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Seyam O, Cardoso FN, Bysani S, Constantin B, Pretell-Mazzini J, Subhawong T. Pseudolesions involving bone and soft tissue regarding orthopedic oncology. Acta Radiol 2024:2841851241248141. [PMID: 38755948 DOI: 10.1177/02841851241248141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Pseudolesions in bone and muscle are encountered mostly incidentally in routine imaging studies, especially due to the recent advancements on many different imaging modalities. These lesions can be categorized into the following categories: normal variants; congenital; iatrogenic; degenerative; and postoperative. In this review, we discuss the many different radiological characteristics of musculoskeletal pseudolesions that appear on imaging, which can prevent non-essential additional studies.
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Affiliation(s)
- Omar Seyam
- Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Fabiano N Cardoso
- Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Suhitha Bysani
- Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Bianca Constantin
- Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Juan Pretell-Mazzini
- Division of Orthopedic Oncology, Baptist Health System South FL, Miami Cancer Institute, Plantation, FL, USA
| | - Ty Subhawong
- Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
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2
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Rodríguez-Laval V, Lumbreras-Fernández B, Aguado-Bueno B, Gómez-León N. Imaging of Multiple Myeloma: Present and Future. J Clin Med 2024; 13:264. [PMID: 38202271 PMCID: PMC10780302 DOI: 10.3390/jcm13010264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Multiple myeloma (MM) is the second most common adult hematologic malignancy, and early intervention increases survival in asymptomatic high-risk patients. Imaging is crucial for the diagnosis and follow-up of MM, as the detection of bone and bone marrow lesions often dictates the decision to start treatment. Low-dose whole-body computed tomography (CT) is the modality of choice for the initial assessment, and dual-energy CT is a developing technique with the potential for detecting non-lytic marrow infiltration and evaluating the response to treatment. Magnetic resonance imaging (MRI) is more sensitive and specific than 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for the detection of small focal lesions and diffuse marrow infiltration. However, FDG-PET/CT is recommended as the modality of choice for follow-up. Recently, diffusion-weighted MRI has become a new technique for the quantitative assessment of disease burden and therapy response. Although not widespread, we address current proposals for structured reporting to promote standardization and diminish variations. This review provides an up-to-date overview of MM imaging, indications, advantages, limitations, and recommended reporting of each technique. We also cover the main differential diagnosis and pitfalls and discuss the ongoing controversies and future directions, such as PET-MRI and artificial intelligence.
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Affiliation(s)
- Víctor Rodríguez-Laval
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
- Department of Medicine, Autonomous University of Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Blanca Lumbreras-Fernández
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
| | - Beatriz Aguado-Bueno
- Department of Hematology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain;
| | - Nieves Gómez-León
- Department of Radiology, University Hospital La Princesa, IIS-Princesa, Calle Diego de León 62, 28005 Madrid, Spain; (B.L.-F.); (N.G.-L.)
- Department of Medicine, Autonomous University of Madrid, Calle del Arzobispo Morcillo 4, 28029 Madrid, Spain
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3
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Liang J, Huang WS, Lan WZ, Li Y, Xu JH. 18 F-FDG PET/CT of a Rare Sternal Osteoblastoma in a Man With History of Lymphoma. Clin Nucl Med 2023; 48:324-326. [PMID: 36716503 DOI: 10.1097/rlu.0000000000004585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
ABSTRACT A 27-year-old man, with a history of non-Hodgkin lymphoma 8 years ago, was admitted due to 9 months of persistent sternal pain. Chest CT revealed a mass in the sternum. 18 F-FDG PET/CT was performed, demonstrating a radioactive accumulation mass in the sternum, accompanied by massive osteogenesis and osteolysis. Histological and immunohistochemical analysis of ultrasound-guided fine-needle aspiration biopsy samples confirmed the diagnosis of aggressive osteoblastoma. We present a rare case of aggressive sternal osteoblastoma, instead of lymphoma recurrence, on 18 F-FDG PET/CT in an adult with history of lymphoma.
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Affiliation(s)
| | | | | | - Yong Li
- Department of Interventional Medical Center, Zhuhai Hospital Affiliated With Jinan University (Zhuhai People's Hospital), Zhuhai, China
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Ong W, Zhu L, Tan YL, Teo EC, Tan JH, Kumar N, Vellayappan BA, Ooi BC, Quek ST, Makmur A, Hallinan JTPD. Application of Machine Learning for Differentiating Bone Malignancy on Imaging: A Systematic Review. Cancers (Basel) 2023; 15:cancers15061837. [PMID: 36980722 PMCID: PMC10047175 DOI: 10.3390/cancers15061837] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
An accurate diagnosis of bone tumours on imaging is crucial for appropriate and successful treatment. The advent of Artificial intelligence (AI) and machine learning methods to characterize and assess bone tumours on various imaging modalities may assist in the diagnostic workflow. The purpose of this review article is to summarise the most recent evidence for AI techniques using imaging for differentiating benign from malignant lesions, the characterization of various malignant bone lesions, and their potential clinical application. A systematic search through electronic databases (PubMed, MEDLINE, Web of Science, and clinicaltrials.gov) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 34 articles were retrieved from the databases and the key findings were compiled and summarised. A total of 34 articles reported the use of AI techniques to distinguish between benign vs. malignant bone lesions, of which 12 (35.3%) focused on radiographs, 12 (35.3%) on MRI, 5 (14.7%) on CT and 5 (14.7%) on PET/CT. The overall reported accuracy, sensitivity, and specificity of AI in distinguishing between benign vs. malignant bone lesions ranges from 0.44–0.99, 0.63–1.00, and 0.73–0.96, respectively, with AUCs of 0.73–0.96. In conclusion, the use of AI to discriminate bone lesions on imaging has achieved a relatively good performance in various imaging modalities, with high sensitivity, specificity, and accuracy for distinguishing between benign vs. malignant lesions in several cohort studies. However, further research is necessary to test the clinical performance of these algorithms before they can be facilitated and integrated into routine clinical practice.
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Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Correspondence: ; Tel.: +65-67725207
| | - Lei Zhu
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Yi Liang Tan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Ee Chin Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Beng Chin Ooi
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Chalamgari A, Valle D, Palau Villarreal X, Foreman M, Liu A, Patel A, Dave A, Lucke-Wold B. Vertebral Primary Bone Lesions: Review of Management Options. Curr Oncol 2023; 30:3064-3078. [PMID: 36975445 PMCID: PMC10047554 DOI: 10.3390/curroncol30030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The assessment and treatment of vertebral primary bone lesions continue to pose a unique yet significant challenge. Indeed, there exists little in the literature in the way of compiling and overviewing the various types of vertebral lesions, which can often have complicated intervention strategies. Given the severe consequences of mismanaged vertebral bone tumors-including the extreme loss of motor function-it is clear that such an overview of spinal lesion care is needed. Thus, in the following paper, we aim to address the assessment of various vertebral primary bone lesions, outlining the relevant nonsurgical and surgical interventional methods. We describe examples of primary benign and malignant tumors, comparing and contrasting their differences. We also highlight emerging treatments and approaches for these tumors, like cryoablation and stereotactic body radiation therapy. Ultimately, we aim to emphasize the need for further guidelines in regard to correlating lesion type with proper therapy, underscoring the innate diversity of vertebral primary bone lesions in the literature.
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Affiliation(s)
| | | | | | | | | | | | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32601, USA
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6
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A Combined Scoring Method Based on 18F-FDG PET/CT for Distinguishing Spinal Infection From Malignancy. Spine (Phila Pa 1976) 2023; 48:270-277. [PMID: 36692156 DOI: 10.1097/brs.0000000000004528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE This study aimed to explore the additional value of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for the detection of early-stage and atypical spinal infections and to find the best combination of indicators from laboratory and imaging systems for higher diagnostic efficiency. SUMMARY OF BACKGROUND DATA Diagnosis of early-stage and atypical spinal infections may be challenging for clinicians. It is particularly important to distinguish spinal infection from malignancy to develop a timely treatment strategy and avoid unnecessary biopsy or surgery. MATERIALS AND METHODS All patients with a discharge diagnosis of spinal infection or malignancy who underwent 18F-FDG PET/CT scans before spinal biopsy between January 1, 2014, and July 30, 2021, were included. Laboratory and imaging data were assessed. A receiver operating characteristic (ROC) curve was created, and the best cut-off point and cumulated area under the curve (AUC) were obtained to distinguish between spinal infection and malignancy. Kappa values were used to assess the agreement between the 18F-FDG PET/CT and MRI findings. Binary logistic regression was used to screen for statistically significant indicators and imaging findings. RESULTS A total of 71 patients with confirmed spinal infections (n=30) or malignancies (n=41) were included in this study. Elevated ESR and significantly elevated tumor biomarkers or positive FLCs assay were significantly different between the two groups. In addition to the total lesion glycolysis of the involved vertebral bodies derived from 18F-FDG PET/CT, four imaging findings (consecutive multilevel vertebral lesions, intervertebral disc, vertebral arch, and extraspinal involvement) also showed significant differences between the two groups (P≤0.010). A combined scoring method based on the above seven indicators was designed with an overall classification accuracy of 95.2%, and it identified all patients with spinal infections (100%, 28/28). In addition, moderate-to-excellent agreement could be reached for the involvement of intervertebral discs, paravertebral soft tissues, and vertebral arches derived from MRI and18F-FDG PET/CT. CONCLUSIONS The combined scoring method based on 18F-FDG PET/CT provided excellent overall accuracy in distinguishing spinal infections from malignancies. This approach may prove useful for patients with MRI contraindications or with equivocal results following laboratory tests or traditional imaging when there is high suspicion for spinal infections or malignancy.
