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From Detection to Decision: T-Score-Guided Use of STIR MRI After CT in Vertebral Fractures
Lior Yehuda Fitoussi1, Árpád Viola1,2, Siran Aslan1,3
1Department of Neurotraumatology, Semmelweis University, 1081 Budapest, Hungary.
Abstract:
Background/Objectives: Vertebral fractures are frequently underdiagnosed after minor trauma in patients with normal or mildly reduced bone mineral density (BMD). CT, the standard first-line imaging, may miss subtle fractures, while STIR MRI is more sensitive but not routinely applied. We evaluated whether DEXA-derived T-scores can guide selective use of STIR MRI in patients > 50 years. Methods: We retrospectively analyzed 214 patients who underwent CT, sagittal whole-spine STIR MRI, and DEXA within 48 h after minor trauma. Fracture counts were compared using the Wilcoxon signed-rank test. Spearman's correlation examined associations between T-score and fracture counts. Subgroups were defined as normal (≥-1), osteopenia (-2.5 < T-score < -1), osteoporosis (-3.5 < T-score ≤ -2.5), and high-risk osteoporosis (≤-3.5). Results: STIR MRI identified more fractures than CT in 87 patients (40.7%), while CT detected more in 19 (8.9%) (p < 0.0001). MRI outperformed CT across all T-score categories. The osteopenia group had the highest number of additional fractures (n = 53), and even patients with normal BMD showed a notable yield (n = 36). Correlations between T-score and fracture counts were weak and not statistically significant. Conclusions: T-score can support imaging triage but should not be used as a strict threshold. STIR MRI is justified in patients with T-scores < -2.5 when clinical suspicion exists and should be considered in those with higher T-scores if CT is negative but symptoms persist. Integrating T-score into imaging protocols may reduce missed fractures and improve outcomes.
Insights
STIR MRI detects more vertebral fractures than CT, even in patients with normal bone density. T-scores can guide imaging but shouldn
Area of Science:
- Radiology
- Orthopedics
- Bone Health
Background:
- Vertebral fractures are often missed after minor trauma, especially in patients with normal or low bone mineral density (BMD).
- Computed tomography (CT) is standard but may miss subtle fractures; STIR MRI is more sensitive but not routinely used.
- Evaluating T-scores to guide STIR MRI use in patients over 50 is crucial for improving diagnosis.
Purpose of the Study:
- To assess if DEXA-derived T-scores can guide the selective use of STIR MRI for detecting vertebral fractures after minor trauma in patients > 50 years.
- To compare the fracture detection rates of CT and STIR MRI across different bone mineral density categories.
Main Methods:
- Retrospective analysis of 214 patients who underwent CT, sagittal whole-spine STIR MRI, and DEXA within 48 hours of minor trauma.
- Comparison of fracture counts between CT and STIR MRI using Wilcoxon signed-rank test; Spearman's correlation for T-score and fracture association.
- Patients categorized into normal (≥-1), osteopenia (-2.5 < T-score < -1), osteoporosis (-3.5 < T-score ≤ -2.5), and high-risk osteoporosis (≤-3.5) subgroups.
Main Results:
- STIR MRI identified significantly more fractures than CT (87 vs. 19 patients, p < 0.0001), outperforming CT across all T-score categories.
- The osteopenia group showed the most additional fractures on MRI (n=53), but even patients with normal BMD had a notable yield (n=36).
- Correlations between T-score and fracture counts were weak and not statistically significant, indicating T-score limitations.
Conclusions:
- T-scores can aid imaging triage but should not be a strict threshold for STIR MRI use.
- STIR MRI is justified for T-scores < -2.5 with clinical suspicion and should be considered for higher T-scores if CT is negative and symptoms persist.
- Integrating T-scores into imaging protocols may reduce missed vertebral fractures and improve patient outcomes.
