Preoperative Imaging Findings Research Articles

Direct Comparison of Four Presurgical Stratifying Schemes for Prediction of Microvascular Invasion in Hepatocellular Carcinoma by Gadoxetic Acid-Enhanced MRI.

Microvascular invasion (MVI) is implicated in the poor prognosis of hepatocellular carcinoma (HCC). Presurgical stratifying schemes have been proposed for HCC-MVI but lack external validation. To perform external validation and comparison of four presurgical stratifying schemes for the prediction of MVI using gadoxetic acid-based MRI in a cohort of HCC patients. Retrospective. Included were 183 surgically resected HCCs from patients who underwent pretreatment MRI. This includes 1.5-3.0 T with T2 , T1 , diffusion-weighted imaging (DWI), and dynamic gadoxetic acid contrast-enhancement imaging sequences. A two-trait predictor of venous invasion (TTPVI), Lei model, Lee model, and Xu model were compared. We relied on preoperative characteristics and imaging findings via four independent radiologists who were blinded to histologic results, as required by the tested tools. Tests of accuracy between predicted and observed HCC-MVI rates using receiver operating characteristic (ROC) curve and decision curve analysis. The intraclass correlation coefficient (ICC) and Cronbach's alpha statistics were used to evaluate reproducibility. HCC-MVI was identified in 52 patients (28.4%). The average ROC curves (AUCs) for HCC-MVI predictions were 0.709-0.880, 0.714-0.828, and 0.588-0.750 for the Xu model, Lei model, and Lee model, respectively. The rates of accuracy were 60.7-81.4%, 69.9-75.9%, and 65.6-73.8%, respectively. Decision curve analyses indicated a higher benefit for the Xu and Lei models compared to the Lee model. The ICC and Cronbach's alpha index were highest in the Lei model (0.896/0.943), followed by the Xu model (0.882/0.804), and the Lee model (0.769/0.715). The TTPVI resulted in a Cronbach's alpha index of 0.606 with a sensitivity of 34.6-61.5% and a specificity of 76.3-91.6%. Stratifying schemes relying on gadoxetic acid-enhanced MRI provide an additional insight into the presence of preoperative MVI. The Xu model outperformed the other models in terms of accuracy when performed by an experienced radiologist. Conversely, the Lei model outperformed the other models in terms of reproducibility. 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:433-447.

Investigating Effective Factors on Estimated Hemorrhage Intraoperative in Brain Meningioma Surgery.

Introduction:The primary and definitive diagnosis of meningioma is based on histological assessment; however, employing imaging methods, like Magnetic Resonance Imaging (MRI) is very helpful to describe lesion’s characteristics. Accordingly, we decided to study the effect of imaging factors, like MRI data on the volume of hemorrhage (estimated blood loss) during meningioma surgery.Methods:This was a cross-sectional, retrospective, and analytical study. The eligible patients were those with meningioma who were candidates for surgery. A total of 40 patients with meningioma were selected and assessed. The preoperative imaging findings were recorded, then estimated blood loss during the surgery was determinedResults:A reverse association was revealed between the degree of proximity to the nearest sinus and the rate of bleeding. Furthermore, the size of the mass was positively associated with the rate of bleeding; however, there was no significant correlation between the volume of bleeding and other parameters, including the degree of edema, the volume of mass, the site of the tumor in the brain, and the histological subtype of the tumor. The mean time of operation was strongly correlated with blood loss. The rate of bleeding was more expected in hypertensive versus normotensive patients.Conclusion:Bleeding in various volumes could be a frequent finding in intracranial meningioma surgery. Overall, tumor size, the duration of surgery, a history of hypertension, and distance to the nearest sinuses were the main determinants for the severity of hemorrhage in patients undergoing meningioma surgery.

Preoperative Magnetic Resonance Imaging Features Associated with Positive Resection Margins in Patients with Invasive Lobular Carcinoma.

