1
|
Viola R, Aslan S, Al-Smadi MW, Süvegh D, Viola Á. From Detection to Decision: How STIR Sequence MRI Influences Treatment Strategies for Osteoporotic Vertebral Fractures. J Clin Med 2024; 13:3347. [PMID: 38893058 PMCID: PMC11172803 DOI: 10.3390/jcm13113347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Osteoporotic vertebral fractures (OVFs) significantly impair quality of life. This study evaluates the impact of STIR sequence MR imaging on clinical decision-making for treating OVFs, mainly focusing on how MRI findings influence treatment modifications compared to those based solely on CT scans. Methods: This retrospective analysis reviewed cases from the Manninger Jenő National Traumatology Institute over ten years, where patients with suspected OVFs underwent CT and STIR sequence MR imaging. The study examined changes in treatment plans initiated by MRI findings. The diagnostic effectiveness of MRI was compared against CT in terms of sensitivity, specificity, and the ability to influence clinical treatment paths. Results: MRI detected 1.65 times more fractures than CT scans. MRI influenced treatment adjustments in 67% of cases, leading to significant changes from conservative-conservative, conservative-surgery, and surgery-surgery based on fracture characterizations provided by MRI. Conclusions: This study demonstrates that integrating STIR sequence MR imaging into the diagnostic pathway for OVFs significantly enhances the accuracy of fracture detection and profoundly impacts treatment decisions. The ability of MRI to reveal specific fracture features that are not detectable by CT scans supports its importance in the clinical evaluation of OVFs, suggesting that MRI should be incorporated more into diagnostic protocols to improve patient management and outcomes. The findings advocate for further research to establish STIR MRI as a standard osteoporosis management tool and explore its long-term benefits in preventing secondary fractures.
Collapse
Affiliation(s)
- Réka Viola
- Department of Psychiatry, Peterfy Sandor Hospital, 1076 Budapest, Hungary;
| | - Siran Aslan
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary;
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (D.S.)
- Doctoral School of Clinical Medicine, Semmelweis University, 1083 Budapest, Hungary
| | - Mohammad Walid Al-Smadi
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (D.S.)
| | - Dávid Süvegh
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (D.S.)
| | - Árpád Viola
- Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary;
- Department of Neurosurgery and Neurotraumatology, Dr. Manninger Jenő National Traumatology Institute, 1081 Budapest, Hungary; (M.W.A.-S.); (D.S.)
| |
Collapse
|
2
|
Lang S, Walter N, Freigang V, Neumann C, Loibl M, Alt V, Rupp M. Increased incidence of vertebral fractures in German adults from 2009 to 2019 and the analysis of secondary diagnoses, treatment, costs, and in-hospital mortality. Sci Rep 2023; 13:6984. [PMID: 37117230 PMCID: PMC10147602 DOI: 10.1038/s41598-023-31654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/15/2023] [Indexed: 04/30/2023] Open
Abstract
The aim of this cross-sectional study was to present the nationwide rates of hospitalized patients with vertebral fractures over one decade and to comprehensively analyze the treatment characteristics and direct costs incurred in 2019. Therefore, the trends in the incidence rate were quantified based on annual ICD-10 diagnosis codes from all German medical facilities between 2009 and 2019, provided by the Federal Statistical Office (Destatis). The ICD-10 Codes "S12.0-2; S22.0-; S32.0-, and S32.1-2" were evaluated. The relative change from 2009 through 2019 was determined. Using data from the Institute for Hospital Remuneration Systems (InEK) for 2019 the secondary diagnoses, OPS-codes, intensive care unit (ICU) treatment, in-hospital mortality, the proportion of G-DRGs and cumulative costs were evaluated. The documented number of vertebral fractures increased by 45.6% between 2009 and 2019 to an incidence of 150.7 per 100,000 inhabitants. The lumbar spine was most commonly affected with an incidence of 70.5/100,000 inhabitants in 2019 (46.8% of all vertebral fractures). The highest increases were seen in the numbers of subaxial cervical fractures (+ 121.2%) and sacral fractures (+ 306.6%). Of all vertebral fractures in 2019, 63.7% were diagnosed in women and 69.0% in patients aged 70 years or older. Osteoporosis was documented in 17.9% of cases as a concomitant diagnosis. In 10.1% of all cases, an ICU treatment was documented. The in-hospital mortality was 2.0% in 2019. I68D was the most frequently used G-DRG code, accounting for 33.3% of cases. The total direct costs for inpatient treatment in 2019 amounted to €589,205,715. The evaluation of 955,091 vertebral fractures showed a sharp increase in the nation-wide incidence rate. The presented age and sex distribution, the comorbidity profile and the in-hospital mortality rate indicate the importance of comprehensive geriatric assessment and emphasize the need for spinal care centers to be established.
