Feasibility, safety, and efficacy of circumferential spine stereotactic body radiotherapy.

Background: With advances in systemic therapy translating to improved survival in metastatic malignancies, spine metastases have become an increasingly common source of morbidity. Achieving durable local control (LC) for patients with circumferential epidural disease can be particularly challenging. Circumferential stereotactic body radiotherapy (SBRT) may offer improved LC for circumferential vertebral and/or epidural metastatic spinal disease, but prospective (and retrospective) data are extremely limited.

Spine Stereotactic Body Radiotherapy to Three or More Contiguous Vertebral Levels.

Background: With survival improving in many metastatic malignancies, spine metastases have increasingly become a source of significant morbidity; achieving durable local control (LC) is critical. Stereotactic body radiotherapy (SBRT) may offer improved LC and/or symptom palliation. However, due to setup concerns, SBRT is infrequently offered to patients with ≥3 contiguous involved levels.

Toward an artificial intelligence-assisted framework for reconstructing the digital twin of vertebra and predicting its fracture response.

This article presents an effort toward building an artificial intelligence (AI) assisted framework, coined ReconGAN, for creating a realistic digital twin of the human vertebra and predicting the risk of vertebral fracture (VF). ReconGAN consists of a deep convolutional generative adversarial network (DCGAN), image-processing steps, and finite element (FE) based shape optimization to reconstruct the vertebra model. This DCGAN model is trained using a set of quantitative micro-computed tomography (micro-QCT) images of the trabecular bone obtained from cadaveric samples.

A digital twin for simulating the vertebroplasty procedure and its impact on mechanical stability of vertebra in cancer patients.

We present the application of ReconGAN, introduced in a previous study, for simulating the vertebroplasty (VP) operation and its impact on the fracture response of a vertebral body. ReconGAN consists of a Deep Convolutional Generative Adversarial Network (DCGAN) and a finite element based shape optimization algorithm to virtually reconstruct the trabecular bone microstructure. The VP procedure involves injecting shear-thinning liquid bone cement through a needle in the trabecular region to reinforce a diseased or fractured vertebra.

Recurrent adamantinoma metastatic to the spine: Clinical and imaging considerations.

Metastatic adamantinoma involving the spine is an extremely rare occurrence. In this case report, we present a patient with recurrent adamantinoma of the tibia which was found to have metastasized to the spine. The metastatic involvement was diagnosed pathologically, status post CT guided percutaneous core needle biopsy, performed after the patient returned with concerning symptoms and imaging findings suggestive of metastasis.

Postoperative Stereotactic Body Radiotherapy for Spinal Metastasis and Predictors of Local Control.

Background: Spine surