[국내논문]What Effects Does Necrotic Area of Contrast-Enhanced MRI in Osteoporotic Vertebral Fracture Have on Further Compression and Clinical Outcome?원문보기
Lee, Ja Myoung
(Department of Neurosurgery, Gyeongsang National University School of Medicine)
,
Lee, Young Seok
(Department of Neurosurgery, Gyeongsang National University School of Medicine)
,
Kim, Young Baeg
(Department of Neurosurgery, Chung-Ang University College of Medicine)
,
Park, Seung Won
(Department of Neurosurgery, Chung-Ang University College of Medicine)
,
Kang, Dong Ho
(Department of Neurosurgery, Gyeongsang National University School of Medicine)
,
Lee, Shin Heon
(Department of Neurosurgery, Chung-Ang University College of Medicine)
Objective : The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome accordi...
Objective : The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. Methods : Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. Results : Further compression was $14.78{\pm}11.11%$ at 1 month and $21.75{\pm}14.43%$ at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was $33.52{\pm}12.96%$, which was higher than that of the non-necrosis group, $14.96{\pm}10.34%$ (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales. Conclusion : The necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.
Objective : The objective of this study was to analyze the correlation between further compression and necrotic area in osteoporotic vertebral fracture (OVF) patients with contrast-enhanced magnetic resonance imaging (CEMRI). In addition, we investigated the radiological and clinical outcome according to the range of the necrotic area. Methods : Between 2012 and 2014, the study subjects were 82 OVF patients who did not undergo vertebroplasty or surgical treatment. The fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen. The correlation between further compression and the necrotic and edematous areas of CEMRI, age, and bone mineral density was examined. Also, necrotic areas were classified into those with less than 25% (non-necrosis group) and those with more than 25% (necrosis group) according to the percentages of the entire vertebral body. For both groups, further compression and the changes in wedge and kyphotic angles were examined at admission and at 1 week, 3 months, and 6 months after admission, while the clinical outcomes were compared using the visual analog scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status grade. Results : Further compression was $14.78{\pm}11.11%$ at 1 month and $21.75{\pm}14.43%$ at 6 months. There was a very strong correlation between the necrotic lesion of CEMRI and further compression (r=0.690, p<0.001). The compression of the necrosis group was $33.52{\pm}12.96%$, which was higher than that of the non-necrosis group, $14.96{\pm}10.34%$ (p<0.005). Also, there was a statistically significantly higher number of intervertebral cleft development and surgical treatments being performed in the necrosis group than in the non-necrosis group (p<0.005). Moreover, there was a statistical difference in the decrease in the height of the vertebral body, and an increase was observed in the kyphotic change of wedge angle progression. There was also a difference in the VAS and ECOG performance scales. Conclusion : The necrotic area of CEMRI in OVF had a strong correlation with further compression over time. In addition, with increasing necrosis, intervertebral clefts occurred more frequently, which induced kyphotic changes and resulted in poor clinical outcomes. Therefore, identifying necrotic areas by performing CEMRI on OVF patients would be helpful in determining their prognosis and treatment course.
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제안 방법
We measured necrotic and edematous area using highly reliable and sensitive contrast-enhanced magnetic resonance imaging (CEMRI) in OVF and examined the strength of the correlation by comparing with compression after 6 months. Additionally, comparative analysis was performed to determine how the range of the necrotic area affected not only radiological outcome but also clinical outcome.
We measured necrotic and edematous area using highly reliable and sensitive contrast-enhanced magnetic resonance imaging (CEMRI) in OVF and examined the strength of the correlation by comparing with compression after 6 months. Additionally, comparative analysis was performed to determine how the range of the necrotic area affected not only radiological outcome but also clinical outcome.
The ratio (%) of reduced vertebral body area was measured at 1 month and 6 months based on the vertebral body area of fracture on lateral plain radiography at admission. Additionally, the edematous and necrotic areas of the fracture lesion in a middle sagittal section were measured using CEMRI, and the fracture areas examined on CEMRI at admission were defined as edematous if enhancement was seen and as necrotic if no enhancement was seen using picture archiving and communication system (Maroview version 5.4, Marotech Inc., Seoul, Korea). The areas of necrosis, edema, and necrosis+edema were obtained as a ratio (%) based on the entire area of the fractured vertebral body (Fig.
1A)12). Then, correlations of further compression were studied with respect to the necrotic and edematous areas seen on CEMRI, age, and bone mineral density (BMD), which were believed to be closely correlated with further compression.
대상 데이터
Eighty-seven patients admitted for OVF from January 2012 to December 2014 were retrospectively recruited as study subjects. The OVF patients engaged in this study were patients aged 50 and older who had single-level vertebral fracture without posterior ligament injury among AO classification A1–3 and compression or burst fracture without neurological deficiency; all subjects also had adequate pain relief with a score of 1–2 points in the thoracolumbar injury classification and severity score15,16).
The study was performed in a total of 82 patients from January 2012 to December 2014, the mean age of subjects was 69.27±10.33 years, and the ratio of men to women was 18 to 64, indicating a greater number of women.
3. A 76-year-old man with a benign osteoporotic vertebral fracture of the first lumbar vertebra. On (A) T2-, (B) T1-, and (C) fat-suppressed T2- weighted MRI, the signal of the vertebral body appears as isointensity and low and high signal intensity rather than as signal void.
This study has some limitations. This study used retrospective data at a single medical center. To overcome this limitation, medical treatment and pain block was actively performed, and vertebroplasty or kyphoplasty was performed in only 5.
데이터처리
The Pearson method was used to determine the correlation between further compression and necrosis and edema, BMD, and age on contrast-enhanced MRI. Variables between the non-necrosis and necrosis groups were compared using an independent t-test, Mann-Whitney’s U test, and chi-squared test.
Variables between the non-necrosis and necrosis groups were compared using an independent t-test, Mann-Whitney’s U test, and chi-squared test.
성능/효과
Based on this, comparative analysis of the clinical and radiological outcome of each group was performed by dividing the groups into those with necrotic areas of less than 25% (non-necrosis group) or more than 25% group (necrosis group) based on the size of the necrotic area on CEMRI.
12% (Table 1). According to this, the correlation between the degree of further compression at 6 months post-injury and age, BMD, necrotic area, and edematous area was obtained. There was no correlation between further compression and age and BMD, but there was a positive correlation between further compression and necrotic area (Pearson’s correlation coefficient=0.
5%) in the non-necrosis group; furthermore, three patients in the necrosis group needed surgical treatment due to neurologic deficiency. The necrosis group had a statistically significantly poorer clinical outcome in comparison to the non-necrosis group based on VAS at 1 month, 3 months, and 6 months post-injury. Moreover, ECOG performance status showed similar results (Table 2).
Furthermore, a surgical procedure can be necessary as nonunion develops. In our results, the incidence of intervertebral cleft was 43.3% in the necrosis group. In addition, the possibility of intervertebral cleft development is high if the necrotic range is large on CEMRI.
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