Vertebral Body Lesions Research Articles

Initial Symptoms of Langerhans Cell Histiocytosis: A Case Series.

Langerhans cell histiocytosis (LCH) is a rare childhood hematopoietic disease, and hence, there are few reports summarizing the course leading to the diagnosis. We described the initial symptoms and the clinical course of LCH. We carried out a retrospective review of charts from a single medical center, and 21 patients with the diagnosis of LCH were enrolled. The initial symptoms of 16 cases were caused by bone lesions; of these cases, there were 8 instances of soft tissue swelling as the initial symptom (38%) and 8 instances of bone pain without swelling (38%). Among the cases of bone lesion, 4 of 6 cases of skull lesion were painless while all vertebral body lesions and long bone lesions were accompanied by pain. LCH bone lesions caused various symptoms depending on the site of the lesion and this makes the diagnosis difficult. A detailed physical examination and imaging studies are recommended for early diagnosis.

Displasia Fibrosa Óssea Extensa em Coluna Cervical de Paciente Jovem e Assintomático

Introdução: A Displasia Fibrosa Óssea (DFO) é uma lesão benigna, representando 5 a 7% dos tumores ósseos benignos. Tem sua etiologia relacionada a mutações somáticas. Classifica-se em monostótica, quando atinge apenas um osso ou poliostótica no envolvimento de mais de um. O acometimento cervical é raro, sendo mais comum na apresentação poliostótica. Os casos com comprometimento funcional ou estético excessivo constituem-se como principais indicações para o tratamento cirúrgico. Objetivos: Os autores mostram o tratamento da lesão destrutiva do corpo vertebral cervical, quinto segmento, causada por DFO monostótica, por meio de somatectomia associada a artrodese anterior com substituto de corpo vertebral, placa de titânio anterior, laminectomia e fixação posterior com cabos de titânio sublaminares. Métodos e Resultados: Relato de caso, inicialmente de trauma automobilístico, que após estudo por imagem da coluna cervical confirmou diagnóstico de DFO. Devido à instabilidade da região cervical indicou-se cirurgia, sobre a qual foram comentadas suas principais etapas.

The preliminary clinical effectiveness of percutaneous kyphoplasty/ percutaneous vertebroplasty in the treatment of stage III of Kümmell's disease without nerve injury

Objective To evaluate the effectiveness and radiographic outcomes of percutaneous kyphoplasty (PKP)/percutaneous vertebroplasty (PKP) in the treatment of stage Ⅲ Kummell's disease without nerve injury. Methods From September 2012 to September 2016, there were 28 patients with stage Ⅲ Kummell's disease recruited to study, of which 16 patients were treated with PKP and the other 12 cases with PVP. with a mean age of 78, ranging from 67 to 95, consisted of 3 males and 29 females. All patients had single vertebral body lesions without symptom of spinal cord injury.Visual analogue scores (VAS) and oswestry dysfunction index (ODI) were recorded before surgery, on the 7 d after surgery and at the last follow-up. Meanwhile, Cobb angles, anterior and posterior heights of the injured vertebral body were measured by X-ray lateral radiography at these three time points. Furthermore, the condition of bone cement in the injured vertebral body was observed with the postoperative CT examination. Results All patients completed the operation safely. Twenty-eight patients were followed up for an average of 18 months (ranging from 12 to 36 months), and 4 patients who failed to be followed up were not included in the statistic analysis. There was no vessel or nerve injury in the operation. Thirteen out of 28 individuals who suffered from bone cement leakage showed no clinical symptom, and recovered walking ability between 12 and 24h after operation. Other types of vertebral body fractures due to compression occurred in 3 cases between 6 and 12 months after surgery, and the symptoms were relieved after another PKP. The rates of improvement at the last follow-up in VAS and ODI were 71.4%(20/28) and 67.9%(19/28), respectively. There was statistical difference in VAS between before surgery and 7d after surgery (t=16.68, P 0.05). Conclusions PKP/PVP may relieve the clinical symptoms safely and effectively of stage Ⅲ Kummell's disease without nerve injury, and may correct heights of kyphosis and vertebral. Nevertheless, it may lead to loss of correction and high rate of bone cement leakage. Further observation is needed for the long-term effectiveness. Key words: Kummell's disease; Vertebroplasty; Osteoporosis

Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial

BackgroundThe Canada-Denmark (CANDEN) definitions of spinal MRI lesions allow a detailed anatomy-based evaluation of inflammatory and structural lesions in vertebral bodies and posterior elements of the spine in patients with...