ObjectiveTo investigate preoperative magnetic resonance imaging (MRI) findings associated with resection margin status in patients with invasive lobular carcinoma (ILC) who underwent breast-conserving surgery.Materials and MethodsOne hundred and one patients with ILC who underwent preoperative MRI were included. MRI (tumor size, multifocality, type of enhancing lesion, distribution of non-mass enhancement [NME], and degree of background parenchymal enhancement) and clinicopathological features (age, pathologic tumor size, presence of ductal carcinoma in situ [DCIS] or lobular carcinoma in situ, presence of lymph node metastases, and estrogen receptor/progesterone receptor/human epidermal growth factor receptor type 2 status) were analyzed. A positive resection margin was defined as the presence of invasive cancer or DCIS at the inked surface. Logistic regression analysis was performed to determine pre- and postoperative variables associated with positive resection margins.ResultsAmong the 101 patients, 21 (20.8%) showed positive resection margins. In the univariable analysis, NME, multifocality, axillary lymph node metastasis, and pathologic tumor size were associated with positive resection margins. With respect to preoperative MRI findings, multifocality (odds ratio [OR] = 3.977, p = 0.009) and NME (OR = 2.741, p = 0.063) were associated with positive resection margins in the multivariable analysis, although NME showed borderline significance.ConclusionIn patients with ILC, multifocality and the presence of NME on preoperative breast MRI were associated with positive resection margins.

Non-Neoplastic Masses of the Pancreas.

Benign non-neoplastic solid lesions of the pancreas are comprised of several separate entities, with their diagnostic identification best performed in correlation with the radiographic and clinical features. These include all of the pancreatitides, intrapancreatic spleen, and a few other rare entities. Preoperative imaging may suggest the correct diagnosis, but occasionally the preoperative imaging findings may be misleading because they overlap with those of pancreatic neoplasms. Masses associated with typical pancreatitides are rarely sampled due to their distinct clinical picture and relative frequency; however, the uncommon variants of pancreatitis may also present as mass lesions mimicking malignancy. Herein, we will discuss the cytopathologic findings of several solid pancreatic lesions, including acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, paraduodenal or groove pancreatitis, and other mass lesions, such as intrapancreatic accessory spleen and abscess. The key cytological features, ancillary studies, and differential diagnoses will also be discussed.

Three-dimensional visualization combined with indocyanine green fluorescence imaging in diagnosis and treatment of primary hepatocellular carcinoma

To explore the value of three-dimensional visualization technology (3DVT) combined with indocyanine green (ICG) fluorescence imaging in the diagnosis and treatment of primary hepatocellular carcinoma (HCC). We retrospectively analyzed the clinical data of 154 patients with HCC admitted to the Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University between January, 2016 and November, 2018. In 57 of the patients (3DVT group), preoperative CT and Gd-EOB-DTPA-enhanced MRI were performed and 3D visualization and surgical planning was carried out before the operation; intraoperative ICG florescence imaging was performed for real-time detection of the tumor location and demarcation, intrahepatic satellite lesions and metastases. According to the intraoperative fluorescent signals and 3D visualization-based surgical planning, the final surgical plan was determined. In the other 97 patients (control group), conventional surgical assessment and surgical resection of the tumor was carried out. The preoperative imaging findings, intraoperative tumor detection, postoperative laboratory results, pathological reports, and follow-up data of the patients were analyzed. In 3DVT group, 63 and 70 lesions were detected by preoperative CT and MRI, respectively; compared with CT examination, intraoperative ICG florescence imaging revealed additional 17 lesions, among which 10 were pathologically confirmed as HCC and 7 as cirrhosis nodules. The median volume of bleeding was 300 mL in 3DVT group, significantly less than that in the control group (400 mL; Z=2.291, P=0.022). In both groups, serious complications or perioperative death occurred in none of the patients. The incidence of postoperative complications was significantly lowed in 3DVT group than in the control group [21% (12/57) vs 48.4% (47/97); χ2=11.406, P=0.001]. The overall disease-free survival rate at 2 years after the operation was significantly higher in 3DVT group than in the control group (74.9% vs 28.9%, P=0.022). 3DVT combined with ICG fluorescence imaging allows precise preoperative diagnosis, surgical planning and implementation, intraoperative detection of small liver cancers and precise navigation for HCC treatment, thereby helping to reduce postoperative complications and improve the disease-free survival rate of the patients.

