David Malfair

Combined Cementoplasty and Radiofrequency Ablation in the Treatment of Painful Neoplastic Lesions of Bone

PURPOSE To assess the safety and effectiveness of combined radiofrequency (RF) ablation and cementoplasty in the treatment of painful neoplastic lesions of bone. MATERIALS AND METHODS The authors performed a retrospective analysis of 25 combined treatments comprising RF ablation followed by injection of polymethylmethacrylate cement performed in 19 patients during a 22-month period. Patients ranged in age from 42 to 82 years (mean, 58.9 years) and included five women and 14 men. Eleven vertebrae (eight lumbar and three thoracic), nine acetabulae, three sacra, one pubis, and one humerus were treated with a total of 36 RF ablations (in several instances, overlapping ablations were used). The location of the primary neoplasm, lesion size, pain before and after the procedure (as determined with a 10-point visual analog scale [VAS]), number of RF treatments, type of device used for cementoplasty, RF time, cement volume, and extravasation were documented. RESULTS A total of 25 combined RF ablations and cementoplasties were performed. The technical success rate was 100% (25 of 25 treatments). There were seven minor complications: six limited cement extravasations and a transient thermal nerve injury. The mean RF time was 9.1 minutes (range, 6-12 minutes). The mean cement volume injected was 6.1 mL (range, 0.8-16 mL). The mean preprocedure pain (as measured with a VAS) was 7.9 (range, 7.0-9.0) and the mean posttreatment pain was 4.2 (range, 0-6); the difference was statistically significant (mean score, 4.08; 95% confidence interval: 3.92, 4.87; P < .0001) using a paired t test. CONCLUSIONS Combined RF ablation and cementoplasty appears to be safe and effective in the treatment of painful neoplastic lesions of bone.

Radiographic evaluation of scoliosis: review.

Despite enormous advances in cross-sectional imaging over the past few decades, radiography remains the main-stay of diagnosis and evaluation of scoliosis. Knowledge of technical factors, measurement error, and measurement techniques is important in the comparison of serial radiographs and affects surgical decision making. This article focuses on adolescent idiopathic scoliosis as a framework for understanding the general concepts in the radiographic evaluation of the scoliotic spine.

Plain Radiograph Assessment of Spinal Hardware

The frequency and variety of spinal instrumentation has increased tremendously over the past 100 years, and imaging plays an important role in evaluating the postoperative spine. Although assessment of spinal hardware often involves a multimodality approach, plain radiographs are the most commonly used modality, given accessibility, cost, relatively low radiation dose compared with computed tomography, and provision of positional information. An approach to assessment of plain radiographs of the postoperative spine is discussed, and examples of common postoperative complications are provided, including infection, hardware failure, incomplete fusion, and junctional failure.

Extrahepatic Metastases of Hepatocellular Carcinoma: A Spectrum of Imaging Findings

Hepatocellular carcinoma (HCC) is the most common primary tumour of the liver, responsible for significant morbidity and mortality worldwide. In the Western world, it primarily affects patients with cirrhosis, secondary to hepatitis C virus and alcoholism. In the rest of the world, HCC is closely associated with hepatitis B virus infections. Radiologists play a key role in accurately staging HCC, which has important implications for treatment planning. This pictorial review aims to describe the routes of HCC spread and the most frequent sites of metastases, to recognize extrahepatic HCC findings on computed tomography and magnetic resonance imaging, and to understand the implications of HCC staging on treatment planning.

Magnetic resonance imaging appearance of partial latissimus dorsi muscle tendon tear

There is still a paucity of information about the clinical presentation, treatment and imaging findings of latissimus muscle tears. Only one study has specifically described the magnetic resonance imaging (MRI) features of latissimus tendon tears. We describe a case of a high-grade tear in the latissimus muscle tendon in an active water skier with no significant prior medical history. MRI demonstrated at least a 50% tear of the latissimus tendon, manifesting as increased signal intensity on T2-weighted sequences and surrounding edema, as well as a diminutive tendon at the humeral insertion.

Radiofrequency Ablation of Solitary Eosinophilic Granuloma of Bone

AJR 2008; 191:W320 0361–803X/08/1916–W320

Imaging in adult scoliosis: preoperative assessment and postoperative complications.

Adult scoliosis rates range from 2 to 32%. Surgery for scoliosis is common. Accurate and surgically relevant information should be provided to the referring surgeon from pre- and postoperative imaging. There are various methods to correct scoliosis surgically with the end points correction of the curve and relief of symptoms. This is achieved through the placement of spinal instrumentation with a goal of osseous fusion across the instrumented levels. There are many potential postoperative complications. The initial and postoperative imaging, types of surgery, and hardware are reviewed along with the common early and late complications with relevant illustrations.

An incidence of anteroinferior cerebellar artery/posteroinferior cerebellar artery anatomic variants penetrating the subarcuate fossa dura: operative technique and identification with 3-dimensional fast imaging employing steady-state acquisition magnetic resonance imaging.

OBJECTIVE This case series reports an incidence of anomalous vascular anatomy within the cerebellopontine angle. The relevant literature effectively describes techniques for mobilization yet underestimates the incidence. There has been no literature on the use of magnetic resonance imaging (MRI) to preoperatively identify this anatomic variant. METHODS We identify 8 cases of anomalous vascular anatomy within the cerebellopontine angle over a period of 6 years. They were uniformly identified through a retrosigmoid approach. Retrospective review of available 3-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) sequences was performed. Intraoperative video capture of technique for mobilization was obtained. Institutional neurosurgical database review identified retrosigmoid craniotomies performed by the senior surgeon. RESULTS We identify 8 of 192 cases (4.2%) as having this anomalous vascular anatomy. This aberrant vascular loop resulted in subtotal resection in 3 of 8 cases (37.5%) and significant morbidity in 1 of 8 cases (12.5%). The retrospective review of the 3D-FIESTA MRI sequences positively identified this aberrant vascular course in 5 of 5 cases (100%). The digital video recording is of high quality and demonstrates proper technique for mobilization. CONCLUSION The presence of this vessel creates the potential for technical difficulty and significant complications. We report the incidence and techniques of mobilization. This variant can potentially be identified on preoperative 3D-FIESTA MRI sequences. Knowledge of this anatomy may guide neurosurgeons in their case preparation.

Answer to Case of the Month #160: Dysplasia Epiphysealis Hemimelica (Trevor's Disease)

A 10-year-old boy presented with a 3to 4-year history of right-sided ankle pain that was aggravated by physical activity and progressed in severity during the day. There was no history of trauma and no other significant medical abnormalities. On examination of the right ankle and foot, the patient had inward pronation and loss of foot arches. Dorsiflexion induced pain, and there was limited motion in the plantar flexion range. Anteroposterior (Figure 1) and oblique (mortise view) (Figure 2) radiographs were obtained.

Radiographic evaluation of scoliosis: self-assessment module.

OBJECTIVE The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of evaluation of scoliosis using radiography. CONCLUSION The solutions to the questions in this activity review the imaging characteristics of radiologic evaluation of scoliosis.