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Lange N, Jörger AK, Ryang YM, Liesche-Starnecker F, Gempt J, Meyer B. Primary Bone Tumors of the Spine—Proposal for Treatment Based on a Single Centre Experience. Diagnostics (Basel) 2022; 12:diagnostics12092264. [PMID: 36140664 PMCID: PMC9498005 DOI: 10.3390/diagnostics12092264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
This study reports a large single-center series of primary bone tumors of the spine (PBTs). We aimed to review the concepts for management, as this kind of tumor represents a very rare entity, and also propose a new treatment algorithm. Retrospective analysis revealed 92 patients receiving surgery for PBTs from 2007 to 2019 at our center. They were analyzed based on surgical management and the course of the disease. A total of 145 surgical procedures were performed (50 cervical, 46 thoracic, 28 lumbar, and 21 sacral). Complete tumor resection was achieved in 65%, of which 22% showed tumor recurrence during follow-up (mean time to recurrence 334 days). The five-year mortality rate was significantly lower after complete resection (3% versus 25% after subtotal resection). Most of the patients improved in their symptoms through surgery. Regarding the tumor entity, the most common PBTs were vertebral hemangiomas (20%), osteoid osteomas (15%), and chordomas (16%). The Enneking graduation system showed a good correlation with the risk of recurrence and mortality. Complete resection in PBTs increased survival rates and remains the method of choice. Thus, quality of life—especially with a higher extent of resection—should be considered.
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Affiliation(s)
- Nicole Lange
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
- Correspondence:
| | - Ann-Kathrin Jörger
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany
| | | | - Jens Gempt
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
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8
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Monroy D, Garcia J, Zarate SD, Belzarena AC. Displaced humeral pathological fracture secondary to intraosseous hemangioma. Radiol Case Rep 2022; 17:1609-1613. [PMID: 35313567 PMCID: PMC8933724 DOI: 10.1016/j.radcr.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 10/30/2022] Open
Abstract
Intraosseous hemangiomas are uncommon slow-growing benign bone tumors. Most of these lesions are located in the spine or skull and long bone location is rare. Here we present the case of a 63-year-old female with a pathological fracture of the left proximal humerus through an intraosseous hemangioma. Imaging features can be highly unspecific when these tumors are found in the long bones. In this case a pathological fracture obscured the diagnosis even further, prompting the need for tissue sampling to exclude an underlying malignancy.
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9
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Devaraj A, Raoof J, Janjua O, Tsang K, Zamir M. Sudden perceived absence of foetal movement - a unique presentation of a vertebral haemangioma in pregnancy. BJR Case Rep 2022; 8:20200199. [PMID: 35136631 PMCID: PMC8803233 DOI: 10.1259/bjrcr.20200199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 08/28/2021] [Accepted: 10/11/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Symptomatic vertebral haemangiomas that present during pregnancy are extremely uncommon with few cases reported in literature. Epidural haemangiomas are rarer still with few documented. METHODS In this report, we describe the case of a 22-year-old pregnant patient who presented with apparent loss of foetal movement at 38 weeks' gestation. Clinical review demonstrated the foetus was well but neurological examination revealed lower limb paresthesia, paresis and evident uterine hypoesthesia. An MRI scan illustrated a haemangioma in the T1 vertebral body with an epidural component causing cord compression. RESULTS The management of spinal haemangiomas that present during pregnancy is a complex clinical scenario, which requires careful multidisciplinary consideration to determine if surgical intervention is appropriate. In this case, the patient had an emergency caesarean section followed by posterior decompression and laminectomy of the T1 vertebra with excellent post-operative recovery. CONCLUSION Gestational increase in the size of vertebral haemangiomas is well documented. We discuss a rare case in which a young pregnant patient presents with an atypical symptom of a vertebral haemangioma (uterine hypoesthesia). This case highlights the importance of prompt imaging in these scenarios and a cohesive multidisciplinary approach in order to provide optimal treatment for the patient.
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Affiliation(s)
- Ankitha Devaraj
- Watford General Hospital, West Hertfordshire NHS Trust, Vicarage Road, Watford, Hertfordshire, United Kingdom
| | - Jamaal Raoof
- Lincoln County Hospital, Greetwell Road, Lincoln, Lincolnshire, UK
| | - Osman Janjua
- University Hospital Monklands, Monkscourt Avenue, Airdrie, UK
| | - Kevin Tsang
- St Mary’s Hospital, Praed Street, London, UK
| | - Muhammad Zamir
- Watford General Hospital, West Hertfordshire NHS Trust, Vicarage Road, Watford, Hertfordshire, United Kingdom
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10
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Khan NU, Lin J, Younas MR, Liu X, Shen L. Synthesis of gold nanorods and their performance in the field of cancer cell imaging and photothermal therapy. Cancer Nanotechnol 2021. [DOI: 10.1186/s12645-021-00092-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractCancer is one of the most common incident in the world, with malignant tumors having a death rate of up to 19%. A new method of treating cancer cells effectively with minimal cytotoxicity is needed. In the field of biomedicine with unique shape-dependent optical properties, gold nanorods (GNRs) have attracted worldwide interest. These nanorods have two distinct plasmon bands. One is transverse plasmon band in the area of visible light, and the other is longitudinal band of plasmons in near infrared region. These specific characters provide promise for the design of new optically active reagents that simultaneously perform light-mediated imaging and photothermal cancer treatment. We begin our review by summarizing the latest developments in gold nanorods synthesis with a focus on seed-mediated growth method. Nanorods spontaneous self-assembly, polymer-based alignment and its applications as a novel agent for simultaneous bioimaging and photothermal cancer therapy are listed in particular.
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Covino M, Vitiello R, De Matteis G, Bonadia N, Piccioni A, Carbone L, Zaccaria R, Cauteruccio M, Ojetti V, Franceschi F. Hip Fracture Risk in Elderly With Non-End-Stage Chronic Kidney Disease: A Fall Related Analysis. Am J Med Sci 2021; 363:48-54. [PMID: 34256032 DOI: 10.1016/j.amjms.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/15/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the risk of fracture as a consequence of trauma and its association with kidney function status in a cohort of elderly patients. METHODS This is an observational, cross-sectional study. We evaluated all fall-related trauma of patients ≥ 65 years in the emergency department (ED) between 2016 and 2018. According to CDK-EPI formula, we stratified the study population in different stages of chronic kidney disease (CKD) for glomerular filtrate rate (GFR) ≥ 15 and < 60, not on hemodialysis. The hip fracture rate was adjusted at multivariate analysis for age, sex, comorbid conditions, and CKD status. RESULTS We enrolled 5620 patients: 3482 patients had GFR ≥60, 1045 had GFR ≥45 and <60, 722 had GFR ≥30 and <45, and 371 had GFR ≥15 and <30. We recorded 636 (11.3%) hip fractures. After adjusting for significant covariates (age, sex, known osteoporosis, osteoporosis therapy, anemia, and dementia), patients with GFR ≥ 45 and <60 and GFR ≥30 and <45 exhibited an increased risk of femur fracture (odds ratio 2.01 [1.36-2.97] and 1.64 [1.08-2.48], respectively). Patients with GFR ≥15 and <30 had a higher risk of fracture, although not reaching statistical significance. CONCLUSIONS Our study confirms that patients with non-end stage CKD have an increased risk of femur fracture after a fall. Our data supports the hypothesis that this risk could be associated with increased bone fragility in CKD patients. Active osteoporosis therapy was found to be an effective preventive factor in our cohort.
