Intravertebral cleft sign on fat-suppressed contrast-enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty

Acad Radiol. 2005 Aug;12(8):992-9. doi: 10.1016/j.acra.2005.05.003.

Abstract

Rationale and objectives: Filling intravertebral clefts during percutaneous vertebroplasty (PVP) is considered to be important for optimal pain control. It is often difficult to detect clefts on non-contrast MR and some fractures show a solid pattern distribution of injected cement without a cleft sign on non-contrast MR. In this study, we evaluated usefulness of fat-suppressed contrast-enhanced MR to predict a solid pattern distribution of injected cement on PVP.

Materials and methods: Twenty-six patients with 35 vertebral compression fractures due to osteoporosis were studied. We performed sagittal T1-weighted, T2-weighted and fat-suppressed contrast-enhanced T1-weighted images prior to PVP. First we evaluated the presence of fluid-filled or gas-containing clefts on non-contrast MR. Next we evaluated contrast-enhanced MR of the same vertebrae for the presence of cleft-shaped unenhanced areas within the diffuse enhancement area. We correlated MR findings with cement distribution patterns of injected cement.

Results: Based on MR findings, 35 osteoporotic fractures were divided into 3 types. Type 1 (11 fractures, 31%): There were no clefts on non-contrast MR and no unenhanced areas on contrast-enhanced MR; Type 2 (13, 37%): There were no clefts on non-contrast MR but there were unenhanced areas on contrast-enhanced MR; Type 3 (13, 37%): There were clefts on non-contrast MR and unenhanced areas on contrast-enhanced MR. Of 35 osteoporotic fractures, thirteen vertebral fractures (37%) were noted to contain clefts on non-contrast MR, while 24 vertebral fractures (69%) contained unenhanced areas on contrast-enhanced MR. Cement distributed as a solid pattern within clefts or unenhanced areas in all fractures with them.

Conclusion: Fat-suppressed contrast-enhanced MR is useful to predict a solid pattern distribution of injected cement prior to PVP.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Barium Sulfate / administration & dosage
  • Bone Cements / therapeutic use
  • Contrast Media / administration & dosage*
  • Female
  • Humans
  • Injections, Spinal
  • Lumbar Vertebrae / diagnostic imaging*
  • Lumbar Vertebrae / injuries*
  • Lumbar Vertebrae / surgery
  • Magnetic Resonance Imaging*
  • Male
  • Osteoporosis / classification
  • Osteoporosis / complications
  • Osteoporosis / diagnostic imaging
  • Osteoporosis / therapy
  • Polymethyl Methacrylate / therapeutic use
  • Radiographic Image Enhancement*
  • Spinal Fractures / classification
  • Spinal Fractures / diagnostic imaging*
  • Spinal Fractures / etiology
  • Spinal Fractures / therapy
  • Statistics as Topic

Substances

  • Bone Cements
  • Contrast Media
  • Barium Sulfate
  • Polymethyl Methacrylate