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Figures for:
Diagnosis of Osteoporotic Vertebral Fractures: Importance of Recognition and Description by Radiologists

[Am J Roentgenol 183(4):949-958, 2004. © 2004 American Roentgen Ray Society]


Figure 1. Drawings show diagnosis and grading of vertebral fractures using semiquantitative method.[60] Vertebral fracture is diagnosed when reduction of height in anterior, middle, or posterior dimension of vertebral body exceeds 20%. Approximate degree of height reduction determines assignment of grade to vertebra. Fractures are classified as wedge, biconcave, or crush, depending on whether anterior, middle, or posterior portion of vertebral body is most diminished in height.

Figure 2a. Pitfalls in diagnosing vertebral fractures. In all examples, note presence of endplate deformities, lack of parallelism of endplates, or altered appearance compared with neighboring vertebrae. Lateral radiograph of lumbar spine shows mild wedge fracture (grade 1) of L3 vertebra.

Figure 2b. Pitfalls in diagnosing vertebral fractures. In all examples, note presence of endplate deformities, lack of parallelism of endplates, or altered appearance compared with neighboring vertebrae. Lateral radiograph of lumbar spine shows moderate wedge fracture (grade 2) of L3 vertebra and moderate crush fracture (grade 2) of L2 vertebra.

Figure 2c. Pitfalls in diagnosing vertebral fractures. In all examples, note presence of endplate deformities, lack of parallelism of endplates, or altered appearance compared with neighboring vertebrae. Lateral radiograph of thoracic spine shows severe wedge fracture (grade 3) of T7 vertebra.

Figure 3a. Pitfalls in diagnosing vertebral fractures. Oblique radiograph of thoracic spine shows apparent wedge fracture.

Figure 3b. Pitfalls in diagnosing vertebral fractures. Lateral radiograph shows normal vertebral shape.

Figure 4a. Abnormalities in vertebral shape mimicking fracture. Lateral radiograph of lumbar spine shows deformity of inferior endplates that may mimic vertebral fracture.

Figure 4b. Abnormalities in vertebral shape mimicking fracture. Frontal radiograph in same individual shows cupid's bow deformity, a developmental variant.

Figure 5. Abnormalities in vertebral shape mimicking fracture. Lateral radiograph of lumbar spine shows limbus L4 vertebra, a developmental variant.

Figure 6. Abnormalities in vertebral shape mimicking fracture. Lateral radiograph of thoracic spine shows H-shaped vertebrae in patient with sickle cell disease.

Figure 7. Abnormalities in vertebral shape mimicking fracture. Lateral radiograph of lumbar spine shows Schmorl nodes at inferior endplates of L2 and L3 vertebrae.

Figure 8. Abnormalities in vertebral shape mimicking fracture. Lateral radiograph of thoracic spine shows endplate irregularity and vertebral wedging characteristic of Scheuermann's disease.

Figure 9a. Differentiating acute and old fractures. Lateral radiograph of lumbar spine shows acute vertebral fracture. Note impaction of trabeculae.

Figure 9b. Differentiating acute and old fractures. Lateral radiograph of lumbar spine shows old vertebral fracture. Note that fractured vertebra appears similar in density to adjacent nonfractured vertebra.

Figure 10a. Lack of edema on MR images indicating old fracture. A Sagittal T1-weighted (A) and T2-weighted fat-suppressed (B) MR images show old L1, L2, and L3 vertebral wedge fractures. Note isointensity of fractured vertebrae compared with nonfractured L4 vertebra.

Figure 10b. Lack of edema on MR images indicating old fracture. B Sagittal T1-weighted (A) and T2-weighted fat-suppressed (B) MR images show old L1, L2, and L3 vertebral wedge fractures. Note isointensity of fractured vertebrae compared with nonfractured L4 vertebra.

Figure 11a. Lack of radiopharmaceutical uptake on bone scan idicating old fracture. Radionuclide bone scan shows no increase in uptake in lumbar spine.

Figure 11b. Lack of radiopharmaceutical uptake on bone scan idicating old fracture. Lateral radiograph shows old mild biconcave fracture of L2.

Figure 12a. Bone scanning for determining age of fracture. Radionuclide bone scan shows uptake in L2 vertebra that may indicate acute or subacute fracture.

Figure 12b. Bone scanning for determining age of fracture. Lateral radiograph shows severe crush fracture of L2.

Figure 13a. MRI for determining age of fracture. MR images show acute wedge fractures of T12 and L1 and old wedge fracture of L2. T1-weighted image shows that acutely fractured T12 and L1 vertebrae have lower signal intensity than chronically fractured L2 vertebra.

Figure 13b. MRI for determining age of fracture. MR images show acute wedge fractures of T12 and L1 and old wedge fracture of L2. T1-weighted fat-suppressed image obtained after administration of contrast agent shows enhancement in T12 and L1 vertebrae but no enhancement of L2 vertebra.

Figure 14a. Alternative to radiography for diagnosing vertebral fractures. Lateral dual-energy X-ray absorptiometry image shows mild thoracic wedge fracture.

Figure 14b. Alternative to radiography for diagnosing vertebral fractures. Lateral radiograph of thoracic spine confirms fracture seen in A.