Pedicle Sign Research Articles

Spinal Metastases without Pedicle Signs on Radiograph and their Associated Clinical and Radiological Features.

The pedicle sign is a radiographic indicator of spinal metastases. However, it is not only the pedicle sign that is important in radiographic diagnosis of bone metastases. In the present study, the radiological features of symptomatic spinal metastases in patients without the pedicle sign were retrospectively examined. Among 186 patients with symptomatic spinal metastases who visited our department between January 1, 2011, and December 31, 2017, 64 without the pedicle sign and with available computed tomography (CT) and magnetic resonance imaging (MRI) data in the first visit were enrolled and their data were analyzed. One author evaluated radiographs for findings suggestive of spinal metastases, CT to assess bone destruction, and MRI to evaluate the extent of lesions. Clinical variables were also examined and compared between patients with and without bone changes on radiography. Bone changes strongly suggesting bone metastasis, other than the pedicle sign, were observed in 31 out of 64 patients: bone cortical disappearance in 20, increased radiolucency of the central area in the vertebral body in 8, an irregular osteoblastic change in 5, and asymmetrical vertebral collapse in 10. An analysis of CT data revealed that intertrabecular, mildly osteolytic, and mildly osteoblastic types were more frequent in patients without any changes suggestive of bone metastases on radiographs. Radiographic findings other than the pedicle sign are useful for diagnosing bone metastases. The key to a radiographic diagnosis of spinal metastases is to pay attention to changes in the bone cortex of all vertebral components on radiographs in addition to the pedicle.

Combination of B-Mode Ultrasound and Doppler Ultrasound in Approaching to Uterine Intracavitary Pathologies Among Women Above 40 Years with Abnormal Uterine Bleeding: A Multicenter-Based Study from Vietnam.

Objectives:To determine the role of B-mode ultrasonography combined with Doppler ultrasonography in diagnosing uterine intracavitary pathology in perimenopausal and postmenopausal women with abnormal uterine bleeding (AUB).Patients and Methods:This prospective observational study included 150 women aged >40 years with AUB hospitalized at Hue University Hospital and Hue Central Hospital between 6/2016 and 6/2019. All participants were investigated by B-mode transvaginal ultrasound and Doppler transvaginal ultrasound, and the result of sonography was compared to the histopathological endpoint.Results:The morphological features, structure, margin, border line of the endometrial-mass lesion, intracavitary uterine fluid, and Doppler signal clearly differed between benign and malignant intracavitary pathologies (P < 0.0001). However, echogenicity had a limited value in distinguishing between uterine intracavitary pathologies (P = 0.1). The sensitivity and specificity of the pedicle sign in diagnosing endometrial polyps were 50.0% and 97.6%, respectively; for the circular pattern in subendometrial fibroids were 46.2% and 100.0%, respectively; for the multiple vessel pattern in endometrial cancer were 64.0% and 96.0%, respectively, and for the scattered-vessel pattern in endometrial hyperplasia were 43.96% and 56.43%, respectively.Conclusions:Ultrasound B-mode combined with Doppler as a noninvasive tool was significantly valuable in the diagnostic procedures for uterine intracavitary pathology in perimenopausal and postmenopausal women with AUB. It could also help differentiate malignant diseases from benign endometrial changes.

Association of Pedicle Sign Type with Clinical and Radiological Features in Patients with Symptomatic Spinal Metastases.

Because of population aging in Japan, the number of cancer diagnoses is increasing rapidly. The pedicle sign is a valuable radiographic indicator of metastases, as the pedicle is the most commonly affected vertebral structure in radiographic assessment. However, few studies have carefully examined the morphological features of pedicle signs. To improve the capacity of medical professionals to diagnose symptomatic spinal metastases, we retrospectively examined the morphological characteristics of pedicle signs and their associations with clinical and radiological features. 186 patients with symptomatic spinal metastases who visited our department during the period from January 1, 2011 through December 31, 2017 were enrolled. The pedicle sign was defined as a missing or obscured pedicle on an anteroposterior radiograph. Radiographs were evaluated for pedicles and other vertebrae structures. Clinical and other radiological features were compared in relation to the type of pedicle sign identified. Pedicle signs were classified as completely disappeared (complete, 26 patients), partially disappeared (partial, 40 patients), or obscured by the osteoblastic background (blastic, 28 patients). Disappearance of both the bone cortex and pedicle was observed in almost half of the patients with complete or partial pedicle signs. The complete pedicle sign was associated with significantly longer survival. Diagnosis of bone metastases requires understanding of pedicle sign types.

