Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring

Purpose

To evaluate technical success, complications, and effective dose in patients undergoing CT fluoroscopy-guided iliosacral screw placement for the fixation of unstable posterior pelvic ring injuries.

Materials and methods

Our retrospective analysis includes all consecutive patients with vertical sacral fractures and/or injury of the iliosacral joint treated with CT fluoroscopy-guided screw placement in our department from 11/2005 to 03/2013. Interventions were carried out under general anesthesia and CT fluoroscopy (10–20 mAs; 120 kV; 16- or 128-row scanner, Siemens Healthcare, Erlangen, Germany). Technical outcome, major and minor complications, and effective patient dose were analyzed.

Results

We treated 99 consecutive patients (mean age 53.1?±?21.7 years, 50 male, 49 female) with posterior pelvic ring instability with CT fluoroscopy-guided screw placement. Intervention was technically successful in all patients (n?=?99). No major and one minor local complication occurred (1 %, secondary screw dislocation). General complications included three cases of death (3 %) due to pulmonary embolism (n?=?1), hemorrhagic shock (n?=?1), or cardiac event (n?=?1) during a follow-up period of 30 days. General complications were not related to the intervention. Mean effective patient radiation dose per intervention was 12.28 mSv?±?7.25 mSv. Mean procedural time was 72.1?±?37.4 min.

Conclusions

CT fluoroscopy-guided screw placement for the treatment of posterior pelvic ring instabilities can be performed with high technical success and a low complication rate. This method provides excellent intrainterventional visualization of iliac and sacral bones, as well as the sacral neuroforamina for precise screw placement by applying an acceptable effective patient dose.     

Coblation vertebroplasty for complex vertebral insufficiency fractures

Objectives

Coblation to create a cavity in the affected vertebral body was performed for complex fractures and/or when there was a posterior wall defect. This permitted a low-pressure injection and potentially reduces the risk of extravasation of cement into the spinal canal.

Methods

Prospective audit for outcome measures and complications allowed retrospective review of cases treated by coblation. A commercial wand inserted via a wide-bore vertebroplasty needle created a cavity before inserting cement. A visual analogue scale assessed pain and Roland Morris scoring assessed mobility.

Results

Thirty-two coblation procedures were performed. Primary diagnoses were myeloma, metastases, osteoporosis and trauma. Outcome measures were recorded with a 56 % success rate, 6 % no change and 32 % with mixed but mainly positive results; 6 % died before follow-up. No complications were observed; in particular no patient suffered neurological damage and none have developed subsequent fractures at the treated levels.

Conclusions

This technique makes possible cementation of patients who would otherwise be unsuitable for vertebroplasty. The modest pain and disability improvement is partly due to our stringent criteria as well as fracture complexity. Further work will assess the efficacy of the method compared with conservative measures.

Key Points

? Treatment of vertebral compression fractures with possible posterior wall defects is controversial. ? Coblation before vertebroplasty allows a low-pressure injection into fractured vertebrae. ? This technique reduces risk of extravasation of cement. ? No serious complication of our coblation procedures was observed.     

Ten-year experience of percutaneous image-guided radiofrequency ablation of malignant renal tumours in high-risk patients

Objectives

To evaluate survival and outcomes after percutaneous radiofrequency ablation (RFA) of malignant renal tumours in high-risk patients with long-term follow-up.

Methods

Between 2002 and 2009, 62 patients (71 tumours), with a median age of 73.5 years (20–87), consecutively treated with RFA under ultrasound or computed tomography guidance for malignant renal tumours were retrospectively selected and prospectively followed until 2012, including 25 patients (40.3 %) with solitary kidney and 7 cystic cancers. Maximal tumour diameters were between 8 and 46 mm (median: 23 mm).

Results

Radiofrequency ablation was technically possible for all patients. Mean follow-up was 38.8 months (range: 18–78 months). Primary and secondary technique effectiveness was 95.2 % and 98.4 % per patient respectively. The rates of local tumour progression and metastatic evolution were 3.2 % and 9.7 % per patient and were associated with tumour size >4 cm (P?=?0.005). The disease-free survival rates were 88.3 % and 61.9 % at 3 and 5 years. No significant difference in glomerular filtration rates before and after the procedure was observed (P?=?0.107). The major complications rate was 5.9 % per session with an increased risk in the case of central locations (P?=?0.006).