The Clinical Value of Prenatal 3D Ultrasonic Diagnosis on Fetus Hemivertebra Deformity- A Preliminary Study.

Objective:The present study is planned to discuss the clinical value of prenatal 3D ultra-sonic diagnosis on fetus hemivertebra deformity through the retrospective analysis of clinical data of fetus hemivertebra deformity.Methods:Selected 9 fetus hemivertebra deformity cases, which have been admitted to our hospital during the period from January, 2010 to January, 2016 as study samples, and analyzed their 2D and 3D ultrasonic examination data.Results:4 cases of the fetus hemivertebra deformity occurred at lumbar vertebra, 3 cases at thoracic vertebra, and 2 cases at thoracolumbar vertebra. There were scoliosis and opened spine bifida (OSB). In 7 cases, there was absence of ribs in fetus. The 2D ultrasonic image showed that: The echo at the center of fetus vertebral arch lesion was blurred or lost. The coronal section showed the deformity of the spine. There was obvious loss of the ossification center. From the cross section, we could see that the vertebral body of the fetus was shrinking and the edges were relatively blurred. The 3D ultrasonic image showed that: the echo at the ossification center of the fetus vertebra was relatively blurred, or even lost. The image also indicated scoliosis deformity of the spine. The vertebral body lesion could be accurately located.Conclusion:9 cases of fetus hemivertebra deformity have been detected through examination. Labor inductions have been carried out after getting the permission from the family members. The X-ray examination of the fetus after labor induction showed that the diagnosis was correct. Prenatal ultra-sonic examination holds strong potential for the diagnosis of fetus hemivertebra deformity quite early and deserves further clinical evaluation with large sample size.

Fluroscopic guided percutaneous transpedicular biopsy of vertebral body lesion: a safe and effective procedure

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Vertebral biopsy is suitable for patients with intractable back pain and vertebral body lesions that are detected with noninvasive imaging modalities. Histologic confirmation is necessary for correct diagnosis and subsequent clinical management. Percutaneous biopsy is less invasive and cost-effective.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Twenty three patients with history of severe back pain with vertebral body lesion identified by any of </span><span lang="EN-IN">computed tomography (CT) or magnetic resonance imaging (MRI) were taken up for percutaneous biopsy. Lesion level was determined under fluoroscopy. Biopsy was taken with trephine needle under local anesthesia. Accuracy and effectiveness analyzed after histologic reports</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Among 23 patients, 2 were having malignant primary lesions (8.6%), 8 were having vertebral metastasis (35%), 10 were having infectious etiology (43.4%) and 3 were osteoporotic fractures. There were no complications. One unsuspected secondary malignancy was detected. True positive cases were 19; true negative cases were 3 and one false negative case. Overall accuracy is 95%. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">This minimal invasive technique is simple, safe and effective in diagnosis of malignancy and infection aiding the treating surgeon in their further management. It is also useful in detecting unsuspected malignancy.</span></p><p class="abstract"> </p>

Transesophageal Bronchoscopic Ultrasound-Guided Fine-Needle Aspiration for Metastatic Vertebral Body Lesion.

Malignant neoplasms frequently cause vertebral metastases. Traditionally, either image-guided percutaneous biopsy or open biopsy has been performed for sampling specimens for the definitive diagnosis. We herein report a case with suspected multiple metastases but unknown primary, who underwent endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph nodes with negative results by rapid onsite cytologic evaluation, followed by the transesophageal approach with the ultrasound bronchoscope for the vertebral body lesion at the same setting that provided a definitive diagnosis of metastatic hepatocellular carcinoma.