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Affiliation(s)
- Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Raffaele Vitiello
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giuseppe De Matteis
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicola Bonadia
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Andrea Piccioni
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Luigi Carbone
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Raffaella Zaccaria
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | - Michele Cauteruccio
- Department of Orthopedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Veronica Ojetti
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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12
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Razek AAKA, Taman S, Gamal W, El Ayouty M, Ali KM, Barakat TE. Diffusion tensor imaging of vertebral bone marrow in children with Gaucher's disease type I and III: Pre- and post-therapy. Clin Imaging 2021; 79:207-212. [PMID: 34116297 DOI: 10.1016/j.clinimag.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess diffusion tensor imaging (DTI) of the vertebral bone marrow (BM) in children with Gaucher's disease (GD) types I and III before and after therapy. METHODS Prospective study was conducted upon 25 children with GD type I (n = 17) and III (n = 8) and 13 age and sex-matched controls underwent DTI of vertebral BM. Mean diffusivity (MD) and fractional anisotropy (FA) of vertebral BM was calculated and correlated with genotyping, chitotriosidase, hemoglobin (HB) and, platelet count. RESULTS There was a statistically significant difference in MD and FA of BM between patients and controls (P = 0.001 and 0.02). The area under the curve (AUC) of MD and FA used to differentiate untreated patients from controls was 0.902 and 0.68 with sensitivity, specificity, and, accuracy 92%, 84.6%, and, 89.5% respectively. There was a significant difference in MD and FA of BM between untreated and treated patients (P = 0.001 and 0.02). AUC of MD and FA used to differentiate untreated from treated patients was 0.93 and 0.649 with sensitivity, specificity, and accuracy of 92%, 80%, and 86% respectively. There was a significant difference in MD and FA (P = 0.03, 0.001 respectively) of BM in GD with homozygous L444P mutation (n = 9) and other mutations (n = 14). Chiotriptase, HB and platelet count of patients was correlated with MD (r = -0.36, 0.42, -0.41) and FA (r = -0.47, -0.37, -0.46) respectively. CONCLUSION DTI of vertebral BM can help in diagnosis and monitoring patients with GD after therapy and correlated with genotyping, and hematological biomarkers of GD.
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Affiliation(s)
| | - Saher Taman
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Walaa Gamal
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Mostafa El Ayouty
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Tarik Elsayed Barakat
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
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13
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Lotfinia I, Mahdkhah A. Spinal epidural cavernous hemangioma of spine, a case report and review of literature. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Sambri A, Fiore M, Giannini C, Pipola V, Zucchini R, Aparisi Gomez MP, Musa Aguiar P, Gasbarrini A, De Paolis M. Primary Tumors of the Sacrum: Imaging Findings. Curr Med Imaging 2021; 18:170-186. [PMID: 33982654 DOI: 10.2174/1573405617666210512011923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/22/2022]
Abstract
The diagnosis of sacral neoplasms is often delayed because they tend to remain clinically silent for a long time. Imaging is useful at all stages of managing sacral bone tumors: from the detection of the neoplasm to the long-term follow-up. Radiographs are recommended as the modality of choice to begin the imaging workup of a patient with known or suspected sacral pathology. More sensitive examinations such as computerized tomography (CT), magnetic resonance (MRI), or scintigraphy are often necessary. The morphological features of the lesions on CT and MRI help to orientate the diagnosis. Although some imaging characteristics are helpful to limit the differential diagnosis, an imaging-guided biopsy is often ultimately required to establish a specific diagnosis. Imaging is of paramount importance even in the long-term follow-up in order to assess any residual tumor when surgical resection is incomplete, to assess the efficacy of adjuvant chemotherapy and radiotherapy, and to detect recurrence.
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Affiliation(s)
- Andrea Sambri
- University of Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant’Orsola, Bologna, Italy
| | | | | | | | | | - Maria Pilar Aparisi Gomez
- Department of Radiology, Auckland City Hospital; 2 Park Road, Grafton, 1023 Auckland, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre; Calle Valle de la Ballestera, 59, 46015 Valencia, Spain
| | - Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem; R. São Luís, 96 - Santana, Porto Alegre - RS, 90620-170. Brazil
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Abdel Razek AAK. Bone-related disorders of the jaw: A clinico-radiological diagnostic algorithm. Neuroradiol J 2021; 34:289-299. [PMID: 33678062 DOI: 10.1177/1971400921998967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bone-related disorders of the jaw (BRDJ) include a spectrum of non-neoplastic and neoplastic lesions of the maxillofacial region that have been recently classified into fibro-osseous lesions, giant cell lesions and osseous tumours. The histopathological features of BRDJ can be similar and overlie each other. Imaging is important in order to reach a specific diagnosis. However, the appearance of BRDJ on imaging is non-specific in some cases. Computed tomography (CT) and magnetic resonance imaging (MRI) are used for accurate localisation, characterisation of the tumour matrix, delineation of the lesion extension and establishment of the relation of BRDJ to the surrounding structures. Imaging is usually done to detect the relationship with the adjacent surrounding vital structures and to diagnose aggressive forms, malignant transformation and associated syndromes. The correlation of the demographic findings, the location and the clinical presentations with the imaging features are important for the diagnosis of BRDJ. The proposed clinico-radiological diagnostic algorithm with CT and MRI helps a specific diagnosis to be reached in some cases.
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16
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Ali S, Qasim A, Sarwar MR, Munam AU, Shams S. Primary Intraosseous Xanthogranuloma in Adult Cervical Spine: A Case Report of Benign Cause of Lytic Bone Lesion. Asian J Neurosurg 2021; 16:208-211. [PMID: 34211897 PMCID: PMC8202395 DOI: 10.4103/ajns.ajns_480_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 10/31/2020] [Accepted: 12/28/2020] [Indexed: 12/15/2022] Open
Abstract
Lytic lesions in adult spine are a common manifestation of aggressive disease such as primary bone tumor, metastasis, myeloma, or infectious pathology. Xanthoma arising in the spine with purely intraosseous component is an extremely rare occurrence with only six cases reported in the adult population, none in the cervical region. We report the first case of primary xanthoma of the cervical spine in a 50-year-old male solely confined to osseous compartment. The imaging mimics of lytic lesion with expansile mass in adult spine are reiterated.
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Affiliation(s)
- Sundus Ali
- Department of Neurosurgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Adnan Qasim
- Department of Neurosurgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Muhammad Rizwan Sarwar
- Department of Neurosurgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Attah Ul Munam
- Department of Neurosurgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
| | - Shahzad Shams
- Department of Neurosurgery, King Edward Medical University/Mayo Hospital, Lahore, Pakistan
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Xu J, Zhang L, Bu R, Liu Y, Lewandrowski KU, Zhang X. Minimally invasive debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis: a long-term follow-up study. BMC Musculoskelet Disord 2021; 22:120. [PMID: 33514356 PMCID: PMC7844889 DOI: 10.1186/s12891-021-03988-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Spondylodiscitis is an unusual infectious disease, which usually originates as a pathogenic infection of intervertebral discs and then spreads to neighboring vertebral bodies. The objective of this study is to evaluate percutaneous debridement and drainage using intraoperative CT-Guide in multilevel spondylodiscitis. Methods From January 2002 to May 2017, 23 patients with multilevel spondylodiscitis were treated with minimally invasive debridement and drainage procedures in our department. The clinical manifestations, evolution, and minimally invasive debridement and drainage treatment of this refractory vertebral infection were investigated. Results Of the enrolled patients, the operation time ranged from 30 minutes to 124 minutes every level with an average of 48 minutes. Intraoperative hemorrhage was minimal. The postoperative follow-up period ranged from 12 months to 6.5 years with an average of 3.7 years. There was no reactivation of infection in the treated vertebral segment during follow-up, but two patients with fungal spinal infection continued to progress by affecting adjacent segments prior to final resolution. According to the classification system of Macnab, one patient had a good outcome at the final follow-up, and the rest were excellent. Conclusions Minimally invasive percutaneous debridement and irrigation using intraoperative CT-Guide is an effective minimally invasive method for the treatment of multilevel spondylodiscitis.
