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Diffusion-weighted imaging for predicting new compression fractures following percutaneous vertebroplasty

Background: Percutaneous vertebroplasty (PVP) is a technique that structurally stabilizes a fractured vertebral body. However, some patients return to the hospital due to recurrent back pain following PVP, and such pain is sometimes caused by new compression fractures. Purpose: To investigate whether the apparent diffusion coefficient (ADC) of adjacent vertebral bodies as assessed by diffusion-weighted imaging before PVP could predict the onset of new compression fractures following PVP. Material and Methods: 25 patients with osteoporotic compression fractures who underwent PVP were enrolled in this study. ADC was measured for 49 vertebral bodies immediately above and below each vertebral body injected with bone cement before and after PVP. By measuring ADC for each adjacent vertebral body, ADC was compared between vertebral bodies with a new compression fracture within 1 month and those without new compression fractures. In addition, the mean ADC of adjacent vertebral bodies per patient was calculated. Results: Mean preoperative ADC for the six adjacent vertebral bodies with new compression fractures was 0.55×10−3 mm2/s (range 0.36–1.01×10−3 mm2/s), and for the 43 adjacent vertebral bodies without new compression fractures 0.20×10−3 mm2/s (range 0–0.98×10−3 mm2/s) (P<0.001). Mean preoperative ADC for the six patients with new compression fractures was 0.55×10−3 mm2/s (range 0.21–1.01×10−3 mm2/s), and that for the 19 patients without new compression fractures 0.17×10−3 mm2/s (range 0.01–0.43×10−3 mm2/s) (P<0.001). Conclusion: The ADC of adjacent vertebral bodies as assessed by diffusion-weighted imaging before PVP might be one of the predictors for new compression fractures following PVP.