Spontaneous and complete regeneration of a vertebra plana after surgical curettage of an eosinophilic granuloma

The eosinophilic granuloma is a unifocal or multifocal Langerhans cell histiocytosis characterized by an expanding proliferation of Langerhans cells in bones. Skeletal LCH is a rare condition, and vertebral regeneration in cases of vertebral body collapse is even rarer. We report the case of a girl with spontaneous complete healing. A 3-year-old girl was referred for nighttime back pain, with no fever and no neurologic signs. Within a few days, she developed sudden painful restriction of all spine movements. X-ray and computed tomography (CT) of the spine showed reduced T7 vertebral body height (vertebra plana).The patient underwent T7 curettage and the histopathological exam was suggestive of LCH. Two additional skull lesions were found and therefore she underwent chemotherapy. After 7years of follow-up, total vertebral reconstruction was observed. Despite the rarity of the condition and despite the rarity of vertebral body lesion resolution, total vertebral body reconstruction was observed over a 7-year period. Long-term follow-up is necessary for a better understanding of the final outcome of patients with EG.

Fluoroscopy Guided Percutaneous Transpedicular Biopsy for Thoracic and Lumbar Vertebral Body Lesion: Technique and Safety in 23 Consecutive Cases.

Background Though some vertebral lesions have typical imaging findings, histological/ microbiological evidence are required for definitive diagnosis and management, specially for tumor and infective lesions so that wrong diagnosis and wrong treatment can be avoided. Conventionally, open biopsy methods are used. With availability of CT scan, MRI, percutaneous transpedicular vertebral biopsy has now become popular as a minimally invasive technique for biopsy of vertebral lesion. Objective To describes technique and to analyzes safety and feasibility of percutaneous transpedicular vertebral biopsy with fluoroscopy guidance for thoracic and lumbar vertebral body lesions. Method Twenty three patients who underwent percutaneous transpedicular vertebral biopsy under fluoroscopy guidance were retrospectively evaluated for demographic data, indication for biopsy, anatomical locations, histological/microbiological diagnosis, complications and final outcome of treatment. True positive, true negative, false positive and false negative cases were defined. Result There were 17 males and 6 female patients of mean age 47 (range 22-73 years). Biopsies were performed in 17 dorsal and six lumbar vertebral bodies. Adequate sample were obtained in all cases. Seventeen patients (12: tubercular pathology, 1: primary tumor, 3: metastasis, 1: osteoporotic fracture) had definitive histological/ microbiological diagnosis. Four patients had no granuloma and tumor. Two had histological features of chronic non specific inflammation. True positive cases were 17, true negative were four and false negative case were two. Overall accuracy was 92%. One patient developed small hematoma at biopsy site. Conclusion Fluoroscopy guided percutaneous transpedicular biopsy of is a safe procedure with high adequacy and accuracy and low complication rate for thoracic and lumbar vertebral body lesion.

Imaging for Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome.

Multifocal osteomyelitis and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome constitute a spectrum of disease that includes inflammatory bone lesions and dermatologic findings. Radiographic features resemble those of the spondyloarthropathies with anterior chest wall involvement. Early radiographic findings are osteodestructive with lytic lesions. Bone scintigraphy of the sternoclavicular region classically yields a 'bull's head' pattern of radionuclide uptake. Magnetic resonance imaging (MRI) can demonstrate corner lesions of vertebral bodies. Ultrasound often reveals peripheral enthesitis. Late radiographic features are usually osteoproliferative. PET/CT can identify chronic lesions. Differential diagnostic considerations include osteomyelitis and malignancy, which often prompt bone biopsy.