Diagnosis and treatment of biliary pancreatic duct dilatation

Diagnosis and treatment of biliary pancreatic duct dilatation

Predicting Patients Found to Have Malignancy at Nipple Duct Surgery

Introduction: The unexpected diagnosis of breast cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, pre-operative diagnosis of malignancy still evades us. The aim of this study was to review the pathological findings of total duct excision and microdochectomy with reference to pre-operative symptoms, ultrasound, or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods: Data were collected retrospectively of all patients who underwent total duct excision surgery in a single centre (2011–2017). Pre-operative demographics, symptoms, and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data were available for 211. Median age was 53 years. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10%) had “risk” lesions (papilloma with atypia, atypical ductal hyperplasia), and 15/211 (7.1%) had malignancy (ductal carcinoma in situ). Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1). 71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7%) had “risk” lesions, and 6/71 (8.5%) had malignant lesions. 83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk, and 10/83 (12%) malignancy. 38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk, and 2/38 (5.3%) malignant lesions. ­Conclusion: Neither imaging nor presenting symptoms correlate with the likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.

Predictive Value of Preoperative Magnetic Resonance Imaging Findings for Survival and Local Recurrence in Patients Undergoing En Bloc Resection of Sacral Chordomas.

Few studies have assessed the prognostic importance of preoperative magnetic resonance imaging (MRI) scan findings in patients undergoing en bloc resection of sacral chordomas. To (1) report in-depth imaging characteristics of sacral chordomas, (2) describe the patterns of local and distant recurrence, and (3) determine imaging predictors of overall survival (OS) and local recurrence (LR). This retrospective case series was obtained from a prospectively maintained spine database from 1995 to 2016. All patients underwent en bloc resection of sacral chordomas. Detailed demographic, outcome, and MRI data were collected. A survival analysis was completed with multivariable cox regression to assess the impact of MRI findings on OS and LR. A total of 41 patients underwent en bloc resection of sacral chordoma with preoperative MRI scans. Tumor characteristics included lobulated: (93%) and soft tissue tail (54%). The following areas had tumor invasion lobulated: sacroiliac (SI) joint (15%), ilium (5%), piriformis (61%), gluteus (46%), subcutaneous fat (32%), and lumbosacral venous plexus (22%). After multivariable analysis, only subcutaneous fat extension was an independent predictor of decreased OS (hazard ratio 5.30, 95% confidence interval 1.47-19.19, P=.011). Though not significant after multivariable analysis, the following factors were significant predictors of LR after univariate logrank testing: above the L5/S1 disc space (P=.004), SI joint invasion (P=.036), and piriformis extension (P=.022). The presence of subcutaneous fat extension was an independent predictor of decreased OS. Other MRI findings with potential for future evaluation include size, presence of soft tissue tail, extension above L5/S1, and SI joint and piriformis invasion.

Masculinizing Genital Surgery: An Imaging Primer for the Radiologist.

OBJECTIVE. Masculinizing genital surgeries for transgender individuals are currently performed at only a select few centers; however, radiologists in any geographic region may be confronted with imaging studies of transgender patients. The imaging findings of internal and external genital anatomy of a transgender patient may differ substantially from the imaging findings of a cisgender patient. This article provides the surgical and anatomic basis to allow appropriate interpretation of preoperative and postoperative imaging findings. We also expand on the most common complications and associated imaging findings. CONCLUSION. As these procedures become more commonplace, radiologists will have a growing role in the care of transgender patients and will be faced with new anatomic variants and differential diagnoses. Familiarity with these anatomic variations and postoperative complications is crucial for the radiologist to provide an accurate and useful report.

Impact of Frailty on Outcomes in Patients Undergoing Open Abdominal Aortic Aneurysm Repair

Frailty is a global state that does not relate directly to comorbidities and is prevalent among patients with vascular disease. The Clinical Frailty Scale (CFS) is a rapid assessment tool to identify vulnerable and frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to independently predict mortality and morbidity after elective open abdominal aortic aneurysm (AAA) repair. We retrospectively reviewed our institutional National Vascular Registry (NVR) data to identify all patients who underwent an elective open juxta or infrarenal AAA repair between January 2014 and December 2018. The NVR data set included preoperative risk factors, imaging findings, intraprocedural variables, and postprocedural outcomes. A total of 184 patients were assessed using the CFS before they underwent elective open AAA repair. Among 26 (14%) individuals categorized as vulnerable using the CFS, there was no significant difference in age or preoperative cardiac and respiratory testing compared with nonfrail patients. However, vulnerable patients were significantly more likely to have a longer length of stay (12.2days vs. 8.8days, P-value 0.044), suffer from respiratory complications (35% vs. 15%, P-value 0.022) and renal failure (23% vs. 6%, P-value 0.013), or die (23% vs. 2%, P-value 0.0003). The regression analysis identified a vulnerable frailty score to be the only significant predictor of mortality (odds ratio=36.7, P<0.001), all other factors were not shown to be independent predictors. The CFS is a practical tool for assessing preoperative frailty among patients undergoing elective open AAA repair and can be used to predict mortality and morbidity after surgery.