Conclusions

Percutaneous renal RFA appears to be safe and effective with useful nephron-sparing results.

Key Points

? Radiofrequency ablation (RFA) is a well-tolerated technique according to mid-term results. ? RFA for malignant renal tumours preserved renal function in high-risk patients. ? Mid-term efficacy of RFA was close to that of formal conservative surgery. ? Tumour size and central location limit the efficacy and safety of RFA.     

Percutaneous radiofrequency ablation of small renal tumours in patients with a single functioning kidney: long-term results

Objectives

To evaluate the long-term results of percutaneous radiofrequency ablation (RFA) of small renal tumours in patients with a single functioning kidney (SFK).

Methods

This is a single-centre prospective study. Patients with an SFK and a tumour smaller than 3.5 cm, treated with RFA over a 7.5-year period, were included. Nineteen consecutive patients (12 male), aged between 33 and 83 years (mean 61.4), were treated for 23 lesions. Primary endpoints were technical success and tumour recurrence rate. Secondary endpoints were the deterioration of renal function and overall survival rate.

Results

The mean follow-up was 56.1 months (range 36–102). Primary technical success was 100 %. There were no major peri-procedural complications. In two cases, minor complications occurred. There was no significant difference between the baseline glomerular filtration rate (GFR) and GFR at 3, 12 and 24 months post-procedure. In four lesions (17 %), recurrence was detected and an additional RFA session was performed. None of the patients developed renal failure during their lifetime. Three of the patients died because of other reasons.

Conclusions

Percutaneous RFA of small renal tumours in patients with an SFK offers very satisfactory long-term results regarding preservation of renal function, local tumour control and overall survival.

Key Points

? Tumour in a single functioning kidney requires minimally invasive treatment. ? Radiofrequency ablation plays an established role in managing small renal tumours. ? Long-term results of radiofrequency ablation have shown satisfactory local tumour control. ? Long-term results have also shown that renal function may be preserved.     

Safety and Efficacy of Sacroplasty for Sacral Fractures: A Systematic Review and Meta-Analysis

PurposeTo evaluate the safety and efficacy of sacroplasty for the treatment of osteoporotic and malignant sacral fractures by performing a systematic review and meta-analysis of existing literature.Materials and MethodsPubMed, Web of Science, and SCOPUS databases were searched from their inception until February 2018 for articles describing sacroplasty. Inclusion criteria were as follows: studies reporting > 5 patients, and pain assessment before and after the procedure recorded with visual analog scale (VAS). Demographic data, procedural details, technical success rates, VAS scores before and after the procedure, and procedural complications were recorded. A random-effects meta-analyses of the VAS pain score before the procedure, at 24–48 hours, at 6 months, and at 12 months were calculated.ResultsNineteen studies (18 case series and 1 cohort study) were identified consisting of 861 total patients (682 women and 167 men; mean age 73.89 ± 9.73 years). Patients underwent sacroplasty for the following indications: sacral insufficiency fractures secondary to osteoporosis (n = 664), malignancy (n = 167), and nonspecified sacral insufficiency fractures (n = 30). Technical and clinical successes were achieved in 98.9% (852/861) and 95.7% (623/651) of patients undergoing sacroplasty, respectively. The pooled major complication rate was 0.3%, with 3 patients requiring surgical decompression for cement leakage. Random-effects meta-analyses demonstrated statistically significant differences in the VAS pain level at preprocedure, 24–48 hours, 6 months, and 12 months, with cumulative pain scores of 8.32 ± 0.01, 3.55 ± 0.01, 1.48 ± 0.01, and 0.923 ± 0.01, respectively.ConclusionsSacroplasty appears safe and effective for pain relief in patients with osteoporotic or malignant sacral fractures, with statistically significant sustained improvement in VAS pain scores up to 12 months.     

Percutaneous long bone cementoplasty of the limbs: experience with fifty-one non-surgical patients

Objective

To review our 10-year experience with percutaneous long bone cementoplasty (PLBC) in poor surgical patients.

