It’s unlikely radiography will unseat MRI for routinely distinguishing between acute and chronic compression fractures of the lumbar vertebrae, but certain X-ray findings might, in cases, obviate the need for the pricier imaging option.
The presence of cleft or density in vertebral sub-endplates visualized on X-rays alone might do the job, according to a study conducted at the University of Colorado and published Oct. 22 in Emergency Radiology [1].
Colin Strickland, MD, and colleagues arrived at the conclusion after retrospectively reviewing cases of patients who had compression fractures and were imaged with both lumbar radiography and lumbar MRI within a 30-day window.
The team used the MRI studies to characterize fracture acuity, then had radiologists who were unfamiliar with the cases interpret X-rays from the same patients.
The X-ray readers recorded findings of endplate osteophyte, sub-endplate density, sub-endplate cleft and sub-endplate cyst, and they registered their overall impressions of fracture acuity.
Analyzing the results for acute fracture diagnosis using radiography, the researchers found sensitivity of 0.52 and specificity of 0.95.
The results were closely similar for chronic fracture diagnoses, 0.52 sensitivity and 0.94 specificity.
Additionally, the authors report,
- the radiographic presence of a sub-endplate cleft increased the odds of a fracture being acute by a factor of 1.75;
- the radiographic presence of sub-endplate density increased the odds of a fracture being acute by a factor of 1.78; and
- the presence of an endplate osteophyte or sub-endplate cyst was not significantly associated with fracture acuity.
Strickland and co-authors conclude:
Radiographs are relatively insensitive in distinguishing between acute and chronic lumbar compression fractures, but the presence of a sub-endplate cleft or sub-endplate density increases the likelihood that a given fracture is acute.”
Abstract here, full study behind paywall.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.