Myomectomy for Multiple or Giant Uterine Fibroids.

Myomectomy for diffuse leiomyomatosis and giant fibroid exceeding 30 cm in length is a particularly difficult operation. For diffuse leiomyomatosis, what kind of incision is put in and nucleated, how to suture the wound is a problem. In the case of giant fibroids, the degree of difficulty varies greatly depending on the site, size, and number of fibroid. The points should be taken into account at the time of surgery are as follows: (1) how to incision because incision becomes long, (2) how to remove multiple fibroids together, reduce incisional wounds, and reconstruct the uterus, (3) how to reduce the bleeding, how to suture not to leave a dead space. From the preoperative magnetic resonance imaging findings for each case, we will conduct surgery as far as possible to simulate, but, in fact, it is necessary to judge instantaneously at the time of laparotomy. It is necessary to see many difficult operations and acquire the judgment ability.

MRI image features and differential diagnoses of Herlyn–Werner–Wunderlich syndrome

This study aims to explore how Herlyn–Werner–Wunderlich Syndrome (HWWS) manifests in diagnostic images and analyze the imaging specifications and differential diagnoses thus improving the understanding of the disease. The preoperative magnetic resonance imaging (MRI) findings and clinical data of 19 patients with HWWS were retrospectively analyzed, taking the intraoperative findings and postoperative pathological results of laparoscopic or hysteroscopy surgery as the diagnostic criteria. In this study, all the 19 patients underwent laparoscopic or hysteroscopic excision of vaginal oblique septum, and the preoperative MRI diagnosis of HWSS was consistent with the clinical postoperative diagnosis, with a diagnosis coincidence rate of 19/19 (100%). According to the classification of vaginal oblique septum syndrome, 16 cases were vaginal oblique septum type I and 3 cases were vaginal oblique septum type II. MRI showed a double uterus and double cervix, blood accumulation and dilatation of the vagina connected with the cervix of the affected side, T1WI showed high signal intensity and T2WI showed low or mixed signal intensity. MRI coronal view of 19 patients clearly showed ipsilateral renal absence with obstruction, including 5 cases on the left and 14 cases on the right. Other pelvic complications included: 1 patient with cervical dysplasia and the absence of right kidney and ureter, 3 patients with right ovarian endometriosis cyst, 1 patient with complicated with adenomyosis, 1 patient with right ovarian follicular cyst, 1 patient with right ovarian fallopian tube and pelvic abscess, and 1 patient with right ovarian hematoma. The MRI image of HWWS has its own features and MRI can more accurately evaluate type and related complications of HWWS, therefore it can be used as the best and effective examination method for preoperative imaging evaluation, thus better providing help for clinical comprehensive preoperative evaluation and guidance of surgery.

Preoperative Maxillary Sinus Imaging and the Outcome of Sinus Floor Augmentation and Dental Implants in Asymptomatic Patients

