DOI:10.2214/AJR.07.2614
AJR 2007; 189:W302
© American Roentgen Ray Society
Preoperative MR Findings Predictive of Cement Leakage During Vertebroplasty: Low Signal Intensity Linear Lesion in Intervertebral Disk
Dong Soo Yoo,
You Me Kim and
Yeong Seok Lee
Dankook University College of Medicine Cheonan, Republic of Korea
WEB—This is a Web exclusive article.
We read with interest the article by Hiwatashi et al.
[1] in the April 2007 issue of
the AJR, in which they showed that cement leakage into an adjacent
intervertebral disk could be predicted by preoperative MRI findings of
abnormal T2 hyperintensity in the intervertebral disk, cortical defect in the
endplate, and absence of intravertebral cleft.
Recently, we published a similar article
[2]. However, for the following
reasons, we analyzed the T1 and T2 low-signal-intensity linear lesion in the
disk space instead of T2 hyperintensity of the adjacent disk. First,
low-signal-intensity linear lesion in the disk space is more common and more
easily detected than T2 hyperintensity lesion, especially in T2-weighted
images. Second, morphologically, low-signal-intensity linear lesion is more
accurately matched to the cement leakage pattern, even when both MRI findings
are present concurrently (Fig.
1A,
1B,
1C).
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Fig. 1A —64-year-old woman who underwent vertebroplasty of T11 body
for acute compression fractures. T1-weighted (A) and T2-weighted
(B) sagittal images show cortical defect at vertebral lower endplate
(arrowheads, A and B) of T11 body, low-signal-intensity
linear lesions (arrows) and T2 hyperintensity lesion (dotted
arrow, B) in the disk. After bone cement injection, fluoroscopic
image (C) shows leakage of bone cement into intervertebral space at the
same site of low signal intensity linear lesion (arrow).
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Fig. 1B —64-year-old woman who underwent vertebroplasty of T11 body
for acute compression fractures. T1-weighted (A) and T2-weighted
(B) sagittal images show cortical defect at vertebral lower endplate
(arrowheads, A and B) of T11 body, low-signal-intensity
linear lesions (arrows) and T2 hyperintensity lesion (dotted
arrow, B) in the disk. After bone cement injection, fluoroscopic
image (C) shows leakage of bone cement into intervertebral space at the
same site of low signal intensity linear lesion (arrow).
|
|
View larger version (152K):
[in this window]
[in a new window]
[as a PowerPoint slide]
|
Fig. 1C —64-year-old woman who underwent vertebroplasty of T11 body
for acute compression fractures. T1-weighted (A) and T2-weighted
(B) sagittal images show cortical defect at vertebral lower endplate
(arrowheads, A and B) of T11 body, low-signal-intensity
linear lesions (arrows) and T2 hyperintensity lesion (dotted
arrow, B) in the disk. After bone cement injection, fluoroscopic
image (C) shows leakage of bone cement into intervertebral space at the
same site of low signal intensity linear lesion (arrow).
|
|
To distinguish from the degenerative change of the intervertebral disk, we
confined the low-signal-intensity linear lesion to that of the oblique or
vertical direction, which was continuous with a cortical defect of the
vertebral endplate.
In the T2-weighted image, both the sensitivity (86.5%) and specificity
(83.9%) of the linear low-signal-intensity lesion were high, whereas in the
T1-weighted image, there was low sensitivity (39.5%) and very high specificity
(92.5%).
Because of the aforementioned reasons, we think that preoperative MRI
findings of low-signal-intensity linear lesion of intervertebral disk can be a
more accurate and useful predictor than T2 hyperintensity in the disk.
References
- Hiwatashi A, Ohgiya Y, Kakimoto N, Westesson PL. Cement leakage
during vertebroplasty can be predicted on preoperative MRI.
AJR 2007; 188:1089
–1093[Abstract/Free Full Text]
- Lee KH, Yoo DS, Kim YM, Lee YS. MR findings predictive of
intradiscal leakage of bone cement in vertebroplasty [in Korean]. J
Korean Radiol Soc 2007; 56:371
–377
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