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. 2009 Dec;46(6):528-31.
doi: 10.3340/jkns.2009.46.6.528. Epub 2009 Dec 31.

Enhancing box sign : enhancement pattern of acute osteoprotic compression fracture

Choong-Hyo Kim  1 , Jae Hyo Park, Sang Ki Chung, Ki-Jeong Kim, Jae Seung Bang, Hyun-Jib Kim
Affiliations

Enhancing box sign : enhancement pattern of acute osteoprotic compression fracture

Choong-Hyo Kim et al. J Korean Neurosurg Soc. 2009 Dec.

Abstract

Objective: Although gadolinium enhancement of compression fractures is well known, the enhancement pattern of the acute stage of a fracture is not completely understood. Here, we investigated the enhancement pattern of acute vertebral compression fractures (VCFs).

Methods: We conducted a retrospective study of patients with acute osteoporotic VCFs admitted to hospital between January 2004 and December 2005. The demographic details, stage of the fracture, management data, and results were analyzed. There were nine men and 22 women, and the mean age was 71 years (range, 53-92 years). According to the onset of pain, patients were divided into the following four groups : Group I (less than 3 days), Group II (4-7 days), Group III (8-14 days), and Group IV (14-30 days).

Results: All patients had central low-signal intensity of the nonenhancing part of vertebral bodies on T1 images. Enhancing box sign (EBS) was seen 7 days of VCF development. After 7 days of onset (Groups III and IV), patch or Kummell's enhancements occurred. EBS has been statistically correlated with stage of compression fracture (Pearson's correlation = -0.774). However, EBS had no statistically significant correlation with prognosis in our study (Pearson's correlation = 0.059).

Conclusion: EBS represents a characteristic sign 7 days of VCF development.

Keywords: Compression fracture; Gadolinium; Magnetic resonance imaging.

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Figures

Fig. 1
Fig. 1
Classification of the enhancement pattern of vertebral compression fracture on sagittal fat-suppressed T1-weighted imaging. A : Enhancing box sign, B : patch enhancement, C : Kummell's enhancement.
Fig. 2
Fig. 2
The enhancement pattern of acute vertebral compression fracture according to the onset of pain. KE : Kummell's enhancement, PE : patch enhancement, EBS : Enhancing box sign.
See this image and copyright information in PMC

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