Alcohol ablation of symptomatic vertebral hemangiomas.

BACKGROUND AND PURPOSE: Many therapeutic techniques have been used for the treatment of symptomatic vertebral hemangiomas (SVH), and each has its own limitations. Our objective was to evaluate the therapeutic efficacy of alcohol ablation for treating these lesions. METHODS: Fourteen patients with SVH were treated by injection of absolute alcohol into the lesion via the percutaneous transpedicular route under CT guidance. Symptoms before treatment included neurologic deficit in 13 patients and debilitating pain in one. All patients underwent preprocedural MR imaging. All patients had clinical and MR imaging follow-up (14 patients at 48-96 hours and 2 months; six at 9-15 months). Results were divided into excellent (resumption of work, alleviation of pain), good (significant improvement), and failure of treatment categories on the basis of subjective assessment of clinical improvement. Clinical improvement/deterioration was correlated with MR-revealed changes. RESULTS: All patients showed transient deterioration of neurologic status after alcohol ablation. Subsequently, excellent results were seen in five patients and eight were in the good category. One patient in whom treatment failed also developed a complication (paravertebral abscess). Four of the eight patients with good results had preprocedural cord changes. Total follow-up ranged from 5 to 31 months, with 11 patients showing stable improvement. One patient developed recurrent hemangioma within a month. Another patient became symptomatic after initial good response, secondary to the collapse of the involved vertebral body. Good correlation was found between clinical improvement and reduction of epidural soft-tissue masses on MR images. Cord signal alteration seen on MR images in four treated patients, however, did not show any change after treatment. CONCLUSION: Alcohol ablation is an effective management option for symptomatic vertebral hemangiomas. Although encouraging results were seen in almost 86% of our patients, a longer follow-up period still is needed to assess the stability of improvement. Potential complications include vertebral collapse and infection.     

聚桂醇注射液与无水乙醇超声引导下治疗肝血管瘤疗效比较

目的 探讨聚桂醇注射液与无水乙醇超声引导下经皮穿刺治疗肝血管瘤的临床疗效与安全性.方法 60例肝血管瘤患者随机分为无水乙醇组和聚桂醇组,每组30例,对比两组患者临床疗效及不良反应发生率.结果 每组临床疗效对比差异无统计学意义(P=0.489,P＞0.05),无水乙醇组不良反应发生率明显高于聚桂醇组,差异有统计学意义(x2=5.963,P=0.03,P＜0.05).结论 超声引导下经皮穿刺聚桂醇注射液与无水乙醇治疗肝血管瘤临床疗效相当,但聚桂醇组不良反应少,疼痛率低,患者耐受性好,此治疗方法值得临床推广应用.     

CT-guided percutaneous ethanol injection of the thymus for treatment of myasthenia gravis

OBJECTIVE: This study was designed to validate the therapeutic effectiveness of CT-guided percutaneous ethanol injection of the thymus for the treatment of myasthenia gravis. SUBJECTS AND METHODS: The subjects were 45 patients with myasthenia gravis. The diagnosis was determined by the patients' histories, physical findings, neostigmine tests, and morphologic changes. According to the Osserman classification, the 45 patients with myasthenia gravis were classified as stage I (n = 26), stage III (n = 13), and stage IV (n = 6). A 21- or 22-gauge needle was inserted into the thymus under CT guidance, and then ethanol was injected step by step until it was distributed throughout the whole thymoma, the hyperplasia of the thymus, or the normal thymus. The amount of ethanol injected ranged from 2 to 13 mL, with a mean of 7 mL. RESULTS: CT follow-up at 3-4 weeks showed that the thymus or thymoma was completely or mostly necrotized. CT follow-up at 3 months showed that the vertical, transverse, and anteroposterior dimensions of the thymus in all 45 myasthenia gravis patients decreased by 59.2%, 68.6%, and 73.2%, respectively, compared with those before percutaneous ethanol injection treatment. The therapeutic effect was observable clinically 2 days after treatment in 44 patients, including 36 patients who were able to open their eyes after treatment. A 5-year follow-up study showed that the condition markedly improved in 35 patients, improved in nine patients, and failed to improve in one patient who did not respond to the treatment. After treatment, 37 patients presented with low-grade fever (range, 37.3-37.7 degrees C; mean, 37.5 degrees C), which resolved 3 days later without treatment; all 45 patients complained of mild retrosternal pain after ethanol injection. CONCLUSION: The therapeutic effect of CT-guided percutaneous ethanol injection into the thymus of patients with myasthenia gravis is definite. This procedure is safe and has low morbidity. CT-guided percutaneous ethanol injection is a minimally invasive alternative treatment for myasthenia gravis.     

