Pre-procedural MR Images Research Articles

Evaluation of junctional zone differential and ratio as possible markers of clinical efficacy in uterine artery embolisation of adenomyosis

BackgroundUterine artery embolisation is a recommended method of adenomyosis treatment with good clinical results. Changes in uterine volume and maximal junctional zone thickness (JZmax) after embolisation are thoroughly analyzed in the literature. In contrast changes in other suggested morphological diagnostic markers of adenomyosis (junctional zone differential / JZdiff—and junctional zone ratio / JZratio) are rarely evaluated. This single-centre retrospective study aimed to analyse the changes in morphological parameters used for the MR imaging diagnosis of adenomyosis (including JZdiff and JZratio) after UAE. Clinical effectiveness and safety were also analysed.Materials and methodsPatients who underwent UAE for pure adenomyosis from Jan 2008 to Dec 2021 were evaluated. Adenomyosis was diagnosed based on JZmax, JZdiff, and JZratio measured on MR imaging. To assess clinical efficacy, the numerical-analog-quality-of-life (QoL) score was routinely obtained from patients at our centre. MRI morphological data were analysed. Statistical analysis was conducted using Wilcoxon signed-rank test, uni- and multivariate regression models, Pearson product-moment correlation, and Kruskal–Wallis tests.ResultsFrom our database of 801 patients who underwent UAE between Jan 2008 to Dec 2021, preprocedural MR images were available in 577 cases and, 15 patients had pure adenomyosis (15/577, 2.6%). Uterine volume, JZmax, and JZdiff decreased significantly after UAE; QoL score increased significantly. A significant correlation was found between QoL change vs. JZmax and JZdiff change. Permanent amenorrhoea and elective hysterectomy 5 years after UAE were both 7.1%.ConclusionChange of JZdiff after UAE in adenomyosis is a potential marker of clinical success. UAE is a clinically safe and effective treatment for adenomyosis.Graphical

Enhancing Annular Fissures and High-Intensity Zones: Pain, Internal Derangement, and Anesthetic Response at Provocation Lumbar Discography.

A high-intensity zone identified on preprocedural MR imaging is known to correlate with pain at provocation lumbar discography. The correlation between enhancing annular fissures and pain at provocation lumbar discography has not been comprehensively evaluated. The purpose of this study was to assess the pain response and imaging features at enhancing annular fissure nonoperated disc levels identified on preprocedural MR imaging with comparison with the high-intensity zone and nonenhancing disc levels in patients referred for provocation lumbar discography. One-hundred nonoperated discs in 44 patients were retrospectively evaluated for an enhancing annular fissure on sagittal postcontrast T1-weighted pre-discogram MR imaging. Enhancing annular fissure discs were graded on the sagittal T2-weighted sequence (Grade 4: like CSF to Grade 1: negative/barely visible) for high-intensity-zone conspicuity. High-intensity-zone detection was performed independently. In the primary assessment, enhancing annular fissure and high-intensity zones were associated with pain response at provocation lumbar discography. Additional analysis included intradiscal anesthetic response and postdiscogram CT appearance. Thirty-nine discs demonstrated an enhancing annular fissure, with 23/39 demonstrating a high-intensity zone. The presence of a high-intensity zone predicted severe pain (concordant + nonconcordant; P = .005, sensitivity of 40%, specificity of 94%) and concordant pain (P = .007, sensitivity of 39%, specificity of 86%) at provocation lumbar discography. Enhancing annular fissures without a detected high-intensity zone were more frequently observed among severely painful (50%) and concordant (36%) discs than among discs negative for pain (9%; P = .01). This finding resulted in a substantially greater overall sensitivity of enhancing annular fissures for severe (P < .001, 64%) and concordant pain (P = .008, 61%), significantly improving the overall predictive ability of a high-intensity zone alone. A high-intensity zone went undetected in 9/11 Grade 1 disc levels with concordant pain present in 7/9. Consideration of enhancing annular fissures on preprocedural MR imaging substantially improves the prediction of severe/concordant pain in provocation lumbar discography.

