Clinical significance of retrograde flow in the vertebral artery

Although retrograde vertebral artery flow was described over 100 years ago, its relationship to symptoms remains unclear. We documented 43 patients who were found by duplex scanning to have reverse flow in the vertebral artery. Of this group, seven patients (16%) were found to have symptoms described as typical for the subclavian steal syndrome. Nearly one-third were asymptomatic. Of the remaining patients, 13 (30%) presented with nonhemispheric symptoms while nine (21%) had hemispheric symptoms. Nine patients had to and fro flow in the vertebral artery. This variant was not found in subclavian steal patients but correlated with nonhemispheric symptoms. During follow-up (mean: 19 months) none of the asymptomatic patients became symptomatic, and there were no strokes or stroke-related deaths. Surgical procedures which restored antegrade vertebral artery flow did not necessarily improve symptoms of posterior circulation ischemia. In some patients improvement in posterior circulation symptoms was noted following carotid endarterectomy. It is concluded that retrograde flow in the vertebral artery is, per se, a benign entity. Accurate selection of surgical candidates remains imprecise. It will require not only identification of vertebrobasilar disease but as yet undefined tests to assure symptoms are due to these stenoses.     

Unusual fractures and dislocations of the axis vertebra

Seven percent of 400 patients with cervical spine fractures and/or dislocations had unusual lesions of the axis. The authors have analyzed axis injuries by review of radiographs and clinical data and have derived a classification of traumatic conditions. Uncommon traumatic axis abnormalities are discussed with reference to incidence, causes, clinical findings, mechanism of injury, and roentgen characteristics.Picker Scholar, James Picker Foundation     

Reference Data of Vertebral Morphometry by X-ray Absorptiometry (MXA) in Argentine Women

Anterior, middle, and posterior heights and A/P and M/P ratios were determined from T5 to L4 in 111 normal Caucasian Argentine women from 20 to 70 years of age using dual energy X-ray absorptiometry (DXA) densitometry (Expert XL). Scanning time was less than 1 minute and the semiautomatic analysis requires ∼5 minutes. The precision error for the measurements ranged from 2.2% to 4.6%. The absolute precision error for heights was 0.6 mm. The vertebral bodies tended to be significantly larger in younger women than older women, especially for anterior and middle heights and the A/P and M/P ratios of the mid-thoracic vertebrae (T6–T10). There were no significant differences between pre- and postmenopausal women in the lumbar vertebral heights. It does not appear that this was a cohort effect because stature was identical in both age groups, and there was no age difference in posterior height. The Expert-XL software normalized the vertebral height based on the average height of the L2-L4 segment in order to minimize the influence of interindividual variation of body size. The average Z-scores for vertebral heights and ratios provided by the software were close to zero indicating that the normalization procedure appropriately corrected for smaller stature in Argentine women. Consequently, the reference values for morphometry X-ray absorptiometry (MXA) were appropriate for our population. In summary, we found that (1) in ``normal' women the anterior heights of the thoracic vertebrae (and therefore the A/P ratio) were higher in premenopausal than in postmenopausal women; and (2) the normalization approach corrected for differences of vertebral height and allowed utilization of the manufacturers software in our population. Received: 28 June 1999 / Accepted: 2 November 1999     

The relationship between phalangeal bone density and vertebral deformities

Radiographic absorptiometry (RA) of the phalanges is a convenient and reliable technique for measuring bone mineral density (BMD). It needs only a radiograph of the hand, which can be sent for evaluation to a central facility, whereas other techniques require specialized equipment. We assessed the relationship between RA measurements and the presence of vertebral deformities in a population-based cohort of postmenopausal women, and to compare the results with simultaneously obtained BMD of the hip by dual-energy X-ray absorptiometry (DXA). A total of 389 women aged 55–84 (mean age 67.2 years, SD 8.7) were randomly selected from a large general practice. RA, DXA of the hip, and vertebral deformities in the lateral spine X-rays by vertebral morphometry were assessed. Thirty-eight women (9.8%) had severe (grade II) vertebral deformities, and their BMD at the phalanges and femoral neck was significantly lower than that of women without severe vertebral deformities. Odds ratios for the presence of severe vertebral deformities of 1.5 (95% CI: 1.1–2.1) for RA and 1.3 (95% CI: 0.9–1.9) for DXA, together with similar receiver operating characteristics curves, were found using age-adjusted logistic regression. Phalangeal BMD is related to vertebral deformities at least as closely as BMD of the femoral neck BMD. RA may therefore help to evaluate fracture risk, especially if no DXA equipment is available. Received: 21 July 1998 / Accepted: 1 July 1999     