Analysis of clinical characteristics of 20 patients with pyogenic spondylitis

To investigate the diagnostic value of clinical manifestation, laboratory examination and imaging changes for pyogenic spondylitis and to summarize the clinical characteristics of patients with pyogenic spondylitis. The clinical data, of 20 patients with pyogenic spondylitis were diagnosed by histopathological examination from March 2012 to March 2015, were retrospectively analyzed. There were 9 males and 11 females, aged from 43 to 72 years old with an average of 58.9 years. Included 3 cases of cervical vertebrae, 7 cases of thoracic vertebrae, 10 cases of lumbar vertebrae. Patients of blood analysis, erythrocyte sedimentation rate(ESR), C reactive protein(CRP), X rays, CT and MRI were performed before treatment. Visual analogue scale (VAS) was used to evaluate the pain of patients suffering from vertebral pain. All the patients had suffered from vertebral pain before treatment. VAS was 9 points in 4 cases, 8 points in 6 cases, 7 points in 1 case, 3 points in 6 cases, and 2 points in 3 cases. Among them, 7 patients complicated with neurological symptoms, 11 with aggravating night pain, 10 with fever. WBC and Neutrophil count (NEU) of 5 cases were increased and other 15 cases were normal;CRP of 19 cases were increased and 1 case was normal;ESR of all 20 cases were increased. X rays showed the intervertebral space narrowing in all 20 cases, 13 cases complicated with destruction of vertebral body; CT showed the lesions of vertebral body in the 20 cases and complicated with destruction, sclerosis of sclerotin; MRI showed that the lesions of the vertebral body in the T1 image had uneven medium low signal, in the T2 image of the 16 cases had uneven high signal and 2 cases had uniform and high signal, 2 cases had main high signal compliated with mixed signal. Thirteen patients underwent surgical treatment and 7 patients received conservative treatment, and the patients left hospital while VAS had significantly improved after treatment. Pyogenic spondylitis is easy to be misdiagnosed or missed in clinic. It can be combined with the clinical manifestations, laboratory examination and imaging characteristics in order to make a definite diagnosis for purulent spondylitis in early.

Temperature distribution during radiofrequency ablation of spinal metastases in a human cadaver model: Comparison of three electrodes.

Radiofrequency ablation (RFA) temperatures reaching 45°C in adjacent tissues are cytotoxic to the spinal cord, nerves and surrounding tissues. This study compares different RFA electrodes with regard to the temperature distribution during ablation of spinal metastases. In vitro experimental study in isolated lumbar vertebrae of a human cadaveric spine. The temperature distribution of RFA electrodes was measured during ablation in human cadaveric lumbar vertebrae containing a simulated vertebral body lesion. The analysis compared a novel bipolar RFA electrode with two conventional monopolar RFA electrodes. A vertebral metastasis model was prepared in eight lumbar vertebrae for each electrode. Differences between the electrodes were evaluated with a one-way ANOVA. The lowest temperature at the thermocouples adjacent to the simulated lesion was achieved when using the bipolar RFA electrode (46.4 ± 3.3°C), but temperature difference to the monopolar RFA electrodes was not significant. In the neural foramen and epidural space of lumbar vertebrae the maximal temperature measured when using the bipolar RFA electrode was 37.0 ± 0°C and 37.3 ± 0.7°C, which was significantly lower than during ablation via either of the monopolar RFA electrodes (p ≤ 0.001). Temperatures in areas of adjacent tissue during RFA using a specific for spinal ablation designed electrode with integrated thermocouples were significantly lower compared to other electrodes, potentially reducing temperature related risks during ablation.

Vertebral haemangioma compared to bony metastasis on magnetic resonance imaging

Vertebral haemangiomas (VHs) are benign vascular lesions of vertebral bodies, and are common incidental findings in imaging, occurring in approximately 10–12% of the adult population.1 These lesions consist of thin-walled blood vessels that pervade the medul-lary cavity between trabecula.2 Typically, VHs are asymptomatic and do not require intervention unless causing neurological compromise.

Radical Debridement and Spinal Reconstruction using Titanium Mesh Cages (TMC's) in Pediatrics Patients with Pott's Disease and Vertebral Osteomyelitis