Prediction of Response of Hepatocellular Carcinoma to Radioembolization: Machine Learning Using Preprocedural Clinical Factors and MR Imaging Radiomics

PurposeTo create and evaluate the ability of machine learning–based models with clinicoradiomic features to predict radiologic response after transarterial radioembolization (TARE). Materials and Methods82 treatment-naïve patients (65 responders and 17 nonresponders; median age: 65 years; interquartile range: 11) who underwent selective TARE were included. Treatment responses were evaluated using the European Association for the Study of the Liver criteria at 3-month follow-up. Laboratory, clinical, and procedural information were collected. Radiomic features were extracted from pretreatment contrast-enhanced T1-weighted magnetic resonance images obtained within 3 months before TARE. Feature selection consisted of intraclass correlation, followed by Pearson correlation analysis and finally, sequential feature selection algorithm. Support vector machine, logistic regression, random forest, and LightGBM models were created with both clinicoradiomic features and clinical features alone. Performance metrics were calculated with a nested 5-fold cross-validation technique. The performances of the models were compared by Wilcoxon signed-rank and Friedman tests. ResultsIn total, 1,128 features were extracted. The feature selection process resulted in 12 features (8 radiomic and 4 clinical features) being included in the final analysis. The area under the receiver operating characteristic curve values from the support vector machine, logistic regression, random forest, and LightGBM models were 0.94, 0.94, 0.88, and 0.92 with clinicoradiomic features and 0.82, 0.83, 0.82, and 0.83 with clinical features alone, respectively. All models exhibited significantly higher performances when radiomic features were included (P = .028, .028, .043, and .028, respectively). ConclusionsBased on clinical and imaging-based information before treatment, machine learning–based clinicoradiomic models demonstrated potential to predict response to TARE.

The Value of Preprocedural MR Imaging in Genicular Artery Embolization for Patients with Osteoarthritic Knee Pain

PurposeTo determine the value of preprocedural MR imaging in genicular artery embolization (GAE) for patients with osteoarthritic knee pain. Materials and MethodsThis single-center study retrospectively analyzed 28 knees in 18 patients who underwent GAE for intractable knee pain < 1 month after MR imaging. The pain experienced in each knee was evaluated on a 100-mm visual analog scale (VAS) at baseline and 1- and 3-month after GAE. “GAE responders” were defined as knees that exhibited greater than 30% reduction of VAS pain scores from baseline at both follow-up visits. Musculoskeletal radiologists evaluated MR images of the affected knee compartment regarding cartilage defects, osteophytes, subchondral cysts, bone marrow lesions (BMLs), meniscal injury, and joint effusion. The performances of Kellgren–Lawrence (KL) grading and MR findings in predicting GAE responders was estimated based on receiver operating characteristic curves. ResultsThe mean VAS pain score was 84.3 mm. BML (area under the curve [AUC], 0.860; P < .001), meniscal injury (AUC, 0.811; P = .003), and KL grading (AUC, 0.898; P < .001) were significantly associated with GAE outcome. To predict GAE responders, KL grade ≤ 2 yielded a sensitivity of 87.5% and a specificity of 60.9%, BML grade ≤ 1 yielded a sensitivity of 75.0% and a specificity of 69.6%, and meniscal injury grade ≤ 2 yielded a sensitivity of 83.3% and a specificity of 72.7%. ConclusionsLarge BMLs and severe meniscal injuries on MR imaging, as well as high KL grades, indicated poor responses to GAE.

Three-Dimensional Augmented Reality Visualization Informs Locoregional Therapy in a Translational Model of Hepatocellular Carcinoma