Materials and methods

Fifty-one patients were included. Primary endpoints were pain and functional outcomes one month following PLBC. A secondary endpoint dealt with factors predicting cement leakage. Delayed adverse events and overall survival (OS) were also investigated.

Results

Sixty-six lesions were treated. Local pain relief at 1-month occurred in 59/66 lesions (89.4 %); pain improvement was significantly more common for lesions of the upper limb (p?p <0.05). Cement leakage was minor and asymptomatic in 26 cases (26/66, 39.4 %); in one case (1/66, 1.5 %) symptomatic minor amount of intra-articular cement leakage occurred. Factors predicting cement leakage were diaphyseal location of the lesions, cortical bone disruption and extra-bone tumour extension (p?Conclusions For poor surgical candidates, at 1-month follow-up, PLBC proved to be safe and effective. If stress fracture occurs following PLBC, surgical external fixation is still an affordable therapeutic option.

Key Points

? Percutaneous long bone cementoplasty may be proposed to poor surgical patients ? Pain palliation is more significant for lesions of the upper limb ? Limb function improves significantly for lesions sized?≤?3 cm ? Fracture is the most common delayed adverse event (9 % of cases) ? If cement stress fracture occurs, surgical external fixation is still feasible     

Combined use of percutaneous cryoablation and vertebroplasty with 3D rotational angiograph in treatment of single vertebral metastasis: comparison with vertebroplasty

Introduction

This study aims to assess the effectiveness of combined procedure of cryoablation and vertebroplasty (CVT) for reduction of pain and improvement of the quality of life in patients with single painful metastatic vertebral fractures.

Methods

We retrospectively analyzed data from 23 patients with single vertebral metastasis treated with combined procedure of CVT, compared with those obtained in 23 patients treated by vertebroplasty. Pain intensity was evaluated by a visual analog scale (VAS) score administered before and 1 day, 1 week, and 1, 3, and 6 months after procedure. Quality of life was evaluated by an Oswestry Disability Index (ODI) score administered before and at 3 and 6 months after procedure.

Results

Procedural success was achieved in all patients without any complications. The VAS and ODI scores showed a reduction in both groups during follow-up (VAS score, p?<?0.05 and p?<?0.001, respectively; ODI score, p?<?0.0001). No difference of the VAS and ODI scores were observed before treatment (p?=?0.33 and 0.78, respectively). VAS score showed a difference at 1 week and 1, 3, and 6 months after treatment (p?<?0.001). ODI score showed a difference at 3 and 6 months after treatment (p?<?0.001).

Conclusion

Our findings suggested that combined procedure of CVT is safe and effective for pain relief in single metastatic vertebral fractures, especially when other standard palliative treatments have failed, and improves disability. Careful needle positioning and accurate fluoroscopic and CT guidance are mandatory for a complication-free treatment.     

Thoraco-lumbar traumatic vertebral fractures augmentation by osteo-conductive and osteo-inductive bone substitute containing strontium–hydroxyapatite: our experience

Introduction

The aim of our study was to evaluate the effectiveness of osteointegrable strontium–hydroxyapatite (Sr–HA) bone cement in the treatment of thoracolumbar traumatic vertebral fractures by percutaneous vertebroplasty (VTP).

Methods

We treated 35 patients [29 (82.85 %) men, 6 (17.14 %) women, mean age 34.05?±?8.36 years (range 21–54 years)] with single type A1.1 and A1.2 thoracolumbar traumatic vertebral fracture without endospecal bone fragments. Pain intensity was evaluated before and at 1 day; 1 week; and 1, 6, and 12 months after VTP by a 10-point visual analog scale (VAS) score (0?=?no pain, 10?=?unbearable pain). Physical status and quality of life were evaluated by Oswestry Disability Index (ODI) questionnaire before and 1, 6, and 12 months after VTP.