Diagnostic value of multislice spiral computed tomography (CT) combined with CT angiography for intra-abdominal undescended testis secondary seminomas

ObjectiveTo discuss the diagnostic value of multislice spiral tomography (CT) combined with CT angiography (CTA) technology in intra-abdominal undescended testis secondary seminoma cases.MethodsWe retrospectively analyzed the CT and CTA imaging features of CT and CTA findings of nine patients with an intra-abdominal undescended testis secondary seminoma.ResultsThe tumors in all nine patients were mainly solid, and the average CT value was 38.4 ± 3.4 HU. Low-density areas of various sizes were visible in the tumors, and calcifications were detected in two patients. The tumors in eight patients had a complete capsule, which pressed on the surrounding structures. In one patient, the tumor had an incomplete capsule, which invaded the surrounding structures. Some of the solid tumors showed progressive and slight enhancement on the CT-enhanced scans. The values in the arterial phase, venous phase, and delayed phase were 46.3 ± 5.1 (40–55 HU), 57.3 ± 7.3HU (48–68 HU), and 65.1 ± 7.2HU (56–77 HU), respectively, with an average increase rate of 27.0 ± 7.2 HU. No enhancement was found in low-density areas on the CTA scans, and the supply arteries of the tumors in the nine patients all originated from the abdominal aortic wall 2–3 cm below the renal ostia. These arteries became thickened and tortuous when near the tumors, and there were no branching vessels. In eight patients, the supply arteries of the tumors originated from the posterior tumor and ended inside the tumor, and they originated from anterior of the tumor in one patient. Testicular venous drainage was detected in three patients, and lymph node metastasis in the abdominal aorta detected in two cases.ConclusionAn intra-abdominal undescended testis secondary seminoma exhibits a characteristic appearance on CT. CTA shows a three-dimensional testicular vascular pedicle sign of a seminoma. A combination of CT and CTA can improve the diagnostic accuracy of an intra-abdominal undescended testis secondary seminoma.

Excision of tumors in the parapharyngeal space using an endoscopically assisted transoral approach: a case series and literature review.

ObjectiveMagnetic resonance imaging (MRI) provides important information regarding tumors in the parapharyngeal space (PPS), revealing their origin, whether they are benign or malignant, and their relationships with surrounding structures.MethodsTwelve tumors in the PPS were completely excised using an endoscopically assisted transoral approach (EATA). The MRI features were analyzed.ResultsTen pleomorphic adenomas confirmed on postoperative pathological examination had the parotid pedicle sign. A fat space between the tumor and parotid gland may distinguish such a tumor from a tumor arising from a minor salivary gland in the prestyloid space and a tumor arising from the deep lobe of the parotid gland. Both the jugular vein and carotid artery were displaced posteriorly in all 10 cases of pleomorphic adenomas. The principal features of the two schwannomas confirmed on postoperative pathological examination were separation of the internal carotid artery and internal jugular vein and anteromedial displacement of the internal carotid artery, suggesting that the tumors originated in the poststyloid space. In this review, 95 tumors were excised by the EATA in the English-language literature.ConclusionsMRI renders differential diagnosis possible. PPS tumors may be completely excised via an EATA guided by tumor features evident on preoperative MRI.

Demonstration of normal and dilated testicular veins by multidetector computed tomography

Recent advances in multidetector computed tomography (MDCT) technology enabled better visualization of testicular (gonadal) vein using submillimeter slice thickness and three-dimensional images. Normally, the testicular vein measures 1-3 mm and drains into the inferior vena cava and left renal vein on the right and left sides, respectively. They can be seen in most patients during MDCT studies. Curved planar and volume-rendered images can be used to display testicular veins. We aim to demonstrate MDCT findings of normal testicular vein and its pathologies including varicocele, varices, the testicular vascular pedicle sign, and phlebolith. The testicular vein can be dilated owing to varicocele or portal hypertension and in patients with intraabdominal seminomas arising from undescended testis. The testicular vein can also cause ureteral compression at the crossing point. Understanding MDCT findings of the normal testicular vein and its various pathologies can allow a correct diagnosis, thereby avoiding further diagnostic tests.