PurposeTo evaluate the utility of visualizing preprocedural MR images in 3-dimensional (3D) space using augmented reality (AR) before transarterial embolization of hepatocellular carcinoma (HCC) in a preclinical model. Materials and MethodsA total of 28 rats with diethylnitrosamine-induced HCCs > 5 mm treated with embolization were included in a prospective study. In 12 rats, 3D AR visualization of preprocedural MR images was performed before embolization. Procedural metrics including catheterization time and radiation exposure were compared vs a prospective cohort of 16 rats in which embolization was performed without AR. An additional cohort of 15 retrospective cases was identified and combined with the prospective control cohort (n = 31) to improve statistical power. ResultsA 37% reduction in fluoroscopy time, from 11.7 min to 7.4 minutes, was observed with AR when compared prospectively, which did not reach statistical significance (P = .12); however, when compared with combined prospective and retrospective controls, the reduction in fluoroscopy time from 14.1 min to 7.4 minutes (48%) was significant (P = .01). A 27% reduction in total catheterization time, from 42.7 minutes to 31.0 minutes, was also observed with AR when compared prospectively, which did not reach statistical significance (P = .11). No significant differences were seen in dose–area product or air kerma prospectively. ConclusionsThree-dimensional AR visualization of preprocedural imaging may aid in the reduction of procedural metrics in a preclinical model of transarterial embolization. These data support the need for further studies to evaluate the potential of AR in endovascular oncologic interventions.

SLIR: Synthesis, localization, inpainting, and registration for image-guided thermal ablation of liver tumors.

Thermal ablation is a minimally invasive procedure for treating small or unresectable tumors. Although CT is widely used for guiding ablation procedures, yet the contrast of tumors against normal soft tissues is often poor in CT scans, aggravating the accurate thermal ablation. In this paper, we propose a fast MR-CT image registration method to overlay pre-procedural MR (pMR) and pre-procedural CT (pCT) images onto an intra-procedural CT (iCT) image to guide the thermal ablation of liver tumors. At the pre-procedural stage, the Cycle-GAN model with mutual information constraint is employed to generate the synthesized CT (sCT) image from the input pMR. Then, pMR-pCT image registration is carried out via traditional mono-modal sCT-pCT image registration. At the intra-procedural stage, the region of the probe and its artifacts are automatically localized and inpainted in the iCT image. Then, an unsupervised registration network (UR-Net) is used to efficiently align the pCT with the inpainted iCT (inpCT) image. The final transform from pMR to iCT is obtained by concatenating the two estimated transforms, i.e., (i) from pMR image space to pCT image space (via sCT) and (ii) from pCT image space to iCT image space (via inpCT). The proposed method has been evaluated over a real clinical dataset and compared with state-of-the-art methods. Experimental results confirm that the proposed method achieves high registration accuracy with fast computation speed.

Real-time probe tracking using EM-optical sensor for MRI-guided cryoablation.

A method of real-time, accurate probe tracking at the entrance of the MRI bore is developed, which, fused with pre-procedural MR images, will enable clinicians to perform cryoablation efficiently in a large workspace with image guidance. Electromagnetic (EM) tracking coupled with optical tracking is used to track the probe. EM tracking is achieved with an MRI-safe EM sensor working under the scanner's magnetic field to compensate the line-of-sight issue of optical tracking. Unscented Kalman filter-based probe tracking is developed to smooth the EM sensor measurements when occlusion occurs and to improve the tracking accuracy by fusing the measurements of two sensors. Experiments with a spine phantom show that the mean targeting errors using the EM sensor alone and using the proposed method are 2.21mm and 1.80mm, respectively. The proposed method achieves more accurate probe tracking than using an EM sensor alone at the MRI scanner entrance.

Novel Computational Analysis of Left Atrial Anatomy Improves Prediction of Atrial Fibrillation Recurrence after Ablation.

The left atrium (LA) can change in size and shape due to atrial fibrillation (AF)-induced remodeling. These alterations can be linked to poorer outcomes of AF ablation. In this study, we propose a novel comprehensive computational analysis of LA anatomy to identify what features of LA shape can optimally predict post-ablation AF recurrence. To this end, we construct smooth 3D geometrical models from the segmentation of the LA blood pool captured in pre-procedural MR images. We first apply this methodology to characterize the LA anatomy of 144 AF patients and build a statistical shape model that includes the most salient variations in shape across this cohort. We then perform a discriminant analysis to optimally distinguish between recurrent and non-recurrent patients. From this analysis, we propose a new shape metric called vertical asymmetry, which measures the imbalance of size along the anterior to posterior direction between the superior and inferior left atrial hemispheres. Vertical asymmetry was found, in combination with LA sphericity, to be the best predictor of post-ablation recurrence at both 12 and 24 months (area under the ROC curve: 0.71 and 0.68, respectively) outperforming other shape markers and any of their combinations. We also found that model-derived shape metrics, such as the anterior-posterior radius, were better predictors than equivalent metrics taken directly from MRI or echocardiography, suggesting that the proposed approach leads to a reduction of the impact of data artifacts and noise. This novel methodology contributes to an improved characterization of LA organ remodeling and the reported findings have the potential to improve patient selection and risk stratification for catheter ablations in AF.