Results

Procedural technical success was achieved in all patients with no deaths observed during follow-up. In three patients (8.57 %), postprocedural CT showed cement leakages: one intradiscal and two in venous plexus. No adjacent vertebral body fractures nor intrasomatic recollapse was detected. The VAS and ODI scores showed a statistically significant reduction 1 week after procedure (P value <0.0001) with a progressive statistically significant reduction during follow-up (P value <0.0001). Twenty-three patients (65.71 %) assigned a value of 0 to the VAS scale at 1 year after treatment.

Conclusions

Strontium–hydroxyapatite bone cement is an effective and safe bone filler in percutaneous vertebroplasty with low leakage rate and absence of major complications when performed by a skilled equipe. It allows an immediate and long-lasting stabilization with a significant pain reduction and quality of life improvement.     

Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study

Objectives

To assess factors influencing prostate cancer detection on multiparametric (T2-weighted, diffusion-weighted, and dynamic contrast-enhanced) MRI.

Methods

One hundred and seventy-five patients who underwent radical prostatectomy were included. Pre-operative MRI performed at 1.5 T (n?=?71) or 3 T (n?=?104), with (n?=?58) or without (n?=?117) an endorectal coil were independently interpreted by two radiologists. A five-point subjective suspicion score (SSS) was assigned to all focal abnormalities (FAs). MR findings were then compared with whole-mount sections.

Results

Readers identified 192–214/362 cancers, with 130–155 false positives. Detection rates for tumours of <0.5 cc (cm³), 0.5–2 cc and >2 cc were 33–45/155 (21–29 %), 15–19/35 (43–54 %) and 8–9/12 (67–75 %) for Gleason ≤6, 17/27 (63 %), 42–45/51 (82–88 %) and 34/35 (97 %) for Gleason 7 and 4/5 (80 %), 13/14 (93 %) and 28/28 (100 %) for Gleason ≥8 cancers respectively. At multivariate analysis, detection rates were influenced by tumour Gleason score, histological volume, histological architecture and location (P?<?0.0001), but neither by field strength nor coils used for imaging. The SSS was a significant predictor of both malignancy of FAs (P?<?0.005) and aggressiveness of tumours (P?<?0.00001).

Conclusions

Detection rates were significantly influenced by tumour characteristics, but neither by field strength nor coils used for imaging. The SSS significantly stratified the risk of malignancy of FAs and aggressiveness of detected tumours.

Key Points

? Prostate cancer volume, Gleason score, architecture and location are MRI predictors of detection. ? Field strength and coils used do not influence the tumour detection rate. ? Multiparametric MRI is accurate for detecting aggressive tumours. ? A subjective suspicion score can stratify the risk of malignancy and tumour aggressiveness.     

Cementoplasty for managing painful bone metastases outside the spine

Objective

To illustrate the effect of treatment with cementoplasty in patients with painful bone metastases in the extraspinal region.

Methods

A retrospective study was conducted to review 51 consecutive patients who underwent cementoplasty under CT or fluoroscopic guidance, a total of 65 lesions involving the ilium, ischium, pubis, acetabulum, humeral, femur and tibia. In 5 patients with a high risk of impending fracture in long bones based on Mirels’ scoring system, an innovative technique using a cement-filled catheter was applied. The clinical effects were evaluated using the visual analogue scale (VAS) preoperatively and postoperatively.

Results

All patients were treated successfully with a satisfying resolution of painful symptoms at 3 months’ follow-up. Cement leakage was found in 8 lesions without any symptoms. VAS scores decreased from 8.19?±?1.1 preoperatively to 4.94?±?1.6 at 3 days, 3.41?±?2.1 at 1 month and 3.02?±?1.9 at 3 months postoperatively. There was a significant difference between the mean preoperative baseline score and the mean score at all of the postoperative follow-up points (P?<?0.01).

Conclusions

Cementoplasty is an effective technique for treating painful bone metastases in extraspinal regions, which is a valuable, minimally invasive, method that allows reduction of pain and improvement of patients’ quality of life.

Key Points

? Metastases in long bones may cause pain and subsequent pathological fractures. ? Cement-filled catheter resulted in a fixation effect to prevent pathological fractures. ? Cementoplasty resulted in significant pain relief in patients with extraspinal metastases.     

