Vascular malformations of the orbit: classification and the role of imaging in diagnosis and treatment strategies*.

Purpose: To describe the authors' experience with orbital vascular malformations using the International Society for the Study of Vascular Anomalies (ISSVA) classification and the preferred radiologic techniques.

Methods: Review of clinical and radiologic experience from 1976 to 2012. This article presents the findings from several studies conducted on vascular malformations of the orbit, all of which received institutional review board approval when needed.

Malignant degeneration of a lumbar osteochondroma into a chondrosarcoma which mimicked a large retropertioneal mass.

We report a case of a lumbar spinal osteochondroma that transformed into a large chondrosarcoma in a 39-year-old male who presented with an abdominal mass and back pain. This mass was also associated with a fracture of the stalk, which on cross-sectional imaging mimicked a mass of retroperitoneal origin. The diagnosis of chondrosarcoma transforming from a lumbar osteochondroma became apparent when comparison was made with previous studies.

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.

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.

Relationship of neural axis level of injury to motor recovery and health-related quality of life in patients with a thoracolumbar spinal injury.

Background: Outcomes following traumatic conus medullaris and cauda equina injuries are typically predicted on the basis of the vertebral level of injury. This may be misleading as it is based on the assumption that the conus medullaris terminates at L1 despite its variable location. Our primary objective was to determine whether the neural axis level of injury (the spinal cord, conus medullaris, or cauda equina) as determined with magnetic resonance imaging is better than the vertebral level of injury for prediction of motor improvement in patients with a neurological deficit secondary to a thoracolumbar spinal injury.

Accuracy and safety of pedicle screw fixation in thoracic spine trauma.

Object: The authors evaluated the accuracy of placement and safety of pedicle screws in the treatment of unstable thoracic spine fractures.

Methods: Patients with unstable fractures between T-1 and T-10, which had been treated with pedicle screw (PS) placement by one of five spine surgeons at a referral center were included in a prospective cohort study. Postoperative computed tomography scans were obtained using 3-mm axial cuts with sagittal reconstructions.

Utility of screening for blunt vascular neck injuries with computed tomographic angiography.

Purpose: To prospectively study the impact of implementing a computed tomographic angiography (CTA)-based screening protocol on the detected incidence and associated morbidity and mortality of blunt vascular neck injury (BVNI).

Methods: Consecutive blunt trauma patients admitted to a single tertiary trauma center and identified as at risk for BVNI underwent admission CTA using an eight-slice multi-detector computed tomography scanner. The detected incidence, morbidity, and mortality rates of BVNI were compared with those measured before CTA screening.

Neuroimaging features of heroin inhalation toxicity: "chasing the dragon".

Objective: Our objective was to illustrate the dramatic neuroimaging findings of toxic leukoencephalopathy caused by heroin vapor inhalation.

Conclusion: Symmetric abnormality involving the cerebellar white matter and posterior limb of the internal capsule is characteristic of heroin vapor inhalation toxicity, although involvement may be more extensive, depending on the severity of the condition. MR imaging and CT appear to be essential for making this diagnosis because clinical history is often unreliable and findings at physical examination are nonspecific.

Clinical exacerbation of multiple sclerosis following radiotherapy.

Background: Radiation of the central nervous system in patients with demyelinating disease may have deleterious effects.

Objective: To describe a 30-year-old woman with multiple sclerosis who developed an attack of demyelination 2 months following radiotherapy for a parotid malignancy.

Results: Magnetic resonance imaging demonstrated new hyperintense lesions that corresponded to both the localization of the patient's symptoms and to the area defined by the 50% isodose radiation field.