脊椎血管瘤手术后复发放射治疗疗效观察(附6例报告)

目的 探讨脊椎血管瘤手术后复发放射治疗疗效和适宜剂量。方法 1968—1992年间共收治手术后复发的有症状的脊椎血管瘤6例，中位年龄28岁。病灶在胸椎5例，腰椎1例。4例有病灶局部疼痛合并不完全性截瘫，2例为局部疼痛合并下肢麻木无力。采用^60Co和8MV—X线照射治疗，总剂量范围30-60Gy，平均40Gy。结果 所有接受放疗的患均获得良好的远期效果，4例不完全截瘫患中3例基本恢复，1例完全恢复，另外2例原有的下肢麻木症状消失，但影像学检查均无明显改变。结论 放射治疗对手术后复发的脊椎血管瘤是安全有效的，剂量以36—40Gy为宜。但放射治疗起效比较慢，且影像学改变不明显，所以应以远期症状改善率作为评价放射治疗效果的标准。     

Efficacy of bleomycin treatment for symptomatic hemangiomas in children

Five children aged 5–19 years had pain in massive, inoperable hemangiomas. They were treated with intralesional injections of 2 mg bleomycin as a 0.4 mg/ml solution in the painful area. The injections were repeated after 4-6 weeks for a total of 6–10 times. All children were relieved of pain, and the swelling was reduced in all cases. There were no complications or side effects. Bleomycin therapy of painful, massive hemangiomas can be recommended in older children.     

33例椎-基底动脉瘤的临床观察

目的：探讨椎－基底动脉瘤治疗方法与预后关系。材料与方法：报告３３例椎－基底动脉瘤。动脉瘤破裂致ＳＡＨ１８例，动脉瘤直径从５ｍｍ到４５ｍｍ。其中９例行保守治疗。直接手术治疗中，９例夹闭术，２例瘤壁加固术。１３例行血管内栓塞治疗。结果：９例保守治疗中３例因再次出血死亡。１１例直接手术均痊愈。１３例血管内栓塞治疗后１～３个月后复查造影，闭塞率＞８０％者１２例。结论：椎－基底动脉瘤积极手术治疗可降低死亡率，依动脉瘤部位与大小采用不同手术入路至关重要，血管内栓塞治疗适于直接手术难以达到者，疗效肯定。     

Diffuse splenic and visceral hemangiomas complicated by chronic consumption coagulopathy

Abstract The case of a 7-year-old girl with a 2 year history of easy bruising associated with thrombocytopenia is reported. On admission she presented with ecchymoses, abdominal distention and splenomegaly. Hemostasis investigation revealed a consumption coagulopathy. Several radiological studies failed to confirm the diagnosis of diffuse splenic and visceral hemangiomatosis, which was eventually estasblished by an explorative laparotomy. Platelet count and the other coagulation abnormalities progressively returned to normal after splenectomy, although the remaining hemangiomas were extensive.     

软组织血管瘤的影像诊断

目的:研究软组织血管瘤的X线平片、CT 和MRI 征象,探讨CT 和MRI对该肿瘤的诊断价值。方法:对经手术病理或临床确诊的软组织血管瘤35例进行回顾性分析。所有病例均行X线平片、CT平扫和增强扫描。其中动态增强扫描8例,MRI检查15例。结果:海绵状血管瘤19例,蔓状血管瘤8例,毛细血管瘤3例,混合型血管瘤2 例,血管瘤病3例。CT平扫肿瘤呈结节状、分叶状、管状或团块状低密度病变。增强扫描后血管成分显著强化,可呈扭曲血管状,而非血管成分不强化或轻度强化。MRIT1WI上肿瘤呈略高信号或等信号,T2WI上呈显著高信号,其中夹杂不均匀信号,病理上代表了脂肪、纤维组织、平滑肌、血栓、静脉石和钙化。结论:CT和MRI对血管瘤均可作出定性诊断,但MRI在显示血管瘤内特征性的血管及血管成分间的脂肪纤维组织方面较CT优越。     

Juxta-articular hemangioma of long bone

We report on a rare case of an intraosseous hemangioma involving the proximal tibia in a 70-year-old man. Radiographically, the lesion was a well-defined osteolytic lesion with marginal sclerosis. The CT images demonstrated a well-defined osteolytic lesion with partial cortical breakthrough. T1-weighted MR images showed a hypointense lesion, while T2-weighted images revealed hyperintense areas, with internal, hypointense septa. Gadolinium-enhanced T1-weighted images showed lattice-like enhancement of the lesion. Received: 28 December 1999 Revision requested: 3 March 2000 Revision received: 23 May 2000 Accepted: 26 May 2000