MR-guided facet joint injection therapy using an open 1.0-T MRI system: an outcome study

Objectives

To evaluate the accuracy, safety and efficacy of magnetic resonance imaging (MRI)-guided facet joint injection therapy using a 1.0-T open MRI.

Methods

One hundred and sixty-six facet joint blocks in 45 patients with lower back pain were performed under MR fluoroscopic guidance using a proton-density-weighted turbo-spin-echo sequence. An in-room monitor, wireless MR-mouse for operator-controlled multiplanar navigation, a flexible surface coil and MR-compatible 20-G needle were used. Clinical outcome was evaluated by questionnaire before intervention and after 1 week, 3, 6 and 12 months using a numerical visual analogue scale (VAS).

Results

All facet joint blocks were considered technically successful with distribution of the injectant within and/or around the targeted facet joint. No major complications occurred. The final outcome analysis included 38 patients. An immediate effect was reported by 63 % of the patients. A positive mid-/long-term effect was seen in 13 patients (34 %) after 6 months and in 9 patients (24 %) after 12 months. Mean VAS was reduced from 7.1?±?1.7 (baseline) to 3.5?±?2.2, 4.1?±?3.0, 3.8?±?2.9 and 4.6?±?2.9 at 1 week, 3, 6 and 12 months (P?<?0.01).

Conclusions

MR-guided facet joint injection therapy of the lumbosacral spine is accurate, safe and efficient in the symptomatic treatment of lower back pain.

Key Points

? MR-guided facet joint infiltration provides an alternative to CT and conventional fluoroscopy. ? Clinical outcomes are comparable with conventional fluoroscopy and CT-guided facet joint interventions. ? Ionising radiation can be avoided for both patient and physician. ? MR-guided facet joint injection provides safe and effective treatment of back pain.     

Automatic detection of osteoporotic vertebral fractures in routine thoracic and abdominal MDCT

Objectives

To develop a prototype algorithm for automatic spine segmentation in MDCT images and use it to automatically detect osteoporotic vertebral fractures.

Methods

Cross-sectional routine thoracic and abdominal MDCT images of 71 patients including 8 males and 9 females with 25 osteoporotic vertebral fractures and longitudinal MDCT images of 9 patients with 18 incidental fractures in the follow-up MDCT were retrospectively selected. The spine segmentation algorithm localised and identified the vertebrae T5-L5. Each vertebra was automatically segmented by using corresponding vertebra surface shape models that were adapted to the original images. Anterior, middle, and posterior height of each vertebra was automatically determined; the anterior-posterior ratio (APR) and middle-posterior ratio (MPR) were computed. As the gold standard, radiologists graded vertebral fractures from T5 to L5 according to the Genant classification in consensus.

Results

Using ROC analysis to differentiate vertebrae without versus with prevalent fracture, AUC values of 0.84 and 0.83 were obtained for APR and MPR, respectively (p?<?0.001). Longitudinal changes in APR and MPR were significantly different between vertebrae without versus with incidental fracture (ΔAPR: -8.5 %?±?8.6 % versus -1.6 %?±?4.2 %, p?=?0.002; ΔMPR: -11.4 %?±?7.7 % versus -1.2 %?±?1.6 %, p?<?0.001).

Conclusions

This prototype algorithm may support radiologists in reporting currently underdiagnosed osteoporotic vertebral fractures so that appropriate therapy can be initiated.

Key points

? This spine segmentation algorithm automatically localised, identified, and segmented the vertebrae in MDCT images. ? Osteoporotic vertebral fractures could be automatically detected using this prototype algorithm. ? The prototype algorithm helps radiologists to report underdiagnosed osteoporotic vertebral fractures.     

MR guidance and thermometry of percutaneous laser disc decompression in open MRI: an initial clinical investigation

Objectives

To assess the feasibility, safety and efficacy of real-time MR guidance and thermometry of percutaneous laser disc decompression (PLDD).

Methods

Twenty-four discs in 22 patients with chronic low-back and radicular pain were treated by PLDD using open 1.0-T magnetic-resonance imaging (MRI). A fluoroscopic proton-density-weighted turbo spin-echo (PDw TSE) sequence was used to position the laser fibre. Non-spoiled gradient-echo (GRE) sequences were employed for real-time thermal monitoring based on proton resonance frequency (PRF). Radicular pain was assessed over 6 months with a numerical rating scale (NRS).