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Affiliation(s)
- Jianbiao Xu
- Department of Orthopaedics,First, Affiliated Hospital of Tsinghua University(Beijing Huaxin Hospital), Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Leiming Zhang
- Department of Neurosurgery, The Sixth Medical Center of PLA Hospital, Beijing, China
| | - Rongqiang Bu
- Beijing Yuhe Orthopaedics Hospital, Beijing, China
| | - Yankang Liu
- Beijing Yuhe Orthopaedics Hospital, Beijing, China.,Shanxi Medical University, Taiyuan, China
| | - Kai-Uwe Lewandrowski
- Center For Advanced Spine Care of Southern Arizona, Surgical Institute of Tucson, Tucson, USA
| | - Xifeng Zhang
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
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Cao L, Wen JX, Han SM, Wu HZ, Peng ZG, Yu BH, Zhong ZW, Sun T, Wu WJ, Gao BL. Imaging features of hemangioma in long tubular bones. BMC Musculoskelet Disord 2021; 22:27. [PMID: 33407312 PMCID: PMC7786894 DOI: 10.1186/s12891-020-03882-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background To investigate the imaging features of hemangiomas in long tabular bones for better diagnosis. Methods Twenty-four patients with long bone hemangiomas confirmed by pathology were enrolled. Nineteen patients had plain radiography, fourteen patients had computed tomography (CT) and eleven had magnetic resonance imaging (MRI). The hemangioma was divided into medullary [13], periosteal [6] and intracortical type [5]. Results Among 19 patients with plain radiography, eleven patients were medullary, three periosteal, and five intracortical. In the medullary type, the lesion was primarily osteolytic, including five cases with irregular and unclear rims and one lesion having osteosclerotic and unclear rims. In three patients with the periosteal type, the lesion had clear rims with involvement of the cortical bone in the form of bone defect, including two cases with local thickened bone periosteum and one case having expansile periosteum. Five intracortical hemangiomas had intracortical osteolytic lesions with clear margins. Among 14 patients with CT imaging, 8 cases were medullary, three periosteal, and three intracortical. Among 8 medullary hemangiomas, one had ground glass opacity, and seven had osteolytic, expansile lesions like soft tissue density with no calcification. In three periosteal cases, the lesion was osteolytic with thickened periosteum and narrowed medullary cavity. In three intracortical hemangiomas, the lesion was of even soft tissue density with no calcification. Among 11 patients with MRI imaging, seven were medullary, two periosteal, and two intracortical. Among 7 medullary lesions, six were of hypointense signal on T1WI and hyperintensesignal on T2 WI. In two periosteal cases, the periosteum was thickened, with one case being of equal signal, and the other having no signal. Two intracortical hemangiomas were both of slightly low signal on T1WI but hyperintense signal on T2WI. Conclusions The long bone hemangiomas had characteristic cystic honeycomb-like presentations in plain radiograph. CT and MRI imagings are helpful for diagnosis of hemangiomas in long bone.
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Affiliation(s)
- Lei Cao
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Jin-Xu Wen
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Shu-Man Han
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Hui-Zhao Wu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Zhi-Gang Peng
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Bao-Hai Yu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Zhi-Wei Zhong
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Tao Sun
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
| | - Wen-Juan Wu
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China.
| | - Bu-Lang Gao
- Department of Radiology the Third Hospital, Hebei Medical University, 139 Ziqiang Road, 050051, Shijiazhuang, Hebei Province, China
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Zou X, Wang B, Yang H, Ge S, Ouyang B, Chen Y, Ni L, Zhang S, Xia H, Ma X. Transoral intraarticular cage distraction and C-JAWS fixation for revision of basilar invagination with irreducible atlantoaxial dislocation. BMC Musculoskelet Disord 2020; 21:766. [PMID: 33218335 PMCID: PMC7679985 DOI: 10.1186/s12891-020-03792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022] Open
Abstract
Background The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Transoral revision surgery has more advantages than a combined anterior and posterior approach in addressing this pathology. The C-JAWS is a cervical compressive staple that has been used in the lower cervical spine with many advantages. Up to now, there is no report on the application of C-JAWS in the atlantoaxial joint. We therefore present this report to investigate the clinical outcomes of transoral intraarticular cage distraction and C-JAWS fixation for revision of BI with IAAD. Methods From June 2011 to June 2015, 9 patients with BI and IAAD were revised by this technique after previous posterior OCF in our department. Plain cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of atlantoaxial dislocation and compression of the cervical cord. The Japanese Orthopedic Association (JOA) score was used to evaluate the neurological function. Results The revision surgeries were successfully performed in all patients. The average follow-up duration was 18.9 ± 7.3 months (range 9–30 months). The postoperative atlas-dens interval (ADI), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and JOA score were significantly improved in all patients (P < 0.05). Bony fusion was achieved after 3–9 months in all cases. No patients developed recurrent atlantoaxial instability. Conclusions Transoral revision surgery by intraarticular cage distraction and C-JAWS fixation could provide a satisfactory outcome for BI with IAAD after a previous unsuccessful posterior operation.
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Affiliation(s)
- Xiaobao Zou
- The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China.,Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Binbin Wang
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Haozhi Yang
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Su Ge
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Bieping Ouyang
- The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China.,Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Yuyue Chen
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Ling Ni
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Shuang Zhang
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Hong Xia
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Xiangyang Ma
- The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China. .,Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.
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20
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Zhang S, Xu S, Yang J, Wang S, Wang Q. Analysis of percutaneous kyphoplasty under different types of anesthesia for the treatment of multiple osteoporotic vertebral fractures. BMC Musculoskelet Disord 2020; 21:743. [PMID: 33183281 PMCID: PMC7664068 DOI: 10.1186/s12891-020-03778-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Surgeons recognize that using percutaneous kyphoplasty (PKP) under local anesthesia to treat osteoporotic vertebral fracture (OVF) prevents interference with the general situation of elderly patients suffering from multiple organ dysfunction. Surgeons can directly assess whether nerve injury occurs while the patient is awake. However, when patients with multiple osteoporotic vertebral fractures (m-OVFs) receive local anesthesia, fluoroscopy time often has to be increased, the operative time has to be extended, or the operation has to be terminated because of discomfort related to body posture. No relevant study has thus far been conducted on the type of anesthesia to administer to patients undergoing PKP for m-OVFs. This study aimed to determine which of the two types of anesthesia is more suitable for PKP for m-OVFs. Methods A retrospective study was conducted involving 159 patients who underwent PKP for m-OVFs from January 2016 to January 2020; 81 patients underwent PKP under general anesthesia (Group G), and 78 patients underwent PKP under local anesthesia (Group L). Clinical and adverse events were compared between the two groups. Results The intraoperative mean arterial pressure, average heart rate, average fluoroscopy times of each vertebral body, and operative time were less in Group G than in Group L. The visual analog scale (VAS) score was significantly lower after than before the operation. The anterior vertebral height (AVH), middle vertebral height (MVH), and kyphotic angle (KA) were significantly improved in both groups postoperatively. The improvement in VAS score, AVH, MVH, and KA in Group G were higher than those in Group L. No significant difference in the incidence of complications was observed between the two groups. Conclusion PKP under either general anesthesia or local anesthesia was reliable. Compared with PKP under local anesthesia, PKP under general anesthesia could more reliably maintain the stability of vital signs, alleviate preoperative pain in patients, and attain a better orthopedic effect. Moreover, the latter does not increase the complications of patients with m-OVFs. However, the high medical expense of PKP under general anesthesia is a factor to consider when choosing the type of anesthesia.
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Affiliation(s)
- Shuai Zhang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China
| | - Shuang Xu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China
| | - Jin Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China
| | - Song Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China.
| | - Qing Wang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Luzhou City, 646000, Sichuan, China.
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Zhong X, Jiang H, Mai H, Xiang J, Li J, Huang Z, Wu S, Luo L, Jiang K. Radiation-induced occult insufficiency fracture or bone metastasis after radiotherapy for cervical cancer? The nomogram based on quantitative apparent diffusion coefficients for discrimination. Cancer Imaging 2020; 20:76. [PMID: 33097093 PMCID: PMC7583230 DOI: 10.1186/s40644-020-00353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Radiation-induced insufficiency fractures (IF) is frequently occult without fracture line, which may be mistaken as metastasis. Quantitative apparent diffusion coefficient (ADC) shows potential value for characterization of benign and malignant bone marrow diseases. The purpose of this study was to develop a nomogram based on multi-parametric ADCs in the differntiation of occult IF from bone metastasis after radiotherapy (RT) for cervical cancer. Methods This study included forty-seven patients with cervical cancer that showed emerging new bone lesions in RT field during the follow-up. Multi-parametric quantitative ADC values were measured for each lesion by manually setting region of interests (ROIs) on ADC maps, and the ROIs were copied to adjacent normal muscle and bone marrow. Six parameters were calculated, including ADCmean, ADCmin, ADCmax, ADCstd, ADCmean ratio (lesion/normal bone) and ADCmean ratio (lesion/muscle). For univariate analysis, receiver operating characteristic curve (ROC) analysis was performed to assess the performance. For combined diagnosis, a nomogram model was developed by using a multivariate logistic regression analysis. Results A total of 75 bone lesions were identified, including 48 occult IFs and 27 bone metastases. There were significant differences in the six ADC parameters between occult IFs and bone metastases (p < 0.05), the ADC ratio (lesion/ muscle) showed an optimal diagnostic efficacy, with an area under ROC (AUC) of 0.887, the sensitivity of 95.8%, the specificity of 81.5%, respectively. Regarding combined diagnosis, ADCstd and ADCmean ratio (lesion/muscle) were identified as independent factors and were selected to generate a nomogram model. The nomogram model showed a better performance, yielded an AUC of 0.92, the sensitivity of 91.7%, the specificity of 96.3%, positive predictive value (PPV) of 97.8% and negative predictive value (NPV) of 86.7%, respectively. Conclusions Multi-parametric ADC values demonstrate potential value for differentiating occult IFs from bone metastasis, a nomogram based on the combination of ADCstd and ADCmean ratio (lesion/muscle) may provide an improved classification performance.