Preoperative maxillary sinus imaging findings have been suggested to be associated with complications and outcomes of sinus lift and dental implant procedures; nonetheless the evidence is controversial. The aim of this study was to examine the association between preoperative maxillary sinus imaging findings and outcomes of sinus lift and dental implant procedures in asymptomatic patients. We included all patients who underwent maxillary sinus lift and dental implant procedures between 2014 and 2017. Maxillary sinus imaging findings were extracted from pre-procedural dental computed tomography scans, and outcomes of the procedures were assessed. A total of 145 procedures were included. No sinonasal symptoms were reported preoperatively. In 46% of cases maxillary sinus imaging was abnormal. The most common imaging finding was peripheral mucosal thickening (38%). Sinus floor cyst/polyp was identified in 13% of the cases, of which 47% occupied more than 50% of the sinus volume. Partial or complete opacification of the maxillary sinus was documented in 3% of cases. The sinus ostium and ostiomeatal complex were obstructed in 7% and 1%, respectively. Mucosal perforation was documented in 22% of cases and was inversely related to mucosal thickening (P = 0.011). Other minor post-operative complications did not correlate with radiological findings. Post-surgical sinusitis was not observed in any of the patients regardless of pre-surgical imaging findings. Incidental maxillary sinus imaging findings such as mucosal swelling, cysts or polyps, regardless of their severity or size, and maxillary ostial obstruction may not need to be addressed prior to sinus augmentation and dental implant procedures in asymptomatic patients. Patients with complete sinus opacification should be referred to an otolaryngologist prior to surgery. Further controlled trials, in larger cohorts, are needed to corroborate our findings.

Inferior vena cava resection without reconstruction for retroperitoneal malignancies

ABSTRACTInferior vena cava (IVC) involvement in retroperitoneal malignancies is a rare occurrence and radical surgery with major vascular resection represents the only potential curative treatment. IVC replacement after resection is still controversial and only small series and few prospective data are available. We report a series of three patients affected by retroperitoneal masses involving IVC treated with vena cava resection without replacement. All patients were treated by a radical R0 surgical procedure associated with infrarenal IVC resection and no reconstruction. Based on preoperative radiologic imaging and intraoperative findings, one patient also underwent right nephrectomy, while another patient underwent left renal vein ligation without nephrectomy. Neither early nor late severe post-operative complications related to the absence of IVC outflow were observed. Resection without replacement of the infrarenal IVC results in acceptable morbidity, thus specific risks related to the use of prosthetic grafts can be avoided.

Comparative effectiveness of imaging modalities for preoperative assessment of anorectal malformation in the pediatric population

ObjectiveThe aim of this study was to compare the accuracy of MRI, colostography/fistulography, and X-ray imaging modalities for preoperative diagnosis of anorectal malformations (ARMs) in pediatric patients. MethodsThis retrospective analysis included a total of 84 pediatric patients with ARMs. Preoperative imaging findings were assessed by 2 radiologists and compared to surgical findings. ResultsMRI identified anomalies of the spine in 25 of 84 patients (29.8%), anomalies of the genital system in 7 of 84 patients (8.3%), anomalies of the urinary system in 22 of 84 patients (26.2%), and underdeveloped sphincter muscle complex in 34 of 84 patients (40.5%). In the 44 subjects receiving both MRI and X-ray, MRI was more sensitive in detecting anomalies of spine (18/44 vs. 8/44; P = 0.002), and both correctly identified the distal end of the rectum in 77.3% (34/44) of the cases. In the 24 subjects receiving both MRI and colostography/fistulography, MRI was more accurate in identifying Pena's classification (22/24 vs. 15/24; P = 0.039). Distal end of the rectum was correctly identified in 75.0% (18/24) and 58.3% (14/24) of the cases (P = 0.125). ConclusionsMRI could clearly reveal fistula anatomy and associated anomalies of ARMs and should be routinely used for preoperative evaluation of ARMs. Type of studyStudy of diagnostic test. Level of evidenceLevel II.

Co-relation between pre-operative imaging findings and per-operative findings in acute abdomen

Background: The term acute abdomen refers to a sudden, severe abdominal pain that is less than 24 hours in duration. It is in many cases an emergent condition requiring urgent and specific diagnosis and/or surgical interventions. Abdominal pain can be just one of the symptoms. Most frequently its cause is benign and/or self-limited, but more serious causes may require urgent intervention. Many new diagnostic and management aids have been introduced into the surgical decision-making process over the past decade or so to improve clinical performance. Correct pre-operative diagnosis of acute abdomen remains challenging despite good history taking and clinical examination, and improvement in new imaging techniques including computer-aided diagnosis, ultrasound imaging, computed tomography and laparoscopy. These imaging techniques need sophisticated equipment and specialist expertise round the clock which is not feasible always. Hence, we have tried studying the accuracy of clinical correlation between these newer modalities of diagnosis and intraoperative diagnosis.Methods: Patients were clinically diagnosed, and then a pre-operative diagnosis was made based on radiological investigations and was then compared with the intra-operative findings for its accuracy.Results: The newer modalities of radiological diagnostic techniques proved to be more accurate in diagnosing the cases of acute abdomen.Conclusions: There was a huge range of correlation between newer diagnostic modalities and our clinical and pre- and post-operative findings.

