Vertebral Fracture Vertebral Fracture Classification Classification By By Advanced Imaging Advanced Imaging Jalal Jalal Shokouhi-M.D. Jalal Jalal Shokouhi-M.D. General secretary of ISR General secretary of ISR (Iranian society of (Iranian society of radiology) radiology) [email protected][email protected]
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Vertebral Fracture Classification By Advanced Imaging Jalal Jalal Shokouhi-M.D. General secretary of ISR (Iranian society of radiology) [email protected].
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Vertebral Fracture Classification Vertebral Fracture Classification By By
Advanced ImagingAdvanced Imaging
Jalal Jalal Shokouhi-M.D.Jalal Jalal Shokouhi-M.D.General secretary of ISR General secretary of ISR
(Iranian society of radiology)(Iranian society of radiology)[email protected]@hotmail.com
MRI might change vertebral body MRI might change vertebral body fracture classificationfracture classification
Special thanks to:Special thanks to:
Rahimi Zadeh –MDRahimi Zadeh –MD
Khadivi –MDKhadivi –MD
Ali Akbar Ameri –MDAli Akbar Ameri –MD
Gholamreza Bakhshande pour –MDGholamreza Bakhshande pour –MD
• CT ScanCT Scan--also known as CAT/TAC scan. --also known as CAT/TAC scan. Computed Axial Tomography. Uses a beam Computed Axial Tomography. Uses a beam of radiation which moves in an arc to create of radiation which moves in an arc to create an image.an image.
• Spiral CT ScanSpiral CT Scan--allows for quicker --allows for quicker assessment (20-30 sec.) of anatomic regions. assessment (20-30 sec.) of anatomic regions. Can obtain 3D images.Can obtain 3D images.
• Bone ScanBone Scan--Identifies metabolic bone activity.--Identifies metabolic bone activity.
CT/CAT SCANCT/CAT SCAN
• Advantages:Advantages:
----Used with Burst fractures to assess Used with Burst fractures to assess
bone fragments in the canal.bone fragments in the canal.
-- AP view allows you to see the fracture plane-- AP view allows you to see the fracture plane
-- Easy to obtain, almost always taken for -- Easy to obtain, almost always taken for traumatrauma
• Disadvantage:Disadvantage:
--Insensitive to edema--Insensitive to edema
--Age of fracture indeterminate--Age of fracture indeterminate
CT In traumaCT In trauma
CT In trauma same pt.CT In trauma same pt.
CT In trauma same pt.CT In trauma same pt.
CT In trauma same pt.CT In trauma same pt.
CT In trauma same pt.CT In trauma same pt.
Is this a case for Kyphoplasty?
Is this a case for Kyphoplasty?
What questions would you ask the doctor?
What questions would you ask the doctor?
MRIMRI
• AdvantagesAdvantages– High resolution, sensitivity and specificityHigh resolution, sensitivity and specificity– Can be useful for identifying micro-Can be useful for identifying micro-
fractures.fractures.– Better for assessing tissue damage, Better for assessing tissue damage,
tumors and infectiontumors and infection
MRIMRI
• Disadvantages:Disadvantages:
--Very costly--Very costly
--Time consuming--Time consuming
--Patient claustrophobia--Patient claustrophobia
--Difficult to differentiate posterior--Difficult to differentiate posterior
element fractureselement fractures
MRIMRI
• T1 - oedema is dark T1 - oedema is dark • T2 - oedema is bright but not always T2 - oedema is bright but not always
visible (can be obscured by fat.)visible (can be obscured by fat.)• STIR – Short Tau eliminates all fat to only STIR – Short Tau eliminates all fat to only
show fluidsshow fluids
• STIR is always the best image to use for STIR is always the best image to use for determining if the fracture is freshdetermining if the fracture is fresh
MRIMRI
T1 STIR
S.T.I.R. = Short Tau Inversion Recovery
T2
What is at T7?What is at T7?
MRI AND X-RAY
Candidate for Kyphoplasty????Candidate for Kyphoplasty????
Lateral FX.Lateral FX.
Enostosis or bone island or bone stoneEnostosis or bone island or bone stoneWhat is your diagnosis?What is your diagnosis?What is your diagnosis?What is your diagnosis?
No need kyphoplastyNo need kyphoplastyNo need kyphoplastyNo need kyphoplasty
500 Traumatic Patients 500 Traumatic Patients
147 Fractures147 Fractures
2 Cases of Spinal puncture or Dural tear 2 Cases of Spinal puncture or Dural tear
Common fractures are anterior wedging Common fractures are anterior wedging and upper end plate depressionand upper end plate depression
Fractures: Single ,2-3 ,5 Fractures: Single ,2-3 ,5
Gold standard: MRI WITH STIRGold standard: MRI WITH STIR
CT is better for V.Body processesCT is better for V.Body processes