Results

PLDD was technically successful in all cases, with adequate image quality for laser positioning. The PRF-based real-time temperature monitoring was found to be feasible in practice. After 6 months, 21 % reported complete remission of radicular pain, 63 % at least great pain relief and 74 % at least mild relief. We found a significant decrease in the NRS score between the pre-intervention and the 6-month follow-up assessment (P?<?0.001). No major complications occurred; the single adverse event recorded, moderate motor impairment, resolved.

Conclusions

Real-time MR guidance and PRF-based thermometry of PLDD in the lumbar spine under open 1.0-T MRI appears feasible, safe and effective and may pave the way to more precise operating procedures.

Key Points

? Percutaneous laser disc decompression (PLDD) is increasingly used instead of conventional surgery. ? Open 1.0-T MRI with temperature mapping seems technically successful in monitoring PLDD. ? Pain relief was at least ‘great’ in 64?% of patients. ? No major complications occurred. ? Open 1.0-T MRI appears a safe and effective option for patient-tailored PLDD.     

Diffusion-weighted MR imaging for differentiating borderline from malignant epithelial tumours of the ovary: pathological correlation

Objectives

To investigate diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiating borderline from malignant epithelial tumours of the ovary.

Methods

This retrospective study included 60 borderline epithelial ovarian tumours (BEOTs) in 48 patients and 65 malignant epithelial ovarian tumours (MEOTs) in 54 patients. DW imaging as well as conventional MR imaging was performed. Signal intensity on DW imaging was assessed and apparent diffusion coefficient (ADC) value was measured. The results were correlated with histopathology and cell density.

Results

The majority of MEOTs showed high signal intensity on DW imaging, whereas most BEOTs showed low or moderate signal intensity (P?=?0.000). The mean ADC value of the solid components in BEOTs (1.562?±?0.346?×?10^?3 mm²/s) was significantly higher than in MEOTs (0.841?±?0.209?×?10^?3 mm²/s). A threshold value of 1.039?×?10^?3 mm²/s permitted the distinction with a sensitivity of 97.0 %, a specificity of 92.2 % and an accuracy of 96.4 %. There was an inverse correlation between ADC value and cell density (r?=??0.609; P?=?0.0000) which was significantly lower in BEOTs than in MEOTs.

Conclusions

DW imaging is useful for differentiating borderline from malignant epithelial tumours of the ovary.

Key Points

? DW MR imaging is useful for differentiating BEOTs from MEOTs. ? Patients with BEOTs are treated differently from patients with MEOTs. ? Conservative fertility-sparing laparoscopic surgery can be performed in patients with BEOTs. ? BEOTs often affect young women of childbearing age.     

Percutaneous Sacroplasty for Sacral Metastatic Tumors Under Fluoroscopic Guidance Only

Percutaneous sacroplasty is a safe and effective procedure for sacral insufficient fractures under CT or fluoroscopic guidance; although, few reports exist about sacral metastatic tumors. We designed a pilot study to treat intractable pain caused by a sacral metastatic tumor with sacroplasty. A 62-year-old man and a 38-year-old woman with medically intractable pain due to metastatic tumors of S1 from lymphoma and lung cancer, respectively, underwent percutaneous sacroplasty. Over the course of the follow-up period, the two patients experienced substantial and immediate pain relief that persisted over a 3-month and beyond. The woman had deposition of PMMA (polymethyl methacrylate) in the needle track, but did not experience significant symptoms. No other peri-procedural complications were observed for either patient.     