Nonrigid Registration of Pre-Procedural MRI and Intra-Procedural CT in CT-Guided Cryoablation of Lung Tumors to Improve Lung Tumor Conspicuity

To improve lung tumor conspicuity during CT-guided cryoablations, we used nonrigid image registrations to fuse pre-procedural MR images and intra-procedural CT images and determined which set of CT images taken at planning, targeting, and monitoring phases of the procedure provided the most accurate and fastest registrations. In 10 percutaneous CT-guided cryoablation procedures, MR images were registered with intra-procedural CT images using a nonrigid registration technique using an intensity-based approach with affine and B-Spline transformations. The time to complete the registration as well as the accuracy of the registration defined by Target Registration Error (TRE), Dice Similarity Coefficient (DSC), and Hausdorff Distance (HD) were measured to assess the performance of the registration. The least significant difference (LSD) method was used as a post-hoc analysis for comparing time and accuracy among planning, targeting, and monitoring phases. The mean TRE of the registration ranged from 6.26 (planning) to 10.31 (monitoring) mm. The mean DSC ranged from 83.86 (monitoring) to 89.22 (planning). The mean HD values ranged from 7.74 (targeting) to 12.20 (monitoring). Mean registration time ranged from 68.67 (monitoring) to 92.02 (planning) s. Using HD, registrations in either the planning or targeting phase were more accurate than in the monitoring phase. The registration was faster using monitoring images than using planning images. Nonrigid registration techniques can be used to fuse pre-procedural MR images with intra-procedural CT images with varying performance depending on the CT images taken at the different phases of the procedure. Therefore, caution should be taken in setting expectations on accuracies and speeds of registration depending on the phases of the CT-guided ablation procedures.

Associations between Cerebral Embolism and Carotid Intraplaque Hemorrhage during Protected Carotid Artery Stenting.

Carotid artery stent placement in patients with intraplaque hemorrhage remains controversial because of the incidence of cerebral embolism after the procedure. The purpose of this study is to determine if intraplaque hemorrhage is a significant risk factor for cerebral embolism during carotid artery stent placement. This prospective study assessed 94 consecutive patients with severe carotid stenosis. These patients underwent preprocedural carotid MR imaging and postprocedural DWI after carotid artery stent placement. Intraplaque hemorrhage was defined as the presence of high signal intensity within the carotid plaque that was >200% of the signal from the adjacent muscle on MPRAGE. We then analyzed the incidence of postprocedural ipsilateral ischemic events on DWI and primary outcomes within 30 days of carotid artery stent placement. Forty-three patients (45.7%) had intraplaque hemorrhage on an MPRAGE image. There was no significant difference in the incidence of postprocedural ipsilateral ischemic events and primary outcomes between the intraplaque hemorrhage and non-intraplaque hemorrhage group. However, postprocedural ipsilateral ischemic events were more frequently observed in the symptomatic group (17/41 [41.5%]) than in the asymptomatic group (8/53 [15.1%]; P = .005). Intraplaque hemorrhage was not a significant risk factor for cerebral embolism during carotid artery stent placement in patients with severe carotid stenosis. Symptomatic patients should receive more careful treatment during carotid artery stent placement because of the higher risk of postprocedural ipsilateral ischemic events.

