Multiple chronic compression deformities

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Clinical History:
An unfortunate 83-year-old lady with severe degenerative spine disease, a history of multiple compression fractures and prior vertebroplasty of L2, presenting once again with intractable back pain

Diagnosis:
Multiple chronic compression deformities, with an acute compression fracture of L4

MR Technique:
4 mm sagittal pre-contrast FSE (3 echoes) T1- and FSE (15 echoes) T2-weighted images are presented, acquired at 1.5 T on a Siemens Espree MR system. Sequence parameters were TR/TE = 665/9.8 and 3130/94 respectively. Scan times were 3:35 and 3:34 min:sec.

Imaging Findings:
Prior vertebroplasty at L2 is noted, with the bone cement visualized as very low signal intensity (black) on all pulse sequences. There is prominent loss of vertebral body height, representing chronic compression fractures, of the T11, T12, and L1 vertebral bodies. There is moderate loss of height of L2 and L4. There is mild loss of height of L3 and L5. The marrow is high signal intensity on T1-weighted images, within all visualized vertebral bodies (other than L4, and the vertebroplasty in L2), without evidence of edema (to indicate additional acute vertebral body compression fractures).

Within the lower half of L4, there is a prominent linear area of low signal intensity seen on the T1-weighted scan. Note that this is not an absence of signal intensity, and is different than the appearance of the vertebroplasty in L2. This finding represents edema and specifically an acute compression fracture, which was confirmed on the T2-weighted scan with fat saturation (not shown). The T2-weighted scan presented was acquired without fat saturation, making identification of edema extremely difficult, and thus being a scan of lower diagnostic value. This case emphasizes the importance of T2-weighted scans with fat saturation, or STIR, for visualization and confirmation of vertebral body edema.