Collapse
Affiliation(s)
- Siegmund Lang
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Nike Walter
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Viola Freigang
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Carsten Neumann
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Markus Loibl
- Department of Spine Surgery, Schulthess Clinic Zurich, Lenghalde 2, 8008, Zurich, Switzerland
| | - Volker Alt
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| |
Collapse
|
3
|
Nudelman B, Mittal A, Rosinski A, Zaborovskii N, Wu S, Kondrashov D. Whole-Spine Magnetic Resonance Imaging: A Review of Suggested Indications. JBJS Rev 2021; 9:01874474-202107000-00004. [PMID: 34257232 DOI: 10.2106/jbjs.rvw.20.00267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The spinal column has a propensity for lesions to manifest in a multifocal manner, and identification of the lesions can be difficult. » When used to image the spine, magnetic resonance imaging (MRI) most accurately identifies the presence and location of lesions, guiding the treatment plan and preventing potentially devastating complications that are known to be associated with unidentified lesions. » Certain conditions clearly warrant evaluation with whole-spine MRI, whereas the use of whole-spine MRI with other conditions is more controversial. » We suggest whole-spine MRI when evaluating and treating any spinal infection, lumbar stenosis with upper motor neuron signs, ankylosing disorders of the spine with concern for fracture, congenital scoliosis undergoing surgical correction, and metastatic spinal tumors. » Use of whole-spine MRI in patients with idiopathic scoliosis and acute spinal trauma remains controversial.
Collapse
Affiliation(s)
- Brandon Nudelman
- San Francisco Orthopaedic Residency Program, San Francisco, California
| | - Ashish Mittal
- San Francisco Orthopaedic Residency Program, San Francisco, California
| | | | - Nikita Zaborovskii
- Spine Surgery and Oncology, R.R. Vreden Russian Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia
| | - Samuel Wu
- San Francisco Orthopaedic Residency Program, San Francisco, California
| | | |
Collapse
|
4
|
Bäcker HC, Wu CH, Perka C, Panics G. Dual-Energy Computed Tomography in Spine Fractures: A Systematic Review and Meta-Analysis. Int J Spine Surg 2021; 15:525-535. [PMID: 33963025 DOI: 10.14444/8074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to perform a systematic literature review and meta-analysis to evaluate the sensitivity, specificity, and accuracy of dual-energy computed tomography (DE-CT) of bone marrow edema and disc edema in spine injuries.In vertebral injuries, prompt diagnosis is essential to avoid any delays in treatment. Conventional radiography may only reveal indirect signs of fractures, such as when it is displaced. Therefore, to detect the presence of bone marrow or disc edemas, adjunctive tools are required, such as magnetic resonance imaging (MRI) or DE-CT. METHODS Search terms included ((DECT) OR (DE-CT) OR (dual-energy CT) OR "Dual energy CT" OR (dual-energy computed tomography) OR (dual energy computed tomography)) AND ((spine) OR (vertebral)), and the PubMed, EMBASE, and MEDLINE databases and the Cochrane Library and Google were used. We found 1233 articles on our preliminary search, but only 13 articles met all criteria. Data were extracted to calculate the pooled sensitivity, specificity, and diagnostic odds ratio for analysis using R software. RESULTS Within the 13 studies, 515 patients, 3335 vertebrae, and 926 acute fractures (27.8%) defined by MRI were included. The largest cohort included 76 patients with 774 vertebrae. In 12 publications, MRI was reported for comparison. For DE-CT, the overall sensitivity was 86.2% with a specificity of 91.2% and accuracy of 89.3%. Furthermore, 5 studies reported the accuracy of CT with an overall sensitivity of 81.3%, specificity of 80.7%, and accuracy with 80.9%. Significant differences were found for specificity (P < .001) and accuracy (P = .023). However, significant interobserver differences were reported. CONCLUSIONS DE-CT seems to be a promising diagnostic tool to detect bone marrow and disc edemas, which can potentially replace the current gold standard, the MRI. LEVEL OF EVIDENCE 2. CLINICAL RELEVANCE This study shows that DE-CT seems to be a promising diagnostic tool with an accuracy of 89.3%.
Collapse
Affiliation(s)
- Henrik C Bäcker
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Berlin, Germany
| | - Chia H Wu
- Department of Orthopedics & Sports Medicine, Baylor College of Medicine Medical Center, Houston, Texas, USA
| | - Carsten Perka
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Berlin, Germany
| | - Gergely Panics
- Department of Orthopaedic Surgery and Traumatology, Uszoki Hospital, Budapest, Hungary
| |
Collapse
|
5
|
Qamar SR, Evans D, Gibney B, Redmond CE, Nasir MU, Wong K, Nicolaou S. Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making. Can Assoc Radiol J 2020; 72:293-310. [PMID: 32268772 DOI: 10.1177/0846537120914247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient's best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.
Collapse
Affiliation(s)
- Sadia Raheez Qamar
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - David Evans
- Department of Surgery, 8167Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Gibney
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciaran E Redmond
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Umer Nasir
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Wong
- Department of Radiology, 71511Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Savvas Nicolaou
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|