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Affiliation(s)
- Xi Zhong
- Department of Medical Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, China
| | - Huali Jiang
- Department of Cardiovascularology, Tungwah Hospital of Sun Yat-Sen University, Dong cheng East Road, Dong guan, 523110, Guangdong, China
| | - Hui Mai
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Jialin Xiang
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, 510000, China
| | - Jiansheng Li
- Department of Medical Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, China
| | - Zhiqing Huang
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, 510000, China
| | - Songxin Wu
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, 510000, China
| | - Liangping Luo
- Department of Medical Imaging, First Affiliated Hospital of Jinan University, Guangzhou, 510000, China.
| | - Kuiming Jiang
- Department of Radiology, Guangdong Women and Children Hospital, Guangzhou, 510000, China.
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Razek AAKA, El Badrawy MK, Alnaghy E. Interstitial Lung Fibrosis Imaging Reporting and Data System: What Radiologist Wants to Know? J Comput Assist Tomogr 2020; 44:656-666. [PMID: 32842067 DOI: 10.1097/rct.0000000000001075] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aim of this work is to review interstitial lung fibrosis Imaging Reporting and Data System (ILF-RADS) that was designed for reporting of interstitial lung fibrosis (ILF). Findings include pulmonary and extrapulmonary findings and is subsequently designed into 4 categories. Pulmonary findings included lung volume, reticulations, traction bronchiectasis, honeycomb, nodules, cysts, ground glass, consolidation, mosaic attenuation and emphysema, and distribution of pulmonary lesions; axial (central, peripheral and diffuse), and zonal distribution (upper, middle, and lower zones). Complications in the form of acute infection, acute exacerbation, and malignancy were also assessed. Extrapulmonary findings included mediastinal, pleural, tracheal, and bone or soft tissue lesions. The lexicon of usual interstitial pneumonia (UIP) was classified into 4 categories designated as belonging in 1 of 4 categories. Lexicon of ILF-RADS-1 (typical UIP), ILF-RADS-2 (possible UIP), ILF-RADS-3 (indeterminate for UIP), and ILF-RADS-4 (inconsistent with UIP).
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Huang Z, Fang T, Si Z, Li Y, Zhang L, Zheng C, Li S, Su M, Liu X, Li X, Wu Y. Imaging algorithm and multimodality evaluation of spinal osteoblastoma. BMC Musculoskelet Disord 2020; 21:240. [PMID: 32290828 PMCID: PMC7158089 DOI: 10.1186/s12891-020-03252-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/31/2020] [Indexed: 11/25/2022] Open
Abstract
Background To analyze the features of CT, MRI and PET/CT and their diagnostic value for spinal osteoblastomas (OBs). Methods The radiological and clinical data of 21 patients with histopathologically-confirmed spinal OBs were analyzed retrospectively. Results Sixteen of the 21 cases were benign and 5 were aggressive OBs. Tumors were located in the lumbar (n = 11), cervical (n = 4), thoracic (n = 5), and sacral (n = 1) spinal regions. Nineteen cases were centered in the posterior elements of the spine, 13 of which extended into the vertebral body. Punctate or nodular calcifications were found in all cases on CT with a complete sclerotic rim (n = 12) or incomplete sclerotic rim (n = 8). The flare phenomenon (indicative of surrounding tissue inflammation) was found in 17/21 cases on CT, thin in 11 cases and thick in 6 cases, and in 19/19 cases on MRI, thin in 1 case and thick in 18 cases. On 18F-FDG PET/CT, all cases (8/8) were metabolically active with the SUVmax of 12.3–16.0; the flare sign was observed in 8 cases, including 7 cases of hypometabolism and 1 case of coexistence of hypermetabolism and hypometabolism. Based on CT, 3, 12, and 6 cases were classified as Enneking stage 1, 2 and 3, respectively. Of 19 cases with MRI, 1 and 18 cases were classified as Enneking stage 2 and 3, respectively. Conclusions Spinal OB has multiple unique characteristic radiological features. Although a larger sample size is needed, combining CT, MRI and PET may be beneficial to optimize preoperative diagnosis and care of patients with OBs.
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Affiliation(s)
- Zihuan Huang
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Tingsong Fang
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, 510515, P.R. China
| | - Zhiguang Si
- Department of Radiology, Dehongzhou People's Hospital, Dehongzhou, Yunan, 678400, P.R. China
| | - Youcai Li
- Department of PET/CT Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510000, P.R. China
| | - Lan Zhang
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Chunling Zheng
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Shenmei Li
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Manting Su
- The First Clinical Medical College, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China
| | - Xiaomin Liu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangzhou, Guangdong, 510515, P.R. China
| | - Xiaodan Li
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangzhou, Guangdong, 510515, P.R. China
| | - Yuankui Wu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangzhou, Guangdong, 510515, P.R. China.
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Loudini N, Glaudemans AWJM, Jutte PC, Yakar D, Kwee TC. The value of prebiopsy FDG-PET/CT in discriminating malignant from benign vertebral bone lesions in a predominantly oncologic population. Skeletal Radiol 2020; 49:1387-1395. [PMID: 32253470 PMCID: PMC7360653 DOI: 10.1007/s00256-020-03426-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the value of prebiopsy 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) in discriminating malignant from benign vertebral bone lesions. MATERIALS AND METHODS This retrospective study included 53 patients with 55 vertebral bone lesions that underwent FDG-PET/CT before CT-guided biopsy. Pathologic examination of the biopsy sample and a minimum follow-up of 1 year were used as reference standard. RESULTS Sensitivity, specificity, positive predictive value, and negative predictive value of visual FDG-PET analysis (with lesion FDG uptake higher than liver FDG uptake as threshold for malignancy) in discriminating malignant from benign vertebral bone lesions were 91.3% (42/46), 22.2% (2/9), 85.7% (42/49), and 33.3% (2/6), respectively. The semiquantitative FDG-PET metrics SUVmax and SUVpeak achieved areas under the receiver operating characteristics curve of 0.630 and 0.671, respectively. Malignant lesions demonstrated bone lysis more frequently than benign lesions (60.9% (28/46) vs. 22.2% (2/9)), and this difference was nearly significant (P = 0.064). All other clinical and conventional imaging characteristics (including patient age, gender, previous diagnosis of malignancy, bone pain, weight loss, any CT abnormality, sclerosis, cortical destruction, bone marrow replacement, associated extraosseous soft tissue mass, and accompanying vertebral height loss, multiple bone lesions on FDG-PET/CT, and suspicious extraosseous lesions on FDG-PET/CT) were not significantly different (P = 0.143 to 1.000). CONCLUSION FDG-PET/CT may steer the diagnosis (particularly thanks to a relatively high PPV and value of semiquantitative measurements), but cannot always classify vertebral bone lesions as malignant or benign with sufficient certainty. In these cases, biopsy and/or follow-up remain necessary to establish a final diagnosis.
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Affiliation(s)
- Naila Loudini
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, |Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Andor W. J. M. Glaudemans
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, |Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Paul C. Jutte
- Department of Orthopedics, |University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Derya Yakar
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, |Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Thomas C. Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, |Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Huang CW, Tang CL, Pan HC, Tzeng CY, Tsou HK. Severe heterotopic ossification in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty: A case report. World J Clin Cases 2019; 7:3047-3054. [PMID: 31624753 PMCID: PMC6795720 DOI: 10.12998/wjcc.v7.i19.3047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical disc arthroplasty (CDA) is an alternative treatment to traditional interbody fusion that maintains postoperative cervical spine mobility. However, the CDA postoperative period is impacted by osteolysis, subsidence, metallosis, or heterotopic ossification (HO). We report a case of severe HO in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty.
CASE SUMMARY A 34-year-old man received hybrid surgery for C4-C5 and C5-C6 arthroplasty with Bryan discs and C6-C7 arthrodesis with polyetheretherketone cage due to traumatic herniation of the intervertebral disc (HIVD). After four years, cervical spine radiographs revealed severe HO around the Bryan discs over the C4-C5 and C5-C6 levels. The magnetic resonance image revealed HIVD over the C3-C4 level with spinal cord compression. Seronegative spondyloarthritis was diagnosed after consultation with a rheumatologist. A second CDA for the adjacent segment disease HIVD with Baguera C disc over the C3-C4 level achieved an excellent outcome.
