骨粗鬆症性脊椎圧迫骨折におけるMRI像と椎体変形の予後との関連

MRI Evaluation and Treatment of Osteoporotic Vertebral Compression Fracture

　抄録：われわれは，脊椎圧迫骨折と診断された症例のうちで治療に安静や体幹装具を要しないものが存在するかどうかについて検討した．対象は胸腰椎移行部における骨粗鬆症性脊椎圧迫骨折8症例10椎体である．いずれも，入院安静臥床や体幹装具の装着を拒否し，外来通院での経過観察のみを行った症例である．全例，疼痛発生後1週間以内に単純X線およびMRI検査を行った．最終経過観察時の椎体変形を単純X線像を用いて評価した．受傷早期の造影MRI矢状断像において造影効果が認められた部位は椎体圧潰の進行を認めず，増強効果が認められない部位では，椎体圧潰の進行を認めた．受傷早期の造影MRIを撮影することにより，最終経過観察時の椎体変形の予測が可能であった．この事実は，椎体変形予防の観点からみると，受傷早期のMRIで広範囲の造影効果を認める場合には，積極的治療を行わなくてもよい可能性があることを示唆していると考えられる．

　The purpose of this study was to investigate the relation between Gd-DTPA enhanced MRI findings and the prognosis of the fractured vertebral body in the patients with fresh osteoporotic compression vertebral fractures. Subjects were 8 cases, 11 vertebrae. All of the cases were treated with no bed rest and no corset. MRI and radiographs were taken within 1 week after injury. MRI signal intensity of the fractured vertebral body altered low on T1WI at acute phase. When the fractured vertebrae were enhanced at whole area with Gd-DTPA at acute phase, the vertebrae showed no progression of wedge deformity by follow up radiographs. On the other hand, when the fractured vertebrae were not enhanced at whole area, the vertebrae showed progression of wedge deformity. These findings suggests that vertebral fractures in osteoporosis should be taken MRI including GD-DTPA in acute phase after injury. When the fractured vertebrae are enhanced with Gd-DTPA in whole body at acute phase, the fracture may need no special treatment. In conclusion, Gd-DTPA enhanced MRI may be useful to determine the prognosis of the osteoporotic compression fracture.