Omental vascular pedicle sign: Multidetector CT finding useful for diagnosis of an omental mass

To describe multidetector CT findings of "omental vascular pedicle" sign. "Omental vascular pedicle" sign was defined as dilated omental vein associated with a mass located in omentum and was observed in 7 patients (5 women, 2 men). Mean age was 45 years. CT examinations and patient records were retrospectively reviewed. CT images were obtained by 16-MDCT (n = 1) and 64-dual source MDCT (n = 6). Curved planar and volume rendered images were reconstructed from axial images. Diameter of omental vein and drainage site were recorded. Images were evaluated by 2 radiologists in consensus. Pathologic diagnosis of patients with "omental vascular pedicle sign" was omental angiosarcoma (n = 1), endometrial adenocarcinoma (n = 2), ovarian serous adenocarcinoma (n = 2), mixed gonadal tumor (n = 1), malignant peripheral sheath tumor (n = 1). In 5 patients, omental vein drained into splenic vein and in 2 patients it drained into right gastroepiploic vein. Mean size of omental masses associated with omental vascular pedicle was 7.1 × 4.5 cm (range 15 × 11 cm to 2.7 × 1.6 cm). Mean diameter of omental vein was 3.1mm (range 6-1.5mm). Diameter of the omental vein increased with the increasing size of omental masses and Pearson's correlation coefficient was 0.99. "Omental vascular pedicle sign" can be helpful to objectively diagnose omental masses in patients with primary and metastatic omental tumors.

Gastrointestinal stromal tumors presenting as gynecological masses: usefulness of multidetector computed tomography

Large extraluminal gastrointestinal tumors (GISTs) may present as pelvic masses and thus mimic gynecological neoplasms in female patients. On clinical examination and pelvic ultrasound, these tumors resemble pedunculated fibroids or ovarian tumors. Multidetector computed tomography (CT), with its ability to perform isotropic multiplanar reconstruction, is useful in differentiating GISTs from true gynecological masses by demonstrating the pedicle sign connecting a pelvic GIST to its organ of origin. This allows a preoperative diagnosis to be made, which may be helpful in guiding therapeutic options and management. We present two cases of GISTs presenting as pelvic masses in which ultrasound findings suggested a gynecological cause, but multidetector CT with multiplanar reconstruction was able to determine their true organ of origin.

A Comparative Study of Spinal Bone SPECT versus X-ray Radiograph, CT or MRI in Patients with an Acute Compression Fracture of a Thoracolumbar Vertebral Body

We retrospectively studied the spinal bone SPECT images of 84 consecutive patients (27 men, 57 women;mean age, 71.3 years;age range, 52 - 89 years) with acute non-traumatic collapse of a vertebra in the thoracolumbar spine. Of the 84 patients, 59(70.2%) had a history of malignancy. Twelve patients (14.3%) had a vertebral metastasis and 72(85.7%) had an osteoporosis in the vertebra. There were no clear differences between the vertebral body uptake patterns in the group with metastasis and the group with osteoporosis alone, although a horseshoe pattern tended to occur in the patients with a osteoporotic lesion (25% vs.42%). Increased pedicle uptake was seen in 20 patients (23.8%, 20/84), 9 of whom (75.0%, 9/12) had a vertebral metastasis and 11(15.3%, 11/72) did not (p<0.001). A pedicle sign or invasion on radiographs and/or CT images was seen in all 9 patients with metastatic disease patients (100%) but not in any of the11patients with osteoporosis. When pedicle uptake on SPECT images and the pedicle sign or invasion were used to diagnose bone metastasis in these84patients, sensitivity, specificity, positive predictive value, negative predictive value were 75.0%(9/12), 84.7%(61/72), 45.0%(9/20), and 95.3%(61/64), respectively. Radiograph and CT remain to be important studies to diagnosis acute non-traumatic collapse of a vertebra, although a spinal SPECT study provides some additional information.

Chance-Type Fractures of the Thoracolumbar Spine: Imaging Analysis in 53 Patients

Chance-type fractures are subtle unstable injuries that are often associated with intraabdominal injuries. CT-based observations made during routine interpretations revealed involvement of a burst component to this fracture pattern and a clue on the transaxial images to its presence. The purpose of this review was to determine how often these features occurred in a retrospective study of a large sample because these findings influence diagnosis and management. A retrospective review of all patients identified from the University of Maryland Shock Trauma Center trauma registry and IDXRad system diagnosed with flexion-distraction injuries of the thoracolumbar spine over an 8-year period was performed. Three trauma radiologists assessed the admission spinal radiographs, CT studies with multiplanar images, and available MRI examinations. Imaging findings were confirmed by consensus. Abdominopelvic CT studies and surgical reports were reviewed for evidence and type of intraabdominal injury. A literature review of previous similar series was performed. Fifty-three patients were identified for inclusion in the study. Associated intraabdominal injury occurred in 40% and most commonly involved the bowel and mesentery. A close examination of the fracture patterns on CT revealed that a burst-type fracture with posterior cortex buckling or retropulsion was a common finding (48%). Also, serial transaxial CT images often (76%) showed a gradual loss of definition of the pedicles that we refer to as the "dissolving pedicle" sign. The study showed that the horizontally oriented fracture planes through the posterior elements can often be recognized radiographically, but these fractures can be very subtle. Intraabdominal injuries occurred in 40% of flexion-distraction thoracolumbar fractures in our study cohort, which is slightly lower than previously reported. About half of the patients with this injury displayed a burst-type component that could have a significant influence on surgical management. The dissolving pedicle sign can assist in recognition of this often subtle injury on transaxial CT.

