La morfometria vertebrale

La morfometria vertebrale è una metodica di misurazione delle altezze vertebrali  per la diagnosi quantitativa delle fratture  vertebrali da osteoporosi 

Le fratture vertebrali sono le più comuni fratture da osteoporosi sia in Europa  che negli USA, interessando il 25% delle donne oltre i 50 anni.
L’identificazione delle fratture vertebrali ha un elevato valore prognostico nella gestione del paziente osteoporotico, perché pazienti con una  frattura vertebrale, anche se di lieve entità,  hanno aumentato di circa 5 volte il rischio per ulteriori fratture vertebrali e di 3 volte il rischio per fratture dell’anca.
Fratture vertebrali multiple sono associate con un aumentato tasso di mortalità e con una ridotta qualità di vita.

La morfometria vertebrale viene comunemente effettuata sulle radiografie della colonna vertebrale  dorsale e lombare che espongono il paziente ad una non irrilevante dose di radiazioni : circa 600 µSv (micro Sievert) solo per la proiezione laterale che aumenta a circa 2000 µSv se viene eseguita anche la proiezione antero-posteriore.

Le immagin radiologiche tradizionali (non acquisite digitalmente) devono essere analizzate da un radiologo esperto secondo il metodo semiquantitativo proposto da Genant  il quale misura l’altezza anteriore, posteriore e media dei corpi vertebrali del tratto dorsale e lombare del rachide. Se almeno una di queste tre altezze risulta del 15% o di 4 mm INFERIORE rispetto a quella delle vertebre adiacienti, allora la frattura risulta essere morfometricamente documentata.La gravità delle deformità vertebrali viene identificata dall’indice semiquantitativo (ISQ) e dall’entità in gradi della riduzione delle altezze (vedi tabella di Genant sottostante). 

La morfometria vertebrale può essere eseguita , sempre su immagini in proiezione laterale, manualmente mediante comune righello oppure in modo computerizzato attraverso la digitalizzazione dell’immagine tradizionale (MRX); in questo secondo caso l’analisi morfometrica utilizza indici quantitativi che mediante l’analisi dei rapporti tra le altezze dei corpi vertebrali permette di valutare con maggiore precisione le deformità somatiche.  


Figura sovrastante – La morfometria vertebrale è una metodica di misura del profilo del corpo vertebrale che viene eseguita su radiografie in proiezione laterale del rachide dorsolombare. Per ogni corpo vertebrale vengono individuati 6 punti che permettono la definizione delle altezze anteriore (Ha), intermedia (Hm) e posteriore (Hp) del corpo vertebrale. 

Morfometria vertebrale con tecnica assorbimetrica a raggi X a doppia energia (DXA) per la valutazione delle fratture vertebrali da osteoporosi (VFA)
La VFA (Vertebral Fracture Assessment ) è una nuova metodica che consente la diagnosi delle fratture vertebrali da osteoporosi con una  esposizione alle radiazioni molto più bassa rispetto alla radiologia convenzionale paria circa 30 µSv 
Ciò è possibile perché la VFA viene effettuata con i densitometri di ultima generazione, che grazie ai recenti progressi della tecnologia  assorbimetrica a doppia energia (DXA) sono in grado di acquisire immagini in proiezione laterale della colonna  vertebrale con buona risoluzione spaziale per la diagnosi delle fratture vertebrali.     
                                                                    

Una volta acquisita l’immagine della colonna vertebrale, uno specifico software consente di effettuare automaticamente la morfoemetria vertebrale identificando in maniera oggettiva e con elevata sensibilità anche le fratture vertebrali lievi. 

   
               
Quindi con lo stesso densitometro nella stessa seduta possono essere effettuate sia la MOC, cioè misura della densità ossea, che la VFA, cioè  la diagnosi delle fratture vertebrali. 
Ciò è molto importante per la valutazione del paziente osteoporotico perché la maggior parte delle fratture vertebrali sono lievi ed asintomatiche per cui non vengono diagnosticate perché le radiografie,  a causa dell’alta esposizione alle radiazioni, vengono spesso  richieste solo in pazienti sintomatici, cioè con dolore alla schiena.

Inoltre considerata la basse dose di esposizione alle radiazioni (<30 µSv) con la tecnica DXA è possibile effettuare la morfometria vertebrale durante il follow up del paziente osteoporotico con la stessa frequenza della densitometria ossea.

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