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Marrow Edema in Acute Fractures - Essay Example

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Marrow Edema Variability in Acute Spine Fractures Mark A. Brinckman, M.D. Cam Chau, M.D Jeffrey S. Ross, M.D. Barrow Neurological Institute St. Joseph Hospital and Medical Center Department of Neuroradiology 350 W Thomas Rd Phoenix, AZ 85013 Abstract Background and Purpose: The presence or absence of marrow edema relate to the assessment of fracture acuity in MR imaging…
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Marrow Edema in Acute Fractures

Download file to see previous pages... Materials and Methods: We conducted a retrospective review of 1215 patients at our hospital for the acute work-up of spine trauma that underwent a combination of CT and MRI. We assessed the patients for the presence or absence of fracture, location, and type of fracture, and absence or degree of marrow edema. Results: The investigation identified 189 patients who had acute fractures on initial screening CT subsequently imaged by MR. 85 out of 189 generated no marrow edema. The majority of these 85 cases were in patients whose history suggested either a hyperextension or a distraction mechanism of injury. Five out of the 85 originated from axial load injury and involved C1 Jefferson fractures. Conclusion: There is variability in the presence or degree of marrow edema resulting from traumatic injury. Only those fractures derived from hyperflexion reliably generate marrow edema. Fractures derived from hyperextension, distraction, and axial loading, do not generate marrow edema, and can lead to a false negative MRI. An awareness of fracture types and traumatic mechanisms that lead to marrow edema is significant in evaluating acute trauma patients. Introduction Multi-detector computed tomography (MDCT) has become the most accurate, efficient, and cost-effective means of identifying fractures of the spinal column in the acute trauma setting.1,2 Despite the obvious advantages of MDCT in this setting, Magnetic Resonance Imaging (MRI) often serves a necessary secondary role when the acuity of the fracture may be in doubt. MRI also apply when soft tissue or ligamentous injury is sought, when epidural or cord hematoma is in question, or when vascular injury is suspected.3-12 With the increasing availability of MRI in the trauma setting, many patients are being evaluated by both modalities during the course of their acute injury work-up. Because of this increased utilization, radiologists must become familiar with the benefits and inherent limitations of each modality in the acute trauma setting. (3, 13, 14) Previous investigations have reported a poor sensitivity and high false negative rate for MRI in the detection of acute osseous fractures. (3, 13) Specifically, an early study in the utility of MRI in acute spinal trauma suggested that fractures of the compression or burst variety were often easier to detect.26 With regard to MRI utilization for acute fracture detection and/or acuity evaluation, we have anecdotally noticed that certain fracture types or fracture mechanisms often result in very little or no marrow edema. While we can infer the acuity of injury from the clinical history or from associated imaging findings, the reliability of marrow edema as a finding for acute fracture varies. The aim of this study was to investigate the variability of marrow edema in the acute trauma setting and characterize which fracture types or mechanisms can relevantly generate, or not generate, bone marrow edema. Based our anecdotal experience, we hypothesized that hyperextension and/or distraction mechanism injuries are most likely to not generate marrow edema and may directly contribute to the high false negative MR examination in acute spinal osseous injury. Materials and Methods After institutional board review approval and with Health Insurance Portability and Accountability Act compliance, we evaluated patients using a combination of CT and MR for acute ...Download file to see next pagesRead More
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