An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry

PurposeTo evaluate the efficacy of sacroplasty for treating sacral insufficiency fractures, including the effect on pain relief, patient function and adverse event rates in an as-treated on-label prospective data registry.Materials and MethodsObservational data including patient reported outcomes (PROs), patient characteristics, osteoporosis treatment, fracture duration, cause of sacral fractures and image guidance used for treatment were collected for patients undergoing sacroplasty. The PROs were collected at baseline then at one, three, and at six months following the procedure. The primary outcomes were pain as measured by the Numerical Rating Scale (NRS) and function as measured by the Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes included adverse events, cement leakage, new neurologic events, readmissions and death.ResultsThe interim results for the first 102 patients included significant pain reduction with mean pain improvement scores at six months decreasing from 7.8 to 0.9 (P < .001) and significant improvement in function with mean RMDQ scores improving from 17.7 to 5.2 (P < .001). Most procedures were performed under fluoroscopy (58%). There was cement leakage in 17.7% of the subjects but only one adverse event which was a new neurologic deficit related to cement extravasation. The readmission rate was 16% mostly due to additional back pain and fractures and there were no subject deaths.ConclusionsSacroplasty with cement augmentation for acute, subacute and chronic painful sacral insufficiency fractures caused by osteoporosis or neoplastic disorders results in highly significant improvements in pain and function with very low rate of procedural related adverse events.     

Magnetic resonance-derived circumferential strain provides a superior and incremental assessment of improvement in contractile function in patients early after ST-segment elevation myocardial infarction

Background

We evaluate whether circumferential strain derived from grid-tagged CMR is a better method for assessing improvement in segmental contractile function after STEMI compared to late gadolinium enhancement (LGE).

Methods

STEMI patients post primary PCI underwent baseline CMR (day 3) and follow-up (day 90). Cine, grid-tagged and LGE images were acquired. Baseline LGE infarct hyperenhancement was categorised as ≤25 %, 26-50 %, 51-75 % and >75 % hyperenhancement. The segmental baseline circumferential strain (CS) and circumferential strain rate (CSR) were calculated from grid-tagged images. Segments demonstrating an improvement in wall motion of ≥1 grade compared to baseline were regarded as having improved segmental contractile-function.

Results

Forty-five patients (aged 58?±?12 years) and 179 infarct segments were analysed. A baseline CS cutoff of -5 % had sensitivity of 89 % and specificity of 70 % for detection of improvement in segmental-contractile-function. On receiver-operating characteristic analysis for predicting improvement in contractile function, AUC for baseline CS (0.82) compared favourably to LGE hyperenhancement (0.68), MVO (0.67) and baseline-CSR (0.74). On comparison of AUCs, baseline CS was superior to LGE hyperenhancement and MVO in predicting improvement in contractile function (P?<?0.001). On multivariate-analysis, baseline CS was the independent predictor of improvement in segmental contractile function (P?<?0.001).

Conclusion

Grid-tagged CMR-derived baseline CS is a superior predictor of improvement in segmental contractile function, providing incremental value when added to LGE hyperenhancement and MVO following STEMI.

Key points

? Baseline CS predicts contractile function recovery better than LGE and MVO following STEMI ? Baseline CS predicts contractile function recovery better than baseline CSR following STEMI ? Baseline CS provides incremental value to LGE and MVO following STEMI     

Prospective evaluation of magnetic resonance enterography for the detection of mesenteric small bowel tumours

Purpose

To prospectively evaluate magnetic resonance (MR) enterography for detecting mesenteric small-bowel tumours (MSBTs) and assess the added value of gadolinium-chelate injection.

Material and methods

Over a 2-year period MR enterography examinations of 75 patients (33 men, 42 women; mean age, 53.8 years; range, 19–85) with suspected MSBT were blindly analysed by two readers for the presence of MSBT. Sensitivities, specificities, predictive positive values (PPVs), negative predictive values (NPVs) and accuracies of MR enterography for the detection of MSBT were calculated on per-patient and per-lesion bases. The McNemar test was used to compare sensitivities and specificities of the unenhanced and gadolinium-enhanced sets of MR enterographies.

Results

Thirty-seven MSBTs were pathologically confirmed in 26 patients. The mean tolerance score of the examinations was 0.7. On a per-patient basis, sensitivity, specificity, PPV, NPV and accuracy for detection of MSBT were 96 % [95 % CI, 89–100 %], 96 % [90–100 %], 93 % [83–100 %], 98 % [94–100 %] and 96 % [92–100 %], respectively. On a per-lesion basis, sensitivity and PPV were 70 % [56–85 %] and 93 % [83–100 %], respectively. Gadolinium injection yielded higher sensitivities on both bases (P?=?0.008).