Image registration of pre-procedural MRI and intra-procedural CT images to aid CT-guided percutaneous cryoablation of renal tumors

To determine whether a non-rigid registration (NRR) technique was more accurate than a rigid registration (RR) technique when fusing pre-procedural contrast-enhanced MR images to unenhanced CT images during CT-guided percutaneous cryoablation of renal tumors. Both RR and NRR were applied retrospectively to 11 CT-guided percutaneous cryoablation procedures performed to treat renal tumors (mean diameter; 23 mm). Pre-procedural contrast-enhanced MR images of the upper abdomen were registered to unenhanced intra-procedural CT images obtained just prior to the ablation. RRs were performed manually, and NRRs were performed using an intensity-based approach with affine and Basis-Spline techniques used for modeling displacement. Registration accuracy for each technique was assessed using the 95% Hausdorff distance (HD), Fiducial Registration Error (FRE) and the Dice Similarity Coefficient (DSC). Statistical differences were analyzed using a two-sided Student's t-test. Time for each registration technique was recorded. Mean 95% HD (1.7 mm), FRE (1.7 mm) and DSC (0.96) using the NRR technique were significantly better than mean 95% HD (6.4 mm), FRE (5.0 mm) and DSC (0.88) using the RR technique (P < 0.05 for each analysis). Mean registration times of NRR and RR techniques were 15.2 and 5.7 min, respectively. The non-rigid registration technique was more accurate than the rigid registration technique when fusing pre-procedural MR images to intra-procedural unenhanced CT images. The non-rigid registration technique can be used to improve visualization of renal tumors during CT-guided cryoablation procedures.

Abstract 5663: Intracardiac Echocardiography From Within the Left Atrium Improves the Accuracy of Image Integration During Catheter Ablation of Atrial Fibrillation

Background: Intracardiac echocardiography (ICE) can be integrated with pre-procedural CT or MR imaging to direct catheter ablation of atrial fibrillation (AF). Prior work has described ICE imaging of the left atrium (LA) with the ICE probe in the RA, but it is feasible to image the LA from an ICE probe placed directly into the LA via a trans-septal puncture performed for the mapping/ablation procedure. The purpose of this study was to determine whether direct LA imaging with ICE results in improved image integration during AF ablation compared with LA imaging indirectly from the RA. Methods: Twenty-five consecutive patients undergoing an AF ablation procedure with the CARTO-Sound system were studied. A 10 French phased array catheter with an embedded CARTO navigation sensor was employed to provide 2D echocardiogram images of the LA - 13 patients underwent imaging from the RA alone and 12 patients from the LA. The accuracy of the image integration was assessed by the average integration error after surface registration and the requirement to take supplementary electroanatomic mapping points to obtain acceptable image integration. Results: Twenty-five patients (56% paroxysmal AF, average LA size = 42±8 mm, average EF = 63±10 %) were examined. There was no difference in the time or number of ultrasound contours required to create a LA anatomic map with ICE imaging from the RA versus the LA (24±17min vs. 24±25min, P=1.0, 24±16 contours vs. 29±18 contours, P=0.5). The average integration error for all patients was 2.19±0.59mm. Direct LA imaging was associated with improved integration error compared to indirect LA imaging from the RA (1.85±0.33mm versus 2.51±0.62mm, P=0.004). Image integration using RA acquired LA images had a tendency to be less accurate resulting in the primary operator acquiring additional registration points to supplement the registration process (patients requiring additional registration points for registration: 3/12 for LA imaging versus 9/13 for RA imaging of the LA, P=0.05). Conclusion: Direct ICE imaging from within the LA is feasible and associated with improved accuracy of image integration during AF ablation.

Intraprocedural Volume Imaging of the Left Atrium and Pulmonary Veins with Rotational X‐Ray Angiography: Implications for Catheter Ablation of Atrial Fibrillation