Percutaneous Technique for Sclerotherapy of Vertebral Hemangioma Compressing Spinal Cord

Purpose: In this study we report a percutaneous technique to achieve sclerosis of vertebral hemangioma and decompression of the spinal cord and nerve roots. Methods: Under CT guidance the affected vertebral body is punctured by a biopsy needle and sclerosant is injected directly into the tumor. In the case of large paravertebral extension, additional injection is given in the paravertebral soft tissue component to induce shrinkage of the whole tumor mass and release of the compressed spinal cord. Results: Using this technique we treated five patients in whom vertebral hemangioma gave rise to neurologic symptoms. In three patients, sclerotherapy was the only treatment given. In the other two patients, sclerotherapy was preceded by transcatheter embolization. Neither decompressive surgery, radiation therapy nor stabilization was required with this technique. Conclusion: Our experience with CT-guided intraosseous sclerotherapy has proved highly satisfactory.     

Methylene diphosphonate uptake in a case of vertebral hemangioma: demonstration with hybrid SPECT/CT

Osseous hemangiomas are usually asymptomatic. Symptomatic hemangiomas are rare and represent approximately 1% of all cases. Hemangiomas usually present as photopenic defects in methylene diphosphonate (MDP) bone scintigraphy. MDP uptake in vertebral hemangiomas is extremely rare. We report a 20-year-old woman who presented with upper back pain. MDP bone scan showed focus of MDP uptake in the seventh dorsal vertebra. SPECT/CT localized the uptake to vertebral body and transverse process with CT findings suggestive of hemangioma. Further, MRI also confirmed hemangioma in the same location.     

Effect of electrocardiogram triggering on reproducibility of coronary artery calcium scoring

PURPOSE: To determine the prevalence of arterioportal shunt associated with hepatic hemangiomas, describe the two-phase spiral computed tomographic (CT) findings, and correlate the presence of arterioportal shunt with the size and rapidity of enhancement of hemangiomas. MATERIALS AND METHODS: The study group consisted of 109 hepatic hemangiomas in 69 patients who underwent two-phase spiral CT during 1 year. CT scans were obtained during the hepatic arterial (30-second delay) and portal venous (65-second delay) phases after injection of 120 mL of contrast material (3 mL/sec). Arterioportal shunts were diagnosed when hepatic arterial phase CT scans showed a wedge-shaped or irregularly shaped homogeneous enhancement in the liver parenchyma adjacent to the tumor and when portal venous phase CT scans showed isoattenuation or slight hyperattenuation, compared with normal liver in that area, and when there was no demonstrable cause of these attenuation differences. The presence of arterioportal shunt in hemangioma was correlated with the size of the tumor and the rapidity of intratumoral enhancement. RESULTS: Arterioportal shunt was found in 28 (25.7%) of 109 hemangiomas. There was no statistically significant relationship between lesion size and presence of the arterioportal shunt (P =.653). Arterioportal shunt was more frequently found in hemangiomas with rapid enhancement (P <.01). CONCLUSION: Arterioportal shunts are not uncommonly seen in hepatic hemangiomas at two-phase spiral CT. Hemangiomas with arterioportal shunts tend to show rapid enhancement.     

Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas.

