The value of combined assessment of vertebral fractures with 99mTc MDP scintigraphy and MRI in selecting and planning percutaneous vertebroplasty

Abstract

Percutaneous vertebroplasty is a minimally invasive radiological procedure intended for relieving painful vertebral fractures. Suitability depends largely on fracture age, with acute osteoporotic fractures being most appropriate. Selection and planning usually involves either Tc MDP scintigraphy or MRI. There is evidence indicating that either modality is predictive of response to vertebroplasty, but there is limited evidence promoting their combined use. The aim of the study was to establish the degree of concordance between MRI and Tc MDP scintigraphy in vertebral fracture assessment. Our institution routinely uses both MRI and Tc MDP scintigraphy in vertebroplasty planning. This retrospective analysis included 39 patients, with a total of 73 vertebral fractures, all treated with vertebroplasty. The fractures were classified according to fracture age, aetiology and intermodality concordance. The overall concordance between MRI and Tc MDP scintigraphy was 63%. Almost twice as many fractures classified as 'acute/ subacute' on MRI were so classified on Tc MDP scintigraphy. Using MRI without Tc MDP scintigraphy, 48.2% of the potentially suitable vertebroplasty targets (37% of the total vertebral lesions) would likely have been overlooked. Clearly, Tc MDP scintigraphy and MRI provide different but complementary information on vertebral fractures, and these results support the use of dual-modality assessment in vertebroplasty selection and planning.