234. Residual arm numbness after laminoplasty for the patients with cervical spondylotic myelopathy

BACKGROUND CONTEXT Laminoplasty has been widely accepted as a standard treatment option for the patients with cervical spondylotic myelopathy (CSM) with good clinical outcomes. However, some patients suffered from the residual arm numbness postoperatively. But the preoperative factor relating to residual arm numbness and its impact on the outcomes of laminoplasty are not well established. PURPOSE To identify the preoperative factor relating the residual arm numbness after laminoplasty, and to demonstrate the effect of the residual numbness on the change of clinical scores and radiographic parameters. STUDY DESIGN/SETTING Retrospective cohort study PATIENT SAMPLE One hundred three patients who underwent laminoplasty for CSM and were followed up over 2 years after surgery. OUTCOME MEASURES Japanese Orthopedic Association (JOA) score including detailed component score (finger motion, upper extremity motion, lower extremity motion, upper extremity sensory, trunk sensory, lower extremity sensory, bladder function), visual analogue scale (VAS; arm pain, arm numbness and neck pain), 36-Item Short-Form Health Survey (SF-36; physical component summary and mental component summary), preoperative radiographic x-ray film parameters (C7 slope, C2-C7 lordotic angle, C2-C7 sagittal vertical axis and range of cervical motion) and preoperative Magnetic Resonance Imaging (MRI) findings (the severity of stenosis and the existence of snake-eye appearance). METHODS Patients were divided into two groups; residual arm numbness group (postoperative VAS >40mm) and control group (≤40mm). Following to univariate analysis comparing the preoperative factors between groups, the variables of p RESULTS The residual arm numbness group included 42 patients (23 female, 67.5±11.3 years old) and the no numbness group included 61 patients (42 female, 65.1±12.7 years old). In the multivariate analysis after univariate comparison, gender and preoperative arm pain were demonstrated as the independent variables (p=0.017 and 0.046) correlating with the postoperative residual numbness. Contrary to our hypothesis, the preoperative arm numbness and intensity change of MRI were not significant factors relating to the residual arm numbness. In the comparison of the change after surgery, the improvement of physical component summary of SF-36 was significantly low in residual arm numbness group (0.040). CONCLUSIONS In our data set, up to 40% of the CSM patients had residual arm numbness 2 years after laminoplasty. Female and preoperative severe arm pain was the independent predictor for the residual arm numbness. The patients with residual arm numbness showed the lower improvement of quality of life compared to the patient without numbness. These results can help physicians to provide adequate information to treat the CSM patients and help surgeons to predict the patients with poor surgical outcomes preoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

11. Predicting disability and pain outcomes one year after elective surgery for degenerative cervical diseases: analysis from quality outcomes database

BACKGROUND CONTEXT In the current era of value-based health care reform, engaging patients in shared decision-making for treatment planning is imperative. Predictive models capable of providing individualized predictions of patient-reported outcomes (PROs) following cervical spine surgery have the potential to be valuable tools for a shared decision-making process. PURPOSE The aim of the study is to develop and validate predictive models for 12-month postoperative disability, pain, and myelopathy outcomes in patients undergoing elective spine surgery for degenerative cervical diseases (radiculopathy and myelopathy). STUDY DESIGN/SETTING This study is a retrospective analysis of prospectively collected data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE Patients undergoing cervical spine surgery for the diagnosis of radiculopathy or myelopathy with degenerative etiologies are eligible for inclusion in the QOD registry. OUTCOME MEASURES The outcomes of interest in this study were neck related disability (NDI), pain [NRS- neck pain (NP) and arm pain (AP)] and modified Japanese Orthopedic Association score for myelopathy (mJOA). METHODS Two distinct sets of multivariable proportional odds ordinal regression models were developed with the outcomes of interest of disability (NDI), pain (NRS-NP and NRS-AP) and myelopathy (mJOA) score in the myelopathy cohort and disability (NDI) and pain (NRS-NP and NRS-AP) in the radiculopathy cohort. Patient characteristics of age, gender, BMI, race, education level, smoking status, history of diabetes, anxiety and depression, symptom duration, motor deficit or numbness at presentation, preoperative imaging finding of listhesis, employment status, workers’ compensation, insurance status, and ambulatory ability, baseline PROs as well as surgery-specific variables of number of levels, arthrodesis, and surgical approach were included in the models. The models were internally validated using bootstrap resampling. RESULTS A total of 5,076 patients who underwent surgery for cervical radiculopathy and 2717 patients who underwent surgery for cervical myelopathy were included in fitting the models for the distinct set of outcomes. There was a significant improvement in all PROs at 12 months after surgery (P CONCLUSIONS These predictive models can provide individualized risk-adjusted estimates of 12-month disability, pain, and myelopathy outcomes for patients undergoing spine surgery for degenerative cervical diseases. Novel predictive models constructed with these data hold the potential to guide individualized patient discussions on postsurgical outcomes and expectations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Imaging Predictors for Significant Lower Motor Neuron Injury in Traumatic Cervical Spinal Cord Injury

