ABSENT BONE MARROW EDEMA ON MRI IMAGING IN A PATIENT WITH ACUTE VCF. IMPLICATIONS FOR VERTEBRAL AUGMENTATION THERAPY.

Abstract 

 
Bone marrow edema seen on MRI imaging has been the most important determinant of the acuity of vertebral compression fractures (VCF). The decision to offer patients vertebral augmentation procedures (balloon kyphoplasty or vertebroplasty) is usually made based on the estimated age of the fracture, with acute or sub-acute fractures being the most amenable to successful treatment. We present the case of the absent bone marrow edema in a multiple myeloma patient with acute vertebral compression fracture. Heightened clinical suspicion and availability of prior imaging made the difference in this patient’s case. Given the potential benefit that patients may derive from timely minimally invasive intervention, this case draws attention to the growing number of instances where acute vertebral compression fractures do not present in the usual fashion, with bone marrow edema seen on MRI imaging. This can lead to the misdiagnosis of VCF and consequently, deprive patients of effective and life-changing treatment.