Introduction TB spondylitis and vertebral osteomyelitis frequently occur in the patients of early ages. The tendency to the multilevel damage with total or subtotal lesions of several vertebral bodies leads to the spine collapse and early kyphosis. Radical debridement and autogenous strut-graft fusion have become the “gold standard” for surgery. The introduction of the TMC in adult's spinal surgery has opened up a variety of applications that are realizable as a result of the versatility of the implant. But the use of TMC in pediatrics spinal surgery is controversial, and results have not been published to date. Patients and Methods Study design: cohort analysis. 74 children aged from 7 months till 17 years underwent spinal reconstruction: 5 (10%) in the cervical spine, 32 (46%) in the thoracic spine and 37 (44%) in the lumbar spine. Clinical series include 18 early age patients under 3 years old. Group 1 (n1 = 25) – tuberculous (TB) spondylitis; group 2 (n2 = 49) – chronic nonspecific spondylitis (CNS) and its consequences, including 16 patients with spondylodiscitis. Disease duration in all patients was at least 4 months prior ineffective antimicrobial therapy. The indications for surgery were destruction with vertebral deformity progression, neurological disorders and ineffective chemotherapy with continuing abscesses. All patients had debridement with anterior column reconstruction, posterior instrumentation and fusion by TMC's with bone auto-grafts. The rate of the fusion was assessed by CT at 6 and 12 months after surgery according to the new rating scale graded from 1 (incorrect implant position) to grade 5 (solid fusion with a structural bone block). Results The number of stabilized spinal segments ranged from 2 to 5. Etiology of spondylitis was identified due to bacteriological, molecular genetics and morphological studies of the operational material. No operative complications and no implant-related complications were recorded in the postoperative period. The fusion rate corresponded to grade 3 in 91,1% ( n = 68) at 6 mns post-op and as grade 4 in 93,2% ( n = 69) at the 12 mns post-op. Till the final follow-up (M 36 - mns, min 12 - mns, max – 4 years) a mean segmental loss of correction was 3,7 (0 ÷ 7) degrees. Destabilization of TMC's was detected after surgery only in two cases due to the late infection's reactivation. Conclusion The anterior interbody fusion by TMC's with bone auto-grafts in pediatric spine reconstruction provides reliable spinal stability in both the short-term and long-term period and does not increase the risk of infectious complications in cases of infectious spondylitis' surgery. TMC produce the early anterior fusion and provide the possibility to earlier removing of posterior instrumentation before the disk degeneration inside the instrumented zone in growing spine.

Anterior Approach for Thoracolumbar Fracture Dislocations: Surgical Management in Poor Resource Region, Record of 7 years Follow-up

Introduction: Thoracolumbar fracture dislocation is a trauma of high energy which generally is treated with longsegment stabilization. Anterior spine exposure may be used alone or in combination with a posterior midline approach in a staged or sequential fashion. In this study, we report the 7-years’ experience of the anterior approach to the thoracolumbar spine fracture dislocations at a single institution. Patients and methods: Over a 7-year period (2007–2014), 15 patients (9 males and 7 females) with a mean age of 41.1 years ranging between 25 and 61 years, were operated on using an anterior approach at our institution. All patients were submitted to standard anterior spine surgery, thoracotomy (in 9 patients), thoracophrenolumbotomy (in 3 patients) and lumbotomy (in 2 patients), one patient required left thoracotomy alone. In all cases, we used heavy duty plate fixation and autologous bone (rib or vertebral bone) inside the cylinder. The criteria for surgical intervention were: partial or progressive neurologic deficit, kyphotic angulation =25o at one segment, progressive kyphosis, lesion with a loss of 50% of vertebral height with angulation and a residual canal diameter 50% of normal. All patients had a failure of the anterior and middle columns as viewed on a CT scan or MRI if available. Results: The average duration of follow-up was 24 months. One patient died during the follow-up period. Concerning ethiology, there were two types of vertebral body lesions, which were traumatic and infectious. There were also 12 patients with traumatic lesions. The mean age was 41.1 years (range 25-61). There were 10 males and 5 female patients. Six patients had a burst fracture (type A3), with compression failure of the anterior and middle columns of the spine (level T12 in 3, level T11 in 1, level L1 in 2,). All patients with traumatic lesions underwent singlestage anterior fixation by heavy duty conventional plate and screw and the gap filled with autograft (rib and morselized vertebral bone). Three patients were operated because of the thoracic and lumbar tuberculous spondylitis and Hydatid cyst (one patient T9, one at T10, one T5). Discussion: Initial reports of the anterior thororacotomic approach to the thoracic spine were related to Pott’s disease, spine surgery innovations and aging with a more active population resulting in a progressive increase in spine instrumentation. The main indication for anterior decompression is an incomplete neurological injury with radiographically demonstrated neural compression by bone or disk fragments. The anterior surgical treatment allows direct decompression of the neural elements and correction of the deformity. Conclusion: The anterior approaches provide excellent exposure of the relevant bony anatomy and can be used to secure anterior column support with bony fusion. Anterior spinal fusion surgery is a safe procedure and can be used with confidence when the nature of a patient’s spinal disorder dictates its use.

