Vertebral bone marrow edema in magnetic resonance imaging correlates with bone healing histomorphometry in (sub)acute osteoporotic vertebral compression fracture

• Published in: European spine journal Vol. 30; no. 9; pp. 2708 - 2717
• Main Authors: Zhang, Yun, Qi, Haoran, Zhang, Yefeng, Wang, Junning, Xue, Jingcai
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2021; Springer Nature B.V
• Subjects: Biopsy; Bone healing; Bone histomorphometry; Bone imaging; Bone marrow; Cancellous bone; Compression; Edema; Fractures; Light microscopy; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Osteoid; Osteoporosis; Surgical Orthopedics; Vertebrae; Bone histomorphometry; Osteoporotic vertebral compression fracture; Bone marrow edema
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-021-06814-3

Background BME on MRI has become the gold standard for the diagnosis of acute/subacute OVCF, but the correlation between the quantitative model of BME and histopathological manifestations of OVCF is rarely discussed in the literature. Objectives This study aimed to retrospectively investigate the relationship between bone marrow edema (BME) in magnetic resonance imaging (MRI) and bone healing histomorphometry in (sub)acute osteoporotic vertebral compression fracture. Methods According to the period since fracture, 125 patients were divided into four stages: stage I (0 to 15 days), stage II (16 to 30 days), stage III (31 to 60 days) and stage IV (61 to 90 days). Bone marrow edema was evaluated by the signal changes and intensity patterns on MRI sagittal images. Decalcified biopsy specimens were obtained from the cancellous bone core in the fractured vertebral body. The histomorphometry study results were analyzed by light microscopy using grid analysis and defined using bone histomorphometry criteria. Results There were 70 (56%) patients in stage I, 29 (23.2%) in stage II, 12 (9.6%) in stage III and 14 (11.2%) in stage IV. BME and histomorphometry characteristics differentiated from each other stage: The BME percentage had a significantly negative correlation with the ratio of osteoid volume/bone volume ( r  =  − 0.539, p  = 0.001) and the ratio of woven bone volume/tissue volume ( r  =  − 0.584, p  = 0.001). There was also a positive correlation between the BME percentage and the ratio of fibrous tissue volume/tissue volume ( r  = 0.488, p  = 0.001). Conclusions Bone marrow edema significantly correlates with bone morphology parameters after vertebral fracture. The characteristics of histomorphological changes during fracture healing process can be preliminarily determined by observing the edema signal.