Abstract INTRODUCTION Traumatic spinal cord injury (SCI) results in loss of both white and grey matter in the spinal cord and adjacent to the site of impact. Loss of gray matter within the injured area leads to lower motor neuron (LMN) injury, due to direct destruction of the alpha motor neurons and associated axonal loss within the adjacent peripheral nerves. The extent of gray matter loss can be discrete, or it can extend multiple levels from the site of impact. Since these changes can become irreversible within a year after injury, early identification of significant LMN injury in patients with traumatic SCI allows them to benefit from available reconstructive surgeries before the window for reinnervation closes. METHODS In this single-center retrospective study the charts of 21 previously healthy individuals aged 15 to 50 yr who suffered traumatic SCI with AIS C4-C8 A-D classification and hand functional impairment, without concomitant peripheral nerve or brachial plexus injury, were reviewed. Magnetic resonance (MR) images of cervical spine, obtained within 6 wk from the injury, were reviewed to identify structural imaging characteristics that correspond to gray matter destruction. Severity of LMN injury predicted by imaging findings was compared with the results of compound muscle action potential (CMAP), motor unit potential (MUP), intraoperative stimulation, and Medical Research Council (MRC) grading of the major muscle groups of the upper extremity. RESULTS The extent of LMN injury as determined by electrophysiological evaluations and intraoperative stimulation could be predicted with some degree of specificity by the preoperative imaging findings. CONCLUSION In this study, simple imaging biomarkers indicate the extent of LMN injury in patients with traumatic SCI. By noting the extent of soft tissue damage within the injured metamere of the spinal cord, the degree of lower motor neuron injury can be anticipated and thus appropriate triage performed.

Clinical Significance of Tumor-Related Edema of Optic Tract Affecting Visual Function in Patients with Sellar and Suprasellar Tumors

Preoperative tumor-related edema of the optic tract (EOT) is often found along the white matter tract of the visual system. However, the relationship of EOT with visual function and outcome remains unclear. Therefore we aimed to elucidate whether the presence of EOT is associated with visual outcome in patients with sellar and suprasellar tumors. A total of 212 eyes of 106 patients who underwent endoscopic endonasal surgery for sellar and suprasellar tumors at our institution between March 2016 and August 2018 were included in this retrospective study. Data on patient characteristics, preoperative magnetic resonance imaging findings, and ophthalmologic evaluations were collected. Patients were assigned to 2 groups depending on preoperative magnetic resonance imaging findings (EOT group= 19 [17.9%], non-EOT group= 87 [82.1%]). Visual acuity, visual field (VF), global visual function score, VF index, VF mean deviation, and retinal nerve fiber layer thickness as determined by optical coherence tomography were compared between the groups before and after treatment. In the EOT group, 4 patients had pituitary adenoma, 8 had craniopharyngioma, and 7 had other pathologies. There was no significant difference of pathologies between the groups. Preoperatively, EOT group showed significantly lower values of global visual function score, VF index, mean deviation, and retinal nerve fiber layer thickness than did the non-EOT group (P < 0.001). Postoperatively, the EOT group showed worse visual outcomes than did the non-EOT group. This study reveals that EOT caused by sellar and suprasellar tumors is associated with worse visual function and poor improvement postoperatively.