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Visualizing bone marrow in the presence of bone fractures with calcium-suppressed CT images

Case Study
Philips CT Clinical Science Philips Healthcare • USA

Clinical history

A 74-year-old female patient arrived at the emergency room with low back pain following a minor fall. CT of the thoracic and lumbar spine was performed to rule out fractures. CT showed a compression fracture of the first lumbar vertebra. One day later, the patient was referred to MRI in order to determine fracture age and bone marrow involvement. MRI revealed bone marrow edema at the fracture level, suggesting an acute vertebral fracture.

 

Underlying bone marrow abnormalities in the presence of fractures can be masked in conventional CT imaging by the dense trabecular bone, making MRI the modality of choice to determine the age and etiology of vertebral fractures.1,2 The Calcium Suppression (CaSupp) image may help the clinician in visualization of bone marrow abnormalities that otherwise are obscured by the dense trabecular bone while comparing to conventional CT imaging.

 

In this case review study, we are showing the clinical utility of CaSupp in helping the clinician with the visualization of bone marrow abnormality after bone suppression in lumbar vertebral fracture. Spectral images are compared to conventional CT as well as MRI images from T1-weighted and Short Tau Inversion Recovery (STIR) sequences.

Image scan parameters

  • 120 kV
  • Helical CT
  • 0.8 mm slice thickness
  • 1.17 pitch
  • 0.4 second rotation time
  • Filter B with standard resolution
  • 3.5 mGy CTDIvol
Figure A Sagittal (T1) MRI image shows a compression fracture  at the body of L1, showing changes to the bone marrow (arrow).Figure B Sagittal (STIR) MRI image shows L1 bone marrow  edema (arrow).
Figure A
Figure B
Sagittal (T1) MRI image shows a compression fracture at the body of L1, showing changes to the bone marrow (arrow).
Sagittal (STIR) MRI image shows L1 bone marrow edema (arrow).
Figure C CaSupp shows indication for bone marrow involvement (arrow) correlated with the MRI images.Figure D Image shows a fused image of CaSupp overlaying the conventional CT image, illustrating the bone marrow involvement in color.
Figure C
Figure D
CaSupp shows indication for bone marrow involvement (arrow) correlated with the MRI images.
Image shows a fused image of CaSupp overlaying the conventional CT image, illustrating the bone marrow involvement in color.

Clinical significance

Visualization of bone marrow is limited in conventional CT imaging and MRI is the modality of choice for diagnosis of bone marrow edema. The illustrated example showed that calcium-suppressed imaging using IQon Spectral CT provides additional information to the clinician that may help in the visualization of bone marrow involvement when bone fractures are presented.

 

Results from case studies are not predictive of results in other cases. Results in other cases may vary.

 

References

  1. Ananya P, et al. Imaging of vertebral fractures. Indian J Endocrinol Metab. 2014 May-Jun;18(3):295–303.
  2. Eriksen, Erik F. Treatment of bone marrow lesions (bone marrow edema). 2015 International Bone & Mineral Society, BoneKEy Reports 4, Article number 755 (2015). doi:10.1038/bonekey.2015.124.


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Nov 16, 2017

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Case Study
IQon Spectral CT
back pain, bone marrow, calcium suppression, emergency department, fracture, fractured vertebrae, lumbar spine, Musculoskeletal, spectral CT, thoracic spine
 

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