CONCLUSION Minimizing intraoperative tissue trauma and achieving postoperative interbody stability avoid soft tissue traction to prevent HO formation after CDA.
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Affiliation(s)
- Chih-Wei Huang
- Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chien-Lun Tang
- Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Hung-Chuan Pan
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Chung-Yuh Tzeng
- Division of Joint Reconstruction, Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County 515, Taiwan
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County 356, Taiwan
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Diagnostic accuracy of diffusion tensor imaging in differentiating malignant from benign compressed vertebrae. Neuroradiology 2019; 61:1291-1296. [DOI: 10.1007/s00234-019-02286-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/26/2019] [Indexed: 12/23/2022]
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Lee MJ, Hung CJ. The benefits of radiological imaging for postoperative orthostatic headache: a case report. BMC Med Imaging 2019; 19:61. [PMID: 31390998 PMCID: PMC6686484 DOI: 10.1186/s12880-019-0365-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background Traditionally, the diagnosis of post-dural puncture headache (PDPH) relied upon the patient’s history regarding dural puncture and symptoms, such as orthostatic headache. However, such evidence may not always be reliable or specific. We report an unexpected diagnosis with spontaneous intracranial hypotension (SIH), which was confirmed upon examination of Magnetic Resonance (MR) images in a patient who was initially suspected to have PDPH because he had recently undergone a uncertain dural puncture. Case presentation A 45-year-old man had undergone a thoracic epidural catheter insertion for perioperative analgesia prior to general anesthesia induction. Due to intermittent dripping of fluid while the epidural needle was being advanced, a dural puncture was suspected. The patient complained of an orthostatic headache after recovery from surgery, therefore a PDPH was suspected. MR images revealed signs of SIH: dural sinus engorgement, contrast enhancement along the neural sleeves of the left C6–7, bilateral C7-T1, T1–2, T2–3, T3–4, T4–5, and T5–6. Computed tomography-guided epidural blood patching (EBP) was performed the following day, with the patient experiencing immediate relief of the headache. Conclusion The benefits of radiological imaging in this case included confirming the correct diagnosis, guiding the accurate level and proper approach of EBP, distinguishing the epidural space from the intrathecal space, and ultimately increasing the likelihood of successful EBP.
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Affiliation(s)
- Mu-Jung Lee
- Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, No.95, Wenchang Rd., Shilin Dist, Taipei City, 111, Taiwan, Republic of China
| | - Chih-Jen Hung
- Department of Anesthesiology, Taichung Veterans General Hospital, No.1650, Sec. 4, Taiwan Blvd., Xitun Dist, Taichung City, 407, Taiwan, Republic of China.
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Ibebuike K, Roussot M, Watt J, Skead G, Dunn R. Diagnostic challenges and surgical management of co-existent osteoblastoma and aneurysmal bone cyst of the lumbar spine in a child: case report. Afr Health Sci 2019; 19:2294-2301. [PMID: 31656516 PMCID: PMC6794550 DOI: 10.4314/ahs.v19i2.56] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Osteoblastomas (OTB) with co-existent aneurysmal bone cysts (ABC) of the spine are extremely rare and more so in the lumbar spine. To the authors' knowledge, only one case of lumbar spine involvement has been reported in a paediatric patient. Objectives To highlight diagnostic challenges and surgical management of co-existent lumbar OTB-ACB in a child. Methods We present a 14-year old female with low back pain and progressive swelling of 2 months. She was evaluated by neuroimaging studies and histopathological assessment of resected tissue. Results X-ray showed a lytic lesion in L3 with loss of the left pedicle. Magnetic resonance imaging (MRI) revealed a fluid-filled, heterogeneously enhanced, lobulated lesion posterior to the vertebral bodies of L3, L4 and L5, which infiltrated the quadratus lumborum muscles bilaterally, and histologically diagnosed as ABC. The L3 pedicle also revealed an expanded, heterogeneously enhanced mass lesion which appeared to be different and showed no fluid-filled levels, histologically diagnosed as OTB. Surgical intervention involved tumour excision with partial spondylectomy of L3 vertebra, posterior instrumented stabilization and fusion. Conclusion The case highlights the diagnostic challenges of co-existent OTB-ABC and the significant role of surgical management via spinal reconstruction, stabilization and fusion after gross total tumour excision.
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Affiliation(s)
- Kaunda Ibebuike
- Visiting Spine Fellow, Division of Neurosurgery, Department of Surgery, Imo State University Teaching Hospital, Orlu, Nigeria
| | - Mark Roussot
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - James Watt
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Garret Skead
- Division of Anatomical Pathology, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Robert Dunn
- Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
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Mak D, Vidoni A, James S, Choksey M, Beale D, Botchu R. Magnetic Resonance Imaging Features of Cervical Spine Intraspinal Extradural Synovial Cysts. Can Assoc Radiol J 2019; 70:403-407. [PMID: 30922789 DOI: 10.1016/j.carj.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/08/2018] [Accepted: 12/15/2018] [Indexed: 11/15/2022] Open
Abstract
Spinal synovial cysts are relatively uncommon and are most frequently found in the lumbar spine and rarely in the cervical spine. Intraspinal extradural cervical synovial cysts can occur and potentially cause cord/nerve root compression with symptoms of myelopathy/radiculopathy; however, most are asymptomatic and incidental findings. We conducted a literature review and present, to our knowledge, the largest imaging case series and describe the magnetic resonance imaging features of cervical synovial cysts.
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Affiliation(s)
- Davina Mak
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alessandro Vidoni
- Cardiff and Vale Orthopedic Centre, University Hospital Llandough, Cardiff, United Kingdom
| | - Steven James
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | | | - David Beale
- Heath Lodge Clinic, Birmingham, United Kingdom
| | - Rajesh Botchu
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.
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Park C, Lee JW, Kim Y, Ahn S, Lee E, Kang Y, Kang HS. Diagnosis of spinal metastasis: are MR images without contrast medium application sufficient? Clin Imaging 2019; 55:165-173. [PMID: 30904626 DOI: 10.1016/j.clinimag.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/18/2019] [Accepted: 03/05/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the usefulness of adding contrast-enhanced (CE) magnetic resonance imaging (MRI) to conventional MRI for evaluation of spinal metastases. MATERIALS AND METHODS One-hundred-and-two whole spine MR examinations, obtained for metastasis work-up within a 2-month period, from 65 men and 37 women (mean age, 64 years) with extra-spinal tumor, who also underwent CE-MRI, were retrospectively evaluated by three radiologists. The number of spine segments with bone marrow involvement was interpreted using a 3-point confidence scale (probable metastasis, equivocal, probably benign) during session 1 (conventional imaging) and session 2 (addition of CE-MRI to conventional imaging). The patients were assigned to 14 categories based on the changes in confidence rating between sessions 1 and 2; these were aggregated to four groups indicating the degree of usefulness of CE-MRI: definitely useful, equivocal, not useful, and presumed non-metastatic groups. Clinical information, metastatic bone type, the number of probably metastatic segments, and anatomical level and position were compared among the former three groups. RESULTS The readers assigned 39-53% of cases to the definitely useful group. The number of probably metastatic segments differed significantly among the three groups for all readers (p ≤ 0.046). Age, sex, primary cancer, metastatic bone type, and anatomical level and position were similar. CONCLUSION Adding CE-MRI to conventional MRI was useful for objectively detecting and characterizing spinal segments with metastases in 39-53% of cases. However, there were no clinical or radiological factors that could predict the usefulness of CE-MRI in evaluating spinal metastases, except for the number of metastatic segments.
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Affiliation(s)
- Chankue Park
- Department of Radiology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsananam-do, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Yongju Kim
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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Abstract
Transcriptome profiling of osteosarcoma (OS) by next generation sequencing technology (NGS) has been broadly performed by previous researches, which uncovers a large number protein-coding driver genes, facilitates our understanding of the molecular mechanisms of OS formation, progression and metastasis. Recently, more and more researchers realize the importance of long non-coding RNAs (lncRNAs) on the development of OS. However, few studies focus on discovering driver lncRNAs.Here we collected somatic copy number alterations (SCNAs) and gene expression profiles of 84 samples from Therapeutically Applicable Research to Generate Effective Treatments (TARGET) project. The RNA sequencing data detected 13,903 expressed lncRNAs, 157 of which were previously reported to be associated with cancer based on the annotations from Lnc2Cancer database.By analyzing the SNP array data, several significant SCNAs were detected, such as the amplifications on chromosomes 1q, 4q, 17p, 17q, and 19q, and deletions on 1q, 3q, 9p, 10q, and 15q. With the SCNA and gene expression profiles, we identified 167 driver genes by integrative analysis, including 162 novel driver lncRNAs, 2 lncRNAs reported to be associated with OS, and another 3 associated with other cancers. Furthermore, functional characterization and survival analysis revealed that RP11-241F15.10 may function as a tumor suppressor in OS, and loss of function may contribute to activation of Wnt signaling pathway.This study not only facilitates our understanding of the oncogenic or tumor-suppressor role of lncRNAs in OS, but also provides potential therapies for the patients with OS with metastasis or relapse.
