Comparison of computed tomographic and magnetic resonance imaging in fracture healing after spinal injury

Study design: Single-centre, prospective (comparative cohort) clinical study, with ethical approval and patient consent. Objective: Confirmation of vertebral fracture union can pose significant challenges for clinicians in the management of spinal cord injury and in the decisions around patient mobilization. Bony union is usually assessed with computed tomography (CT). This study hypothesizes that magnetic resonance imaging (MRI) can identify vertebral bone union. Setting: A major spinal injuries unit in the United Kingdom. Method: Patients underwent CT and MRI at 12 weeks post-injury, if conservatively managed, or 12 weeks post-fixation. With CT as the gold standard, the MRI scans were reviewed blind to the CT result and indicators for fracture healing were compared. Results: A total of 35 patients with 55 fractures were imaged. Comparison of CT and MRI showed sensitivity of 88%, specificity of 100% and positive predictive value of 100% for fracture union imaged with MRI using CT as the gold standard. Conclusion: MRI correlates well with CT in identifying vertebral fracture union and non-union. We suggest that where imaging is indicated in the assessment of vertebral body fracture healing MRI can be used routinely with CT reserved for problematic or inconclusive cases. Spinal Cord (2009) 47, 874-877; doi:10.1038/sc.2009.59; published online 16 June 2009