Vertebroplasty for osteoporotic fractures with spinal canal compromise

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty can aggravate spinal canal narrowing, especially in patients with preoperative retropulsion. The purpose of this study was to evaluate changes in spinal canal dimension during percutaneous vertebroplasty for osteoporotic fractures with retropulsion. MATERIALS AND METHODS: We reviewed all cases of osteoporotic vertebral fractures treated with vertebroplasty. Twenty-one patients (25 vertebrae) had a retropulsed fragment that compromised the dimension of the spinal canal on preoperative imaging. We measured the degree of retropulsion before and after vertebroplasty to evaluate changes in spinal canal dimension. We also evaluated pain, neurologic status, vertebral body height, and wedge angle. RESULTS: Mean retropulsion was 4.2 mm before and 4.4 mm after vertebroplasty. There was no statistically significant difference (P = .32). Mean increase in vertebral body height was 2.6 mm anteriorly, 1.7 mm centrally, and 0.3 mm posteriorly. Mean decrease in wedge angle was 4.7 degrees. There were statistically significant improvements in height and wedge angle (P < .01). None of our patients developed new symptoms during vertebroplasty or thereafter. Twenty of 21 patients (95%) showed partial or complete immediate pain relief, whereas 1 patient did not improve. CONCLUSION: Vertebroplasty can be performed safely in patients with spinal canal compromise. This procedure can reduce pain, increase vertebral body height, and decrease wedge angle without worsening of retropulsion.     

Diffusion tensor MR imaging of the cervical spinal cord in patients with multiple sclerosis

Our purpose was to evaluate the ability of diffusion tensor imaging (DTI) to characterize cervical spinal cord white matter (WM) in patients with multiple sclerosis (MS). DTI were obtained in 21 MS patients and 21 control subjects (CS). Regions of interest (ROIs) were placed at C2/3, C3/4, and C4/5 within the right, left, and dorsal (WM) to calculate fractional anisotropy (FA) and the apparent diffusion coefficient (ADC). Measurements in plaques and normal-appearing white matter (NAWM) of MS patients were compared with mean FA and ADC of WM in CS. FA was significantly lower in all regions in MS patients than in CS. ADC was significantly higher in all regions in MS patients than in CS except for in the dorsal WM at C2/3 and the bilateral WM at C4/5. The mean FA was 0.441 for plaques and 0.542 for NAWM, as compared with 0.739 in CS. The mean ADC was 0.810 × 10⁻³ mm²/s for plaques and 0.722 × 10⁻³ mm²/s for NAWM, as compared with 0.640 ×10⁻³ mm²/s for CS. FA and ADC showed significant differences between plaques, NAWM and control WM(P < 0.01).     

Catheter thrombolysis of thrombosed hepatic arteries in liver transplant recipients: predictors of success and role of thrombolysis

Hepatic artery thrombosis is an uncommon complication of liver transplantation. However, it is a major indication for re-transplantation. The use of transcatheter thrombolysis and subsequent surgical revascularization as a graft salvage procedure is discussed. Four of 5 cases (80%) were successful in re-establishing flow and uncovering underlying arterial anatomic defects. None were treated definitively by endoluminal measures due to an inability to resolve the underlying anatomic defects. However, 2 of 5 cases (40%) went on to a successful surgical revascularization and represent successful long-term outcome of transcatheter thrombolysis followed by definitive surgical revascularization. We conclude that, definitive endoluminal success cannot be achieved without resolving associated, and possibly instigating, underlying arterial anatomical defects. However, reestablishing flow to the graft can unmask underlying lesions as well as asses surrounding vasculature thus providing anatomical information for a more elective, better planned and definitive surgical revision.     

Prolapse of a single-system ureterocele causing urinary retention in an adult woman

A 41-year-old woman presented with pelvic pain and a bulge from her urethra. On physical examination, she was noted to have a mucosal bulge from her urethra that intermittently squired urine. Further imaging showed single systems on both sides, no stones, and mild left-sided hydroureteronephrosis with a ureterocele. The ureterocele was endoscopically incised and excised, resolving her symptoms.     

MR angiography of the TMJ in asymptomatic volunteers

To evaluate the vascular anatomy of the temporomandibular joint (TMJ) and surrounding soft tissue non-invasively, we applied magnetic resonance (MR) angiography for delineating the arterial architecture around the TMJ. MR angiograms of the left and right TMJs in asymptomatic volunteers were obtained using 3D/Time-of-flight (TOF) (First Field Echo, TR/TE/FLIP=46ms/6.8ms/17^o) with intravenous contrast. These MR angiograms were compared with experimental angiograms of human TMJ autopsy specimens in order to identify each of the branches of the arteries on the MR angiograms. This study enabled the depiction by MR angiography of arterial vessels around the TMJ region to some degree. In conclusion, MR angiography appears promising as a non-invasive tool to evaluate the vascular anatomy of the TMJ.