PURPOSETo investigate the usefulness of preoperative percutaneous injections in vertebral hemangiomas.METHODSFour patients presented with complicated vertebral hemangioma (spinal cord compression in three cases, intermittent spinal claudiction in one case). A three-part treatment was performed: initially, arterial embolization in three cases; 1 day later, percutaneous injections of methyl methacrylate into the vertebral body to strengthen it and of N-butyl cyanoacrylate into the posterior arch to optimize hemostasis during surgery; finally, the day after percutaneous injections, decompressive laminectomy and epidural hemangioma excision (when present).RESULTSLaminectomy was performed with minimal blood loss. The epidural component present in three cases was excised without any difficulty. The follow-up (average, 20 months) showed no evidence of vertebral collapse.CONCLUSIONPercutaneous injections of methyl methacrylate and N-butyl cyanoacrylate might be useful before surgery for vertebral hemangiomas.     

Patterns of contrast enhancement of benign and malignant hepatic neoplasms during bolus dynamic and delayed CT

Bolus dynamic and delayed computed tomographic (CT) scans of the liver were evaluated in 43 patients with 54 hepatic hemangiomas and 111 patients with primary or secondary malignant hepatic neoplasms. Twelve patterns of contrast enhancement were recognized during the bolus dynamic phase and delayed scanning. A "typical" CT pattern for hemangiomas (present in 29 of 54 hemangiomas [53.7%]) was established: (a) diminished attenuation prior to intravenous contrast medium administration (excluding lesions arising in a liver with diffuse fatty infiltration), (b) peripheral contrast enhancement during the bolus dynamic phase, and (c) complete isodense fill-in on delayed scan images. Using these criteria, we distinguished hemangiomas from malignant neoplasms in most patients. Only one of 63 (1.6%) malignant neoplasms manifested these typical CT criteria of hemangioma. There is an 86% chance that a lesion with the typical CT appearance of hemangioma is actually a hemangioma, even when found in a patient with a known nonhepatic primary neoplasm.     

F18-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of vertebral vascular tumors

PurposeThe uptake of ¹⁸F-FDG is higher in most malignancies than in benign tumors. This study aimed to investigate the diagnostic value of ¹⁸F-FDG PET/CT in vertebral vascular tumors.Materials and methodsWe retrospectively collected PET/CT and clinical data of patients with vertebral vascular tumors and analyzed the location, number, and bone destruction and FDG uptake features of the lesion. We measured SUVmax and maximum diameter and analyzed the correlations between SUVmax and the pathological results, size, and CT features.ResultsTwenty-one pathology-proven vertebral vascular tumors were included: 2 angiosarcomas (SUVmax, 11.6 and 32.3), 1 epithelioid hemangioendothelioma (SUVmax, 5.7), 1 epithelioid hemangioma (SUVmax, 8.5), and 17 aggressive hemangiomas. Twelve cases of typical hemangiomas were included as controls. The SUVmax and diameter of the aggressive hemangiomas were higher than those of the typical hemangiomas. The mean SUVmax of aggressive hemangiomas with cortical destruction was higher than that of those without cortical destruction (t = −2.566, P = 0.022). Radioactive distribution in aggressive hemangiomas was homogeneous and heterogeneous in nine and eight cases, respectively. In six aggressive hemangiomas, the FDG uptake of residual and marginal sclerosing bone was higher than that of the osteolytic destruction area and/or paravertebral soft tissue. Six aggressive hemangiomas involved the spinal canal, without clear visualization on PET/CT.Conclusion¹⁸F-FDG uptake of vertebral malignant vascular tumors is higher than that of hemangiomas. The FDG uptake of hemangiomas varies and may be related to concurrent cortical destruction. ¹⁸F-FDG PET/CT shows limitations in evaluating the spinal canal involvement of aggressive hemangioma.     