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Affiliation(s)
- Zhenguo Luo
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University
- Department of Anesthesiology, Honghui Hospital, Xi’an Jiaotong University
| | - Li Xiao
- Department of Anesthesiology, Honghui Hospital, Xi’an Jiaotong University
| | - Jing Li
- Department of Intensive Care Unit, The Fourth Hospital of Xi’an, Xi’an, Shannxi Province, China
| | - Buhuai Dong
- Department of Anesthesiology, Honghui Hospital, Xi’an Jiaotong University
| | - Chunsheng Wang
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University
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Quantitative MR neurography of brachial plexus lesions based on diffusivity measurements. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Shin SK, Choi DJ, Kim JH, Kim YS, Kwon OS. Characteristics of contrast-enhanced ultrasound in distinguishing small (≤3 cm) hepatocellular carcinoma from intrahepatic cholangiocarcinoma. Medicine (Baltimore) 2018; 97:e12781. [PMID: 30313099 PMCID: PMC6203535 DOI: 10.1097/md.0000000000012781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is highly accurate in depicting the vascularity of liver nodules. The aim of this study was to verify the characteristics of CEUS in distinguishing small (≤3 cm) hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC).A total of 65 patients with a liver nodule (HCC, n = 58; ICC, n = 7) smaller than 3 cm who underwent liver CEUS and pathologic confirmation were retrospectively reviewed. CEUS findings were compared with histopathologic and clinical data.Arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS were observed in 77.6% (45/58) of HCCs and 85.7% (6/7) of ICCs. Time of arterial-phase hyperenhancement (11 seconds [6-20] vs 16 seconds [14-19], P = .008), time of portal-delayed-phase wash-out (65 seconds (15-260) vs 35 secconds (27-54), P = .002), and time interval between arterial-phase hyperenhancement and portal-delayed-phase wash-out (50 seconds [5-249] vs 19 seconds [13-35], P < .001) on CEUS were significantly different between HCCs and ICCs showing arterial-phase hyperenhancement and portal-delayed-phase wash-out. The sensitivity, specificity, positive predictive value, and negative predictive value of time interval more than 25 seconds between arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS for the differentiation of HCCs and ICCs were 91.1%, 83.3%, 97.6%, and 55.6%, respectively.The time interval between arterial-phase hyperenhancement and portal-delayed-phase wash-out on CEUS was the most sensitive indicator in distinguishing small HCC from ICC showing arterial-phase hyperenhancement and portal-delayed-phase wash-out.
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Guo R, Yang X, Zhong Y, Lai Q, Gao T, Lai F, Dai M, Zhan P, Zhang B. Correlations between Modic change and degeneration in 3-joint complex of the lower lumbar spine: A retrospective study. Medicine (Baltimore) 2018; 97:e12496. [PMID: 30235755 PMCID: PMC6160214 DOI: 10.1097/md.0000000000012496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Modic changes (MCs) associated with low back pain (LBP) have been assessed in a few studies. It has been documented that patients with LBP have MCs in a specific segment, but the relationship between facet joint or disc degeneration and MCs is still disputed. Thus, we aimed to evaluate the correlation between MC and facet joint or disc degeneration using imaging. METHODS Imaging data of patients were retrospectively analyzed at the Orthopedic Department of the First Affiliated Hospital of Nanchang from January 2014 to August 2017. MCs, facet joint degeneration, and disc degeneration in L3-S1 were evaluated by lumbar MRI. χ test and contingency correlation coefficient were used for the statistical analyses, and a P value < .05 was considered statistically significant. RESULTS In the descriptive statistical analysis, MCs were found to have the highest incidence in the L4-5 segment. Type II MCs had a higher incidence than type I and type III MCs regardless of whether they were in the L3-4, L4-5, or L5-S1 segment. On one hand, MCs were more frequently distributed in grades 3, 4, and 5 of the degenerative lumbar discs regardless of whether they were in the L3-4, L4-5, or L5-S1 segment (P < .000, V: contingency coefficient >0); particularly, type II MCs were closely related to lumbar disc degeneration (P < .05, V > 0). On the other hand, MCs were more frequently distributed in grades 1, 2, and 3 of the degenerative lumbar facet regardless of whether they were in the L3-4, L4-5, or L5-S1 segment (P < .05, V > 0). Particularly, type II MCs were frequently distributed in grades 1, 2, and 3 of the facet joint in the L4-5 and L5-S1 segments (P < .05, V > 0). CONCLUSION MCs are correlated with the grade of lumbar spine degeneration, including lumbar disc and facet joint degeneration. MCs, especially type II, frequently occurred in severe degeneration of the lumbar disc and facet joint. Thus, MC may be one of the manifestations of lumbar disc and facet joint degeneration.
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Affiliation(s)
- Runsheng Guo
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University,Nanchang
| | - Xiaowei Yang
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University,Nanchang
| | - Yanchun Zhong
- Department of Orthopedics, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Qi Lai
- Department of Orthopedics, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Tian Gao
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University,Nanchang
| | - Fuchong Lai
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University,Nanchang
| | - Min Dai
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University,Nanchang
| | - Ping Zhan
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University,Nanchang
| | - Bin Zhang
- Department of Orthopedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University,Nanchang
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Romeo V, Cavaliere C, Sorrentino C, Ponsiglione A, Ugga L, Barbuto L, Verde F, Covello M. Clinical impact of coronal-STIR sequence in a routine lumbar spine MR imaging protocol to investigate low back pain. Medicine (Baltimore) 2018; 97:e10789. [PMID: 29879016 PMCID: PMC5999459 DOI: 10.1097/md.0000000000010789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim of this study is to assess the clinical impact of coronal short tau inversion recovery (STIR)-weighted magnetic resonance (MR) sequence, when acquired in a lumbar spine MR imaging protocol, in detecting significant extraspinal imaging findings in patients with low back pain (LBP).We retrospectively evaluated 931 lumbar spine MR examinations of patients with LBP. Extraspinal MR imaging findings were categorized as: probably related to LBP (Category 1), not related to LBP but with relevant implications on patient's care (Category 2), and not related to LBP without significant implications on patient's care (Category 3). For each MR imaging finding was also assessed if it was detectable or not on the conventional sagittal and axial acquisition planes.Of the 931 evaluated MR examinations, 60 (6.4%) showed additional extraspinal MR imaging findings, categorized as follows: 55% (33/60) probably related to LBP (Category 1), 22% (13/60) not related to LBP but with relevant implications on patient's care (Category 2), and 23% (14/60) not related to LBP and without significant implications on patient's care (Category 3). Among categories 1 and 2 (n = 46), the 72% (33/46) of imaging findings were detected only on coronal plane. Coronal-STIR sequence significantly changed patients' diagnostic work-flow in 3.5% (33/931) of cases.Coronal STIR sequence, acquired in a lumbar spine MR imaging protocol to investigate LBP, may aid radiologists in detecting additional extraspinal MR imaging findings that could be related to LBP, addressing to the most appropriate clinical management.
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Affiliation(s)
- Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples Federico II
| | | | | | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples Federico II
| | - Luigi Barbuto
- Department of Advanced Biomedical Sciences, University of Naples Federico II
| | - Francesco Verde
- Department of Advanced Biomedical Sciences, University of Naples Federico II
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Tootell A, McEntee M, Szczepura K, Hogg P. Effective Dose and Effective Risk from Post-Single Photon Emission Computed Tomography Imaging of the Lumbar Spine. J Med Imaging Radiat Sci 2016; 47:267-275. [PMID: 31047291 DOI: 10.1016/j.jmir.2016.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Planar bone scans play an important role in the staging and monitoring of malignancy and metastases. Metastases in the lumbar spine are associated with significant morbidity; therefore, accurate diagnosis is essential. Supplementary imaging after planar bone scans is often required to characterize lesions; however, this is associated with additional radiation dose. This article provides information on the comparative effective dose and effective risk from supplementary lumbar spine radiographs, low-dose computed tomography (LDCT), and diagnostic CT (DCT). METHOD Organ dose was measured in a phantom using thermoluminescent dosimeters. Effective dose and effective risk were calculated for radiographs, LDCT, and DCT imaging of the lumbar spine. RESULTS Radiation dose was 0.56 mSv for the anteroposterior and lateral lumbar spine radiographs, 0.80 mSv for LDCT, and 3.78 mSv for DCT. Additional imaging resulted in an increase in effective dose of 12.28%, 17.54%, and 82.89% for radiographs, LDCT, and DCT, respectively. Risk of cancer induction decreased as age increased. The difference in risk between the modalities also decreased. Males had a statistically significant higher risk than female patients (P = .023), attributed to the sensitive organs being closer to the exposed area. CONCLUSIONS Effective dose for LDCT is comparable with radiographs of the lumbar spine. With the known benefits of image fusion, it is recommended that LDCT replace radiograph imaging for characterization of lumbar spine lesions identified on planar bone scans. DCT is associated with significantly higher effective dose than LDCT. Effective risk is also higher, and the difference is more marked in younger female patients.