Conclusion

MR enterography is an accurate and well-tolerated imaging modality for detecting MSBT. Intravenous administration of gadolinium-chelate improves sensitivity for MSBT detection.

Key Points

? MR enterography accurately detects mesenteric small bowel tumours. ? MR enterography is a well-tolerated imaging technique. ? Intravenous administration of gadolinium chelate improves sensitivity for detecting small-bowel tumours.     

MR imaging of renal cortical tumours: qualitative and quantitative chemical shift imaging parameters

Objectives

To assess qualitative and quantitative chemical shift MRI parameters of renal cortical tumours.

Methods

A total of 251 consecutive patients underwent 1.5-T MRI before nephrectomy. Two readers (R1, R2) independently evaluated all tumours visually for a decrease in signal intensity (SI) on opposed- compared with in-phase chemical shift images. In addition, SI was measured on in- and opposed-phase images (SI^IP, SI^OP) and the chemical shift index was calculated as a measure of percentage SI change. Histopathology served as the standard of reference.

Results

A visual decrease in SI was identified significantly more often in clear cell renal cell carcinoma (RCCs) (R1, 73 %; R2, 64 %) and angiomyolipomas (both, 80 %) than in oncocytomas (29 %, 12 %), papillary (29 %, 17 %) and chromophobe RCCs (13 %, 9 %; all, P?<?0.05). Median chemical shift index was significantly greater in clear cell RCC and angiomyolipoma than in the other histological subtypes (both, P?<?0.001). Interobserver agreement was fair for visual (kappa, 0.4) and excellent for quantitative analysis (concordance correlation coefficient, 0.80).

Conclusions

A decrease in SI on opposed-phase chemical shift images is not an identifying feature of clear cell RCCs or angiomyolipomas, but can also be observed in oncocytomas, papillary and chromophobe RCCs. After excluding angiomyolipomas, a decrease in SI of more than 25 % was diagnostic for clear cell RCCs.

Key Points

? Chemical shift MRI offers new information about fat within renal tumours. ? Opposed-phase signal decrease can be observed in all renal cortical tumours. ? A greater than 25 % decrease in signal appears to be diagnostic for clear cell RCCs     

18F-FDG uptake in breast cancer correlates with immunohistochemically defined subtypes

Objectives

To determine whether a correlation exists between maximum standardized uptake value (SUV_max) on ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) and the subtypes of breast cancer.

Methods

This retrospective study involved 548 patients (mean age 51.6 years, range 21–81 years) with 552 index breast cancers (mean size 2.57 cm, range 1.0–14.5 cm). The correlation between ¹⁸F-FDG uptake in PET/CT, expressed as SUV_max, and immunohistochemically defined subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 (HER2) positive and triple negative) was analyzed.

Results

The mean SUV_max value of the 552 tumours was 6.07?±?4.63 (range 0.9–32.8). The subtypes of the 552 tumours were 334 (60 %) luminal A, 66 (12 %) luminal B, 60 (11 %) HER2 positive and 92 (17 %) triple negative, for which the mean SUV_max values were 4.69?±?3.45, 6.51?±?4.18, 7.44?±?4.73 and 9.83?±?6.03, respectively. In a multivariate regression analysis, triple-negative and HER2-positive tumours had 1.67-fold (P?<?0.001) and 1.27-fold (P?=?0.009) higher SUV_max values, respectively, than luminal A tumours after adjustment for invasive tumour size, lymph node involvement status and histologic grade.

Conclusion

FDG uptake was independently associated with subtypes of invasive breast cancer. Triple-negative and HER2-positive breast cancers showed higher SUV_max values than luminal A tumours.

Key Points

? ¹⁸ F-FDG PET demonstrates increased tissue glucose metabolism, a hallmark of cancers. ? Immunohistochemically defined subtypes appear significantly associated with FDG uptake (expressed as SUV _max ). ? Triple-negative tumours had 1.67-fold higher SUV _max values than luminal A tumours. ? HER2-positive tumours had 1.27-fold higher SUV _max values than luminal A tumours.