A Case of Primary Aggressive Non Hodgkin’s Lymphoma of Parotid Gland

Introduction: Primary parotid Non Hodgkin lymphoma is rare and is generally overlooked in differential diagnosis. A high index of suspicion is therefore warranted for the diagnosis. In the present case report, we describe a case of high grade diffuse large B cell Non-Hodgkin’s lymphoma of the parotid gland. Case presentation: A 24 Years old Male presented with a painless mass over the Left parotid region. Imaging studies were suggestive of an infiltrative mass lesion in left parotid along with lytic lesions in vertebral bodies of dorsolumbar spine. The patient underwent total parotidectomy of left Parotid gland with facial nerve preservation. Histopathology of the resected specimen was consistent with primary diffuse large B cell lymphoma of the parotid gland. Conclusion: Lymphomas arising from the parotid gland are an uncommon entity, said to account for only 0.6–5% of tumors or tumor-like lesions of the parotid, and are therefore commonly overlooked. This misdiagnosis often leads to unnecessary diagnostic procedures, delaying the initiation of proper treatment

Core Needle Percutaneous Transpedicular Vertebral Body Biopsy

We report an accurate technique for percutaneous transpedicular core needle biopsy of vertebral body lesions, and evaluate its effectiveness for histologic diagnosis retrospectively. The purpose of this study is to evaluate the effectiveness and accuracy of this method retrospectively. Better knowledge of vertebral pedicle morphometry has led to the development of transpedicular fixation techniques in spinal surgery. After experience with these techniques, we have been performing percutaneous transpedicular vertebral body core needle biopsies (transpedicular biopsy) for histologic diagnosis since 1993. A total of 128 patients who had undergone transpedicular biopsy for T1-L5 vertebral body lesions were evaluated. The biopsies were carried out under local anesthesia, except in children, for whom general anesthesia was used. Biopsy specimens were obtained by passing 8 or 11 G needle biopsy instruments percutaneously through the pedicle into the site of the lesion under C-arm fluoroscopy guidance. Histologic analyses were performed, and the accuracy and effectiveness of this technique were evaluated. The pathologic evaluations were definitive in 120 patients (93.8%) and not diagnostic in 8. The accuracy of the results differed among the diagnostic categories. Diagnostic accuracy was 78.6% for primary neoplasms and 97.0% for metastatic neoplasms. There was a significant difference in the diagnostic criteria and spinal segment. True positive rate was higher in the thoracic spine (92.2%) than that of lumbar spine (76.6%). Transpedicular biopsy is a useful procedure for evaluation of thoracic and lumbar vertebral body lesions.

Percutaneous Vertebroplasty Combined with Percutaneous Pediculoplasty for Lytic Vertebral Body and Pedicle Lesions of Metastatic Tumors

Background: Percutaneous pediculoplasty (PP) consists of the injection of Poly(methyl methacrylate) (PMMA) into the fractured pedicle or lytic vertebral pedicle lesions, as a technique derived from vertebroplasty. Objectives: To evaluate the short-term analgesic effect of percutaneous vertebroplasty (PV) and percutaneous pediculoplasty (PP) in patients with lytic vertebral body and pedicle lesions of metastatic tumors. Study Design: Single-center retrospective observational study. Setting: An interventional pain management practice, a medical center, major metropolitan city, China. Methods: Single-center retrospective observational study of all patients managed with PV and PP for painful vertebral body and pedicle metastatic tumors between 2007 and 2013. For each patient, symptom duration and pain intensity were recorded. PP was performed under local analgesia, in the prone position, with C-arm fluoroscopy guidance. The mixture of PMMA and Doxorubicin was delivered into the vertebral body with a non-beveled needle for the initial treatment followed by the mixture delivery into the lytic pedicle during needle withdrawal. Results: Nine patients (5 women, 4 men) were enrolled in the study with a mean age of 65.9 years (range 57 – 75). Technical success was defined as the ability to access the lesion using the approach. A positive clinical response for pain relief was achieved in these patients in whom vertebroplasty and pediculoplasty had been performed. Pain level was not significantly reduced in 3 patients in whom just vertebroplasty has been performed because the medial wall of the pedicle was destroyed by the metastatic lesion. Limitations: This study is limited by its sample size. Conclusions: PV and PP via the transpedicular approach for infiltrated vertebral bodies and infiltrated pedicles of metastatic tumors may be considered a valid therapeutic option. Key words: Percutaneous pediculoplasty, percutaneous vertebroplasty, lytic pedicular lesions, bone cement

