spine
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6. TerminologyWedge compression fracture - fracture of the vertebral body involving one endplate but not the posterior wallSplit fracture - involvement of both endplates but not the posterior wallBurst fracture - involvement of one (incomplete) or both (complete) endplates and the posterior wall
7. Genant Classification of Vertebral FracturesGrade 0: normalGrade 1: mild, <25% loss of heightGrade 2: moderate, 25-40% loss of heightGrade 3: severe, >40% loss of height
8. Acute vs chronic - Clinical history - Previous imaging - Cortical disruption - Trabecular impaction - MRI: marrow oedema - Scintigriphy: increased tracer uptake
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11. Osteoporotic vs pathological - no bony destruction - preserved fatty bone marrow signal on MRI - low signal band indicating a fracture line - retropulsion, not posterior bulging - multiple compression fractures…favour a benign compression fracture
12. RadiographsInexpensiveWidely availableQuick to perform, therefore well toleratedLow radiation doseLimited bony detail, diminished by: - increased body habitus - reduced bone densityDifficult to determine chronicityLimited by patient position
13. CTAvailable out of hours Takes less than 1 minuteImages can be reformatted in multiple planes and filters (bone, soft tissue, 3D)No contrast neededDual energy CT and SPECT can help determine chronicityImages can be degraded by movement or breathingHigher radiation dose than radiographsSoft tissue detail of cord, epidural space and nerve roots is limitedCan miss subtle fractures if patient is very osteopenic
14. MRILimited out of hours availabilityExcellent soft tissue detailNo contrast neededCan establish chronicityCan help determine benign vs pathologicalNo radiationImages can be degraded by movement or breathingTakes 20-30 minutes
15. Measuring vertebral body height loss% vertebral body height loss = A+C/2 – B x 100 A+C/2
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21. In summary…Clinical history is critical to help interpret imagesCompare with previous imagingCT and MRI can be used as problem solversIf unsure, please come speak to a radiologist. We’re happy to help.Thank you