眼眶血管瘤CT动态增强诊断探讨

目的 分析眼眶血管性肿瘤的动态增强CT表现,提高对其诊断和鉴别诊断的能力。资料与方法 对24例眼眶血管瘤(海绵状血管瘤13例,静脉性血管瘤11例)行CT动态增强扫描,分析其表现,测定各时间段的CT值。结果 两种肿瘤均有显著强化,多数病例表现为早期局部强化,延迟扫描均匀强化填充,少数病例呈均匀强化;部分静脉性血管瘤填充不完全;两种肿瘤的密度在增强后10min内无下降,20min后才开始降低,它们的CT值在平扫和增强后20min内均无差异,30min时有差异,静脉性血管瘤CT值下降较多(P<0.05)。结论 眼眶海绵状血管瘤和静脉性血管瘤的CT动态增强表现具有特征性,可与其他肿瘤进行鉴别,两者表现较相似,但也有所不同。     

软组织血管瘤介入治疗

目的 分析软组织血管瘤的影像诊断和鉴别诊断,以及介入治疗经验.方法 29例患者,1例婴儿左侧面部巨大毛细血管瘤行左侧颈外动脉造影,未行栓塞治疗;26例静脉畸形中,13例行穿刺造影和无水乙醇加平阳霉素和碘油乳剂硬化治疗;1例左肘和1例右小腿肌肉蔓状血管瘤(AVF和AVM)使用真丝线段或PVA颗粒行末梢动脉栓塞,使用钢圈行主干栓塞.结果 1例要儿面部巨大毛细血管瘤供血动脉增粗,染色明显,引流静脉增粗.10例静脉畸形的X线平片显示静脉石;13例MRI显示T_1等信号,T_2高信号,增强有强化;3例CT示血管瘤软组织肿块;9例初诊彩超显示血管瘤内异常血流.行血管瘤造影18例,成功16例,其中行血管瘤硬化治疗13例,注射1～5次,无水乙醇碘油乳剂硬化治疗5例,痊愈1例,好转4例; 无水乙醇加平阳霉素和碘油乳剂治疗8例,其中6例痊愈,2例好转.结论 软组织血管瘤正确的影像诊断可协助治疗方案的制订.根据血管畸形的血流情况可采用不同的介入方法.     

Percutaneous Pediculoplasty for Vertebral Hemangioma Involving the Neural Arch: A Case Report

Vertebral hemangiomas occasionally involve the neural arch and they can be symptomatic. We report a case of symptomatic vertebral hemangioma mainly involving the unilateral neural arch which was successfully treated with percutaneous pediculoplasty using a single-needle technique.     

经皮椎体成形术的初步临床应用

目的　探讨经皮椎体成形术治疗椎体病变的临床效果。方法　应用经皮椎体成形术治疗2 5例椎体病变 ,其中骨质疏松性骨折 13例、转移性肿瘤 8例、血管瘤 4例。病变部位分别在L112个、L2 6个、T12 和L4均为 4个、L3 3个、L5和S1各 1个。在C形臂X线机透视导向下 ,经皮穿刺到病变椎体后注入 3～ 10ml骨水泥 (平均 5 .6ml) ,术毕患者保持仰卧位 4h ,观察、抗感染治疗 1～ 3d并复查平片或和CT后出院。观察止痛效果、有效率和并发症。结果　技术操作全部获得成功 ,共治疗 2 5例 31个椎体 (其中 2 3例 2 9个椎体行单侧穿刺、2例 2个椎体行双侧穿刺 ) ,18例疼痛完全缓解 ,6例明显好转 ,1例无明显改善。 2例存在一过性神经根刺激症状 ,予以激素、消炎止痛后疼痛明显减轻并逐渐消失。随访 1～ 15个月 ,所有患者疼痛无反复。无严重并发症发生。结论　创伤小、操作简单、并发症少 ,能有效缓解骨质疏松性椎体压缩骨折和椎体肿瘤引起的临床症状     