The use of preprocedural CT or MR imaging to generate patient-specific cardiac anatomy greatly facilitates catheter ablation of the left atrium and pulmonary veins (LA-PVs) to treat atrial fibrillation (AF). This report details the accuracy and utility of an intraprocedural means to generate 3-D volumetric renderings of the LA-PV anatomy: contrast-enhanced rotational X-ray angiography (3DRA). Preprocedural CT or MR imaging and intraprocedural rotational angiography was performed in 42 patients undergoing AF ablation procedures. Initially, pulmonary artery (PA) bolus-chase contrast injections were performed (20 mL, 20 mL/s) to establish pulmonary transit time and cardiac isocentering. Depending on cardiac size, either a single PA injection (80-100 mL, 20 mL/s) or two separate dedicated left/right PA branch injections were performed (60 mL each, 20 mL/s). For the latter, the two volumes of the left/right portions of the LA-PVs were registered and fused. LA-PV 3DRA images were assessed qualitatively and quantitatively in comparison with CT/MR images. The majority of the 3DRA acquisitions (71%) were deemed at least "useful" in delineating the LA-PV anatomy. The LA appendage was delineated in 57% of the cases. A blinded quantitative comparison of PV ostial diameters resulted in an absolute difference of only 2.7 +/- 2.3 mm, 2.2 +/- 1.8 mm, 2.4 +/- 2.2 mm, and 2.2 +/- 2.3 mm for the left-superior, left-inferior, right-superior, and right-inferior PVs, respectively. The feasibility for registering the 3DRA image with real-time electroanatomical mapping was also demonstrated. Intraprocedural contrast-enhanced rotational angiography provides volumetric 3-D images of the LA-PVs of comparable diagnostic value to dedicated preprocedural CT/MR imaging.

Preprocedural MR imaging for percutaneous vertebroplasty: special interest in contrast enhancement

The success of percutaneous vertebroplasty (PVP) depends greatly on preprocedural evaluation of the patients. The purpose of this study was to evaluate the efficacy of preprocedural magnetic resonance imaging (MRI) for the indications of PVP. A retrospective review of 122 osteoporotic compression fractures in 63 patients who underwent preprocedural gadolinium-enhanced MRI and PVP was performed. Based on the extent of contrast enhancement on preprocedural MRI, each case was classified into one of two groups: group 1, which represented more than 50% of the vertebral body enhanced; and group 2, which represented less than 50% of the vertebral body enhanced. The most enhancing level was evaluated in multilevel PVP sessions. We evaluated the difference of pre- and postprocedural pain scales between groups 1 and 2 using Mann-Whitney's U-test. There was a trend toward higher preoperative pain score in group 1, but it was not statistically significant (P = 0.0537). In addition, the postoperative pain score in group 2 was significantly higher than that in group 1 (P = 0.0007). The difference between the pre- and postoperative pain scores was significantly higher in group 1 than in group 2 (P = 0.0001). Contrast enhancement on MRI indicates a painful lesion and extensive contrast enhancement predicts better pain relief after PVP.

Fast and Accurate Automatic Registration for MR-Guided Procedures Using Active Microcoils

A fast, robust, accurate, and automatic registration technique based on magnetic resonance (MR) active microcoils (active markers) for registration of tracked medical devices to preprocedural MR-images is presented. This allows for a straight-forward integration of position measurement systems into clinical procedures. The presented method is useful for guidance purposes in clinical applications with high demands on accuracy and ease-of-use (e.g., neurosurgical or orthopedic applications). The determination of the positions of the active markers is integrated into the preparation phase of the actual MR imaging scan. The technique features a generic interface using DICOM standards for communication with navigation workstations linked to an MR system. The position of the active markers is fixed with respect to a reference system of an optical positioning measurement system (OPMS) and thus the coregistration of the MR system and the OPMS is established. In a phantom study, a mean overall targeting accuracy of 0.9+/-0.1 mm was achieved and compared favorably to results obtained from manual registration tests (1.8+/-0.3 mm) carried out in parallel. For a test person trained for both registration methods, workflow improvements of 3-6 min per registration step were found. The need for manual interaction is entirely eliminated thus avoiding user-bias, which is advantageous for the usage in clinical routine. The method improves the ease-of-use of tracking equipment during stereotactic guidance. The method is finally demonstrated in a volunteer study using a model of a Mayfield skull clamp with integrated active and optical reference markers.