Abstract No. 404 - Utilizing 3-D fluoroscopic imaging techniques in musculoskeletal oncologic intervention

Understand concept, benefits and utility of 3-D fluoroscopic imaging in the setting of radiofrequency ablation and cement augmentation in metastatic spinal lesions. Vertebral body lesions are frequently a source of significant pain in patients with metastatic disease. Interventions such as radiofrequency ablation with cement augmentation of metastatic lesions has been increasingly shown to result in the highest degree of palliative pain control. These procedures are often under CT guidance or CT fluoroscopy. At our institution, we utilize 3-D fluoroscopic spin imaging as our technique of choice in performing these procedures. The patient is placed prone on the table, as near to the iso-center of the c-arm as possible. The c-arm is then positioned over the area of interest and preliminary rotation of the C-arm is performed to ensure there is no obstruction. A 220 degree fluoroscopic spin is performed which results in volumetric acquisition of data. In the case of spinal intervention, a bone algorithm is applied and a bony MIP of the spine is generated. This allows for three dimensional visualization of metastatic lesions in question. At our institution we utilize a unilateral transpedicular approach for ablation. Using the MIP we can generate exact coordinates for the table and c-arm in order to facilitate cannulation in orthogonal planes. These coordinates are preset into fluoroscopy console. We then proceed with ablation and augmentation. -Allows for pre- and post-procedural global evaluation of the lesion due to volumetric acquistion.-Manipulation of data into virtually any plane necessary to plan your approach.-Evaluate positioning of canulas in the middle of treatment.-Ability to obtain coordinates for specific positions of vertebral bodies of interest also facilitates in patient positioning and avoids radiation exposure from trial and error.-Personnel does not have to present during spin acquisition where much of the planning is done.-Allows for these interventions to be performed in the angiography suite as image acquisition and manipulation is entirely software based.-Allows for realtime monitoring of ablation and more importantly cement augmentation.

Differential diagnosis of osteoblastic metastases from bone islands in patients with lung cancer by single-source dual-energy CT: Advantages of spectral CT imaging

ObjectivesTo evaluate the diagnostic efficacy of spectral CT for the differentiation of osteoblastic metastases (OBMs) from bone islands (BIs) in patients with lung cancer. MethodsIn 94 patients with lung cancer who underwent spectral CT, focal hyperdense lesions in vertebral bodies were diagnosed as OBMs or BIs. Regions of interest were placed within each lesion to measure the mean CT value and its standard deviation (SD) on polychromatic single-energy CT (SECT) at 140kVp and dual-energy virtual monochromatic spectral (VMS) images. The mean bone (Dbone(wa)) and water densities (Dwa(bone)) of each lesion were also measured. The slope (k) of the spectral curve was calculated. Independent-sample t-test was used to compare those values between OBMs and BIs. Receiver operator characteristic analysis was performed to compare the area under curve (AUC) for the differentiation of OBMs from BIs. ResultsA total of 79 OBMs and 43 BIs were confirmed. The CT and SD values on SECT at 140kVp and VMS images at 50–130keV, k value, and Dbone(wa) for OBMs were significantly lower than for BIs; Dwa(bone) was significantly higher for OBMs than for BIs (p<0.05 for all). The AUC for the SD value at 110keV was the highest among those parameters. The optimal cut-off value for this differentiation was 68.6HU for the SD value on VMS images at 110keV with sensitivity of 93.0% and specificity of 93.3%. ConclusionSpectral CT is helpful for the differentiation of OBMs from BIs in patients with lung cancer, particularly using SD of the CT value on high-energy VMS images.