Spinal epidural cavernous hemangioma: MR findings

PURPOSE: Cavernous hemangiomas with a spinal epidural location are very uncommon vascular tumors in contrast to those in the vertebral body. The purpose of this study was to describe the radiologic findings, focusing on the MR studies, of spinal epidural cavernous hemangiomas. METHOD: Five pathologically proven cases of spinal epidural cavernous hemangioma were retrospectively reviewed. MR (n = 5) and CT (n = 1) were evaluated. RESULTS: The level was thoracic (n = 4) or lumbosacral (n = 1). The mass was located in the epidural space and showed paravertebral extension in all cases. It showed a lobulated contour in all cases and encircled the spinal cord partially with a larger posterior (n = 3) or anterior (n = 1) component in four cases. In all cases, the mass showed high signal intensity on T2-weighted images and homogeneous, strong enhancement. Adjacent bony erosion (n = 5) and intervertebral neural foraminal widening (n = 4) were common. CONCLUSION: Spinal epidural cavernous hemangioma shows characteristic MR findings of a lobulated contoured epidural mass partially encircling the spinal cord with a larger posterior component in the spinal canal, high signal intensity on T2-weighted images, and homogeneous, strong enhancement.     

椎体动脉栓塞治疗椎体血管瘤的临床应用与研究(附5例报告)

目的:探讨椎体动脉栓塞法治疗椎体血管瘤的优越性及其临床应用价值。材料与方法:使用两种栓塞材料——真丝线段0.5cm长的1号医用缝合丝线,可吸收明胶海棉块1mm~3,对5例椎体血管瘤患者进行了栓塞治疗,5例均为女性,年龄29～62岁,其中胸,_(12)2例,胸_(10)腰_3及胸_8人工椎体置换术后复发各1例,5例患者均有不同程度的脊髓、神经根压迫症状,2例出现痉挛性截瘫。结果:5例患者经栓塞治疗后,除1例于1年后死于肝癌,但其症状有明显改善;4例均在一段时间后,临床症状和体征基本消失或完全恢复正常,生活完全自理,随访6～10年无复发,取得显著疗效。结论:椎体动脉栓塞治疗椎体血管瘤是一种安全、有效的治疗方法,与手术及放射疗法比较有明显的优越性。     

Fluoroscopy guided L5-S1 transforaminal injection as a treatement for s1 radiculopathy

OBJECTIVE: To assess the efficacy of fluoroscopy guided L5-S1 transforaminal steroid injections for the treatment of S1 radiculopathy secondary to intervertebral disk disorder. METHOD: 41 patients were included: prospective study (20 patients) and retrospective study (21 patients). All patients suffered from S1 radiculopathy secondary to nerve root compression by intervertebral disk material, as demonstrated by lumbar spine CT. The patients underwent 2 fluoroscopy guided L5-S1 transforaminal injections of steroid (Hydrocotancyl 125 mg), at 8 days interval. RESULTS: 60% of patients showed significant improvement of their painful radiculopathy at day 8 (n:41), 60-67% at day 30 (n:41) and 67% at day 90 (n:18). CONCLUSION: Fluoroscopy guided L5-S1 transforaminal injection showed good efficacy in the treatment of S1 radiculopathy.     

Vertebroplasty as treatment of aggressive and symptomatic vertebral hemangiomas: up to 4 years of follow-up

Introduction  This study aimed to illustrate the validity of the treatment with vertebroplasty (VP) in patients with aggressive or symptomatic vertebral hemangioma (VH) with or without epidural extension. Methods  From January 2003 to December 2007, 24 consecutive patients have been treated with VP, for a total of 36 vertebral bodies affected by VH: two cervical, ten dorsal, 24 lumbar. All the patients complained of a pain syndrome resistant to continuous medical medication; four of 24 patients also presented aggressive magnetic resonance features of the vertebral lesion and two patients showed also epidural extension. A unipedicular approach has been performed in 16 patients; a bipedicular approach has been performed in six, while for the cervical spine an anterior–lateral approach with manual dislocation of the carotid axis has always been performed. Bone biopsy was never done. All procedures have been carried out with local anesthesia, except for the treatment of the cervical hemangiomas which has always been performed under general anesthesia. Four vertebral bodies in the same session have been treated in one case. Results  Results have been evaluated with the visual analog scale and the Oswestry Disability Index methods. In all the patients, in the following 24–72 h, a successful outcome has been observed with a complete resolution of pain symptom. Extravertebral vascular or discal cement leakage has been observed in four patients, without any onset of clinical radicular syndrome due to epidural diffusion. Clinical and radiological follow-up until 4 years has been performed in 12 patients and it showed stability of the treatment and absence of pain. Conclusions  Percutaneous treatment with VP for aggressive and symptomatic vertebral hemangiomas even with epidural extension is a valuable, mini-invasive, and quick method that allows a complete and enduring resolution of the painful vertebral symptoms without findings of fracture of a vertebral body adjacent or distant to the one treated.     