Ovarian vascular pedicle sign in ovarian metastasis arising from gall bladder carcinoma

A case of a large mass in the pelvis confirmed to be a rare ovarian metastasis arising from a primary adenocarcinoma of the gall bladder is presented. The value of the recently described ovarian pedicle sign in confirming the organ of origin of the pelvic mass is emphasized.

Pedicle sign and diagnosis of endometrial adenosarcoma.

Journal of Ultrasound in MedicineVolume 23, Issue 9 p. 1217-1219 Case Report Pedicle Sign and Diagnosis of Endometrial Adenosarcoma Michael Crade MD, Corresponding Author Michael Crade MD mkcrade@mac.com Departments of Radiology and Obstetrics and Gynecology, University of California, Irvine, and Ultrasonix, Long Beach, California USAAddress correspondence and reprint requests to Michael Crade, MD, Department of Diagnostic Radiology, University of California at Irvine, 33325 Palo Verde Ave, Suite 105, Long Beach, CA 90808 USA.Search for more papers by this authorPaul Weber MD, Paul Weber MD private practice, obstetrics and gynecology, Long Beach, California USASearch for more papers by this author Michael Crade MD, Corresponding Author Michael Crade MD mkcrade@mac.com Departments of Radiology and Obstetrics and Gynecology, University of California, Irvine, and Ultrasonix, Long Beach, California USAAddress correspondence and reprint requests to Michael Crade, MD, Department of Diagnostic Radiology, University of California at Irvine, 33325 Palo Verde Ave, Suite 105, Long Beach, CA 90808 USA.Search for more papers by this authorPaul Weber MD, Paul Weber MD private practice, obstetrics and gynecology, Long Beach, California USASearch for more papers by this author First published: 01 September 2004 https://doi.org/10.7863/jum.2004.23.9.1217Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume23, Issue9September 2004Pages 1217-1219 RelatedInformation

"Ovarian vascular pedicle" sign revealing organ of origin of a pelvic mass lesion on helical CT.

We evaluated the "ovarian vascular pedicle" sign as a way of differentiating ovarian from subserosal uterine lesions on single-detector helical CT. We prospectively evaluated 131 patients who had a pelvic mass suspected of originating in the ovary or subserosal zone of the uterus and had undergone helical CT before surgery. A total of 108 ovarian lesions and 23 subserosal uterine myomas were confirmed. CT images were analyzed prospectively by consensus of two radiologists who thoroughly evaluated the retrograde tracing of the gonadal veins to the ovary or pelvic mass. To assess the value of analyzing the ovarian vascular pedicle sign in identifying the organ of origin of a pelvic mass, we compared statistical proportions for the frequencies of the sign in ovarian tumors and subserosal uterine myomas by performing the chi-square test. The probabilities for the presence of the ovarian vascular pedicle sign as a positive finding for a pelvic mass of ovarian origin were calculated. The presence of the ovarian vascular pedicle sign was identified in 92% (99/108) of ovarian masses and in 13% (3/23) of subserosal uterine myomas. The sign was statistically significant (p < 0.01) for differentiating a mass of ovarian origin from a mass of subserosal uterine origin. When the ovarian vascular pedicle sign on helical CT confirmed the ovarian origin, the sensitivity, specificity, positive predictive value and negative predictive value, and diagnostic accuracy were 92% (99/108), 87% (20/23), 97% (99/102), 69% (20/29), and 91% (119/131), respectively. The presence of the ovarian vascular pedicle sign on helical CT is valuable for confirming the ovarian origin of a pelvic tumor and for differentiating an ovarian tumor from subserosal uterine myoma.

Torsion of the Greater Omentum with Infarction: The Vascular Pedicle Sign

Torsion of the Greater Omentum with Infarction: The Vascular Pedicle Sign

The "Vascular Pedicle Sign" in the Diagnosis of Pelvic Masses

Establishing a meaningful differential diagnosis during the sonographic evaluation of an adnexal mass requires the determination of the organ of origin. The authors presents two cases of pedunculated fibroids with uncharacteristic ultrasound findings, in which they demonstrate a clear vascular pedicle between each mass and the uterine fundus by color-flow Doppler sonogtaphy. The "vascular pedicle sign" may be a valuable sonographic tool for those cases in which defining the organ of origin of an adnexal mass is difficult.