Robot-assisted needle placement in open MRI: System architecture, integration and validation

In prostate cancer treatment, there is a move toward targeted interventions for biopsy and therapy, which has precipitated the need for precise image-guided methods for needle placement. This paper describes an integrated system for planning and performing percutaneous procedures with robotic assistance under MRI guidance. A graphical planning interface allows the physician to specify the set of desired needle trajectories, based on anatomical structures and lesions observed in the patient's registered pre-operative and pre-procedural MR images, immediately prior to the intervention in an open-bore MRI scanner. All image-space coordinates are automatically computed, and are used to position a needle guide by means of an MRI-compatible robotic manipulator, thus avoiding the limitations of the traditional fixed needle template. Automatic alignment of real-time intra-operative images aids visualization of the needle as it is manually inserted through the guide. Results from in-scanner phantom experiments are provided.

Correlation Between Preprocedural MRI Findings and Clinical Outcomes in the Treatment of Chronic Symptomatic Vertebral Compression Fractures with Percutaneous Vertebroplasty

The purpose of our study was to correlate findings of prevertebroplasty MRI with outcomes in the treatment of chronic osteoporotic compression fractures. Forty-five patients with osteoporotic spinal compression fractures of more than 1 year's duration were treated with vertebroplasty. Changes in pain and mobility were assessed by follow-up of 1-28 months. Preprocedural MR images were reviewed using the Modic criteria and were correlated with outcomes. Fifteen patients (33%) had marrow edema on MRI and 30 (67%) of the 45 patients did not. All 15 of the patients with edema had clinical benefit: six patients (40%) achieved complete relief and nine (60%) experienced symptom improvement. Ten patients (67%) had improvement in mobility, and the remaining five patients (33%) had no change. Of patients with no marrow edema (n = 30), five (17%) had complete resolution of pain, 19 (63%) were improved, and six (20%) were unchanged. None had worsening of their symptoms. Mobility was improved in 17 (57%) and unchanged in 10 (33%). Mobility was diminished in three patients (10%). In two cases, impaired mobility was due to causes other than spine disorders. Most (87%) of the 45 patients with compression fractures older than 1 year derived clinical benefit from vertebroplasty irrespective of MRI findings. Although 100% of patients with bone marrow edema had clinical benefit, no direct correlation was seen between symptom resolution and the presence of edema on preprocedural MRI. In our experience, absence of abnormal marrow signal does not definitively predict the outcome of vertebroplasty in chronic fractures.

Medical problems of adults who were sexually abused in childhood

<i>BACKGROUND AND PURPOSE:</i> Many therapeutic techniques have been used for the treatment of symptomatic vertebral hemangiomas (SVH), and each has its own limitations. Our objective was to evaluate the therapeutic efficacy of alcohol ablation for treating these lesions. <i>METHODS:</i> Fourteen patients with SVH were treated by injection of absolute alcohol into the lesion via the percutaneous transpedicular route under CT guidance. Symptoms before treatment included neurologic deficit in 13 patients and debilitating pain in one. All patients underwent preprocedural MR imaging. All patients had clinical and MR imaging follow-up (14 patients at 48–96 hours and 2 months; six at 9–15 months). Results were divided into excellent (resumption of work, alleviation of pain), good (significant improvement), and failure of treatment categories on the basis of subjective assessment of clinical improvement. Clinical improvement/deterioration was correlated with MR-revealed changes. <i>RESULTS:</i> All patients showed transient deterioration of neurologic status after alcohol ablation. Subsequently, excellent results were seen in five patients and eight were in the good category. One patient in whom treatment failed also developed a complication (paravertebral abscess). Four of the eight patients with good results had preprocedural cord changes. Total follow-up ranged from 5 to 31 months, with 11 patients showing stable improvement. One patient developed recurrent hemangioma within a month. Another patient became symptomatic after initial good response, secondary to the collapse of the involved vertebral body. Good correlation was found between clinical improvement and reduction of epidural soft-tissue masses on MR images. Cord signal alteration seen on MR images in four treated patients, however, did not show any change after treatment. <i>CONCLUSION:</i> Alcohol ablation is an effective management option for symptomatic vertebral hemangiomas. Although encouraging results were seen in almost 86% of our patients, a longer follow-up period still is needed to assess the stability of improvement. Potential complications include vertebral collapse and infection.