Ergebnisse der Strahlentherapie von Wirbelkörperangiomen

PURPOSE: Assessment of treatment results of symptomatic vertebral hemangiomas and review of the literature (Table 3). PATIENTS AND METHODS: Ten patients treated between 1974 to 1997 were retrospectively analyzed. Efficacy of treatment was determined according to improvement of pain and/or neurological symptoms (Table 1). RESULTS: Improvement was achieved in 8 of 10 patients. The initially existing neurological symptoms of 3 patients disappeared completely in 2 cases and improved in 1 case. Acute side effects were slight. Late side effects were not seen. A dose-effect relationship could not be assessed. There was no relapse. CONCLUSION: Radiotherapy with 30 Gy for symptomatic vertebral angioma as primary therapy is indicated. In case of neurological symptoms a radiotherapy after operative therapy is recommendable even if the patient is free of symptoms to prevent progress or relapse.     

Hepatic hemangioma: dynamic bolus CT

Forty-seven patients with 58 hepatic hemangiomas were studied prospectively with a dynamic bolus CT protocol (single-level or incremental scans) that included precontrast scans, rapid-sequence scanning during the IV bolus injection of 150 ml of 60% contrast agent, and delayed scans taken as long as 60 min after contrast. Three CT criteria are believed to be necessary to make a specific diagnosis of hemangioma: lesion with diminished attenuation on precontrast scan; peripheral contrast enhancement during the dynamic bolus phase of scanning; and complete isodense fill-in on delayed scans obtained up to 60 min after contrast. These CT criteria were seen in only 32 (55%) of 58 hemangiomas, making CT a relatively poor imaging technique for diagnosis.     

儿童肝脏血管瘤的介入治疗方法及疗效的初步探讨

目的探索儿童肝脏血管瘤的介入治疗方法及疗效。 方法回顾性分析我院31例实施肝脏血管瘤介入治疗患者的临床资料。年龄6 d至9岁；先天型肝脏血管瘤26例，婴儿型肝脏血管瘤5例；肝脏多发病变5例，单发病变26例。所有患者均接受CT平扫、CT增强扫描以及肝脏血管瘤硬化栓塞术。依据患者治疗前后CT影像学表现，分析肝脏血管瘤硬化栓塞术对不同分型患者治疗疗效。采用配对样本t检验分别比较婴儿型及先天型肝血管瘤介入治疗术前、术后体积差异。 结果23例接受单次介入治疗，6例接受2次介入治疗，2例接受3次介入治疗。26例患儿接受随访，包括先天型肝血管瘤23例，婴儿型肝血管瘤3例。11例瘤体完全消失，患儿完全康复，15例瘤体部分缩小（4例缩小70%以上，效果显著；6例缩小30%~50%，部分有效；5例缩小低于30%，效果欠佳）。先天型肝血管瘤术前、术后平均体积分别为（161.86 ± 21.40）cm³、（41.46 ± 9.73）cm³，婴儿型肝血管瘤术前、术后平均体积分别为（22.73 ± 1.92）cm³、（11.18 ± 3.18）cm³，术前、术后体积差异均具有统计学意义（P < 0.001）。 结论肝脏血管瘤硬化栓塞术是一种安全、有效的微创治疗方法，对儿童肝脏血管瘤治疗效果较好，且术前分型是儿童肝脏血管瘤介入治疗疗效的重要因素。