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Affiliation(s)
- Andrew Tootell
- Directorate of Radiography, Centre for Health Sciences Research, University of Salford, Salford, UK.
| | - Mark McEntee
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Katy Szczepura
- Directorate of Radiography, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Peter Hogg
- Directorate of Radiography, Centre for Health Sciences Research, University of Salford, Salford, UK
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Patnaik S, Jyotsnarani Y, Uppin SG, Susarla R. Imaging features of primary tumors of the spine: A pictorial essay. Indian J Radiol Imaging 2016; 26:279-89. [PMID: 27413280 PMCID: PMC4931792 DOI: 10.4103/0971-3026.184413] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Primary tumors of spine are rare accounting for less than 5% of new bone tumors diagnosed every year. These tumors may exhibit characteristic imaging features that can help in early diagnosis and improved prognosis. Plasmacytoma/multiple myeloma and lymphoproliferative tumors are the most common malignant primary spinal tumors. Hemangioma is the most common benign tumor of the spine. Computed tomography is useful to assess tumor matrix and osseous change. Magnetic resonance is useful to study associated soft tissue extension, marrow infiltration, and intraspinal extension. Confusing one tumor with the other based on only imaging findings is not uncommon. However, radiologic manifestations of these tumors need to be correlated with the age, sex, location, and presentation to arrive at a close clinical diagnosis.
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Affiliation(s)
- Sujata Patnaik
- Department of Radiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Y Jyotsnarani
- Department of Radiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantiveer G Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rammurti Susarla
- Department of Radiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Computed tomography and magnetic resonance imaging of maxillofacial lesions in renal osteodystrophy. J Craniofac Surg 2015; 25:1354-7. [PMID: 24902107 DOI: 10.1097/scs.0000000000000819] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study aims to describe the computed tomography (CT) and magnetic resonance (MR) imaging appearance of maxillofacial lesions in renal osteodystrophy. PATIENTS AND METHODS We retrospectively reviewed the CT and MR imaging of maxillofacial region in 9 patients (6 females and 3 males with mean age of 31 yr) with renal osteodystrophy. They presented with facial swelling (n = 6), facial disfigurement (n = 2), and oral cavity mass (n = 1). They underwent CT and MR imaging of the maxillofacial region. RESULTS Brown tumors (n = 6) were seen in the mandible (n = 4) and maxilla (n = 2). They appeared as mixed lytic and sclerotic (n = 4) and sclerotic (n = 2) lesions at CT. The lesions appeared as hypointense at T1-weighted images and of mixed signal intensity at T2-weighted images with intense contrast enhancement (n = 6). Uremic leontiasis ossea (n = 2) appeared at CT as diffuse hyperostosis with protruded maxilla and obliterated sinus. At MR imaging, there was expansion of the maxilla with obliteration of the maxillary sinuses and protrusion of the mandible. The lesion exhibited low signal intensity at T1-weighed images. At T2-weighted images, the lesion showed low signal intensity with small hyperintense lesions. Dystrophic calcification (n = 2) was seen in the parotid and the check. CONCLUSION We concluded that CT and MR imaging are helpful for diagnosis and treatment planning of maxillofacial lesions of patients with renal osteodystrophy.
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Momjian R, George M. Atypical imaging features of tuberculous spondylitis: case report with literature review. J Radiol Case Rep 2014; 8:1-14. [PMID: 25926906 PMCID: PMC4394978 DOI: 10.3941/jrcr.v8i11.2309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Spinal tuberculosis in its typical form that shows destruction of two adjacent vertebral bodies and opposing end plates, destruction of the intervening intervertebral disc and a paravertebral or psoas abscess, is easily recognized and readily treated. Atypical tuberculous spondylitis without the above mentioned imaging features, although seen infrequently, has been well documented. We present, in this report, a case of atypical tuberculous spondylitis showing involvement of contiguous lower dorsal vertebral bodies and posterior elements with paravertebral and epidural abscess but with preserved intervertebral discs. The patient presented in advanced stage with progressive severe neurological symptoms due to spinal cord compression. Non-enhanced magnetic resonance imaging led to misdiagnosis of the lesion as a neoplastic process. It was followed by contrast enhanced computed tomography of the chest and abdomen that raised the possibility of an infectious process and, post-operatively, histopathological examination of the operative specimen confirmed tuberculosis. This case indicates the difficulty in differentiating atypical spinal tuberculosis from other diseases causing spinal cord compression. The different forms of atypical tuberculous spondylitis reported in the literature are reviewed. The role of the radiologist in tuberculous spondylitis is not only to recognize the imaging characteristics of the disease by best imaging modality, which is contrast enhanced magnetic resonance imaging, but also to be alert to the more atypical presentations to ensure early diagnosis and prompt treatment to prevent complications. However, when neither clinical examination nor magnetic resonance imaging findings are reliable in differentiating spinal infection from one another and from neoplasm, adequate biopsy, either imaging guided or surgical biopsy is essential for early diagnosis.
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Affiliation(s)
- Rita Momjian
- Department of Radiology, Khoula Hospital, Muscat, Sultanate of Oman
| | - Mina George
- Department of Histopathology, Khoula Hospital, Muscat, Sultanate of Oman
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Kim YS, Han IH, Lee IS, Lee JS, Choi BK. Imaging findings of solitary spinal bony lesions and the differential diagnosis of benign and malignant lesions. J Korean Neurosurg Soc 2012; 52:126-32. [PMID: 23091671 PMCID: PMC3467370 DOI: 10.3340/jkns.2012.52.2.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 06/03/2012] [Accepted: 08/17/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purpose of this study was to present the MRI and CT findings of solitary spinal bone lesions (SSBLs) with the aims of aiding the differential diagnoses of malignant tumors and benign lesions, and proposing a diagnostic strategy for obscure SSBLs. METHODS The authors retrospectively reviewed the imaging findings of 19 patients with an obscure SSBL on MRI at our hospital from January 1994 to April 2011. The 19 patients were divided to benign groups and malignant groups according to final diagnosis. MRI and CT findings were evaluated and the results of additional work-up studies were conducted to achieve a differential diagnosis. RESULTS At final diagnoses, 10 (52.6%) of the 19 SSBLs were malignant tumors and 9 (47.4%) were benign lesions. The malignant tumors included 6 metastatic cancers, 3 multiple myelomas, and 1 chordoma, and the benign lesions included 4 osteomyelitis, 2 hemangiomas, 2 nonspecific chronic inflammations, and 1 giant cell tumor. No MRI characteristics examined was found to be significantly different in the benign and malignant groups. Reactive sclerotic change was observed by CT in 1 (10.0%) of the 10 malignant lesions and in 7 (77.8%) of the 9 benign lesions (p=0.005). CONCLUSION Approximately half of the obscure SSBLs were malignant tumors. CT and MRI findings in combination may aid the differential diagnosis of obscure SSBLs. In particular, sclerotic change on CT images was an important finding implying benign lesion. Finally, we suggest a possible diagnostic strategy for obscure SSBLs on MRI.
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Affiliation(s)
- Young Soo Kim
- Department of Neurosurgery, Pusan National University Hospital, Busan, Korea
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Anderson ME. Spinal tumors found in the athlete. Clin Sports Med 2012; 31:569-80. [PMID: 22658002 DOI: 10.1016/j.csm.2012.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Spine tumors in the athlete are rare but should be included in the differential diagnosis of any patient in the adolescent or young adult age group with persistent or severe pain. Presenting symptoms are often nonspecific, so a high index of suspicion is needed to diagnose these lesions in a timely fashion. Early recognition and referral to an appropriate multidisciplinary spine tumor center can greatly improve prognosis for these challenging cases.
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Affiliation(s)
- Megan E Anderson
- Children's Hospital Boston, Department of Orthopaedic Surgery, Boston, MA 02115, USA.
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