Localizer sequences of magnetic resonance imaging accurately identify osteoporotic vertebral fractures

- This study has evaluated the accuracy of MR-localization sequences in the detection of vertebral fractures.
- MR-localization sequences are always performed before any MRI examination.
- Sagittal T1-weighted MR scans were defined as gold standard.
- MR-localizer proved to be an accurate tool for this purpose.

The aim of the present study was to evaluate the performance of sagittal MR localizer (MR-loc), in terms of diagnostic accuracy and intra- and inter-observer agreement in the detection of vertebral fractures (VFs). Three-hundred MR examinations of the thoracic and/or lumbar spine were randomly collected. A semi-quantitative approach was used and morphometric analysis was performed when a VF was suspected. MR-loc images were evaluated blindly by three radiologists in two different sessions. A full diagnostic sagittal T1-weighted fast spin echo MR sequence was used as standard of reference (RS). Degenerative arthritis was also scored on RS. Only vertebral bodies which were assessable by both MR-loc and RS were considered for the analysis. Area under the receiver operating characteristic curve (AUROC), Cohen kappa statistic, and linear-by-linear association were used for statistical analysis. Kappa values were compared by means of the z distribution.A total of 2186 vertebrae were analysed in 300 MRI exams (147 males, 153 females, 59.4 ± 16.4 y.o.). Sixty-seven out of 2136 (3.1%) VFs were identified in 23/300 (7.7%) patients submitted to MRI. In the detection of VFs, sensitivity and specificity of MR-loc were both 100% (accuracy AUROC = 1.000). Inter-observer agreement was excellent (k = 0.938 ± 0.013), while intra-observer agreement was perfect (k = 1.000). The diagnostic performance was independent from degenerative arthritis, vertebral level, type and grade of VFs.MR-loc is a simple but accurate tool in the detection of VFs. It should be introduced for systematic evaluation in the detection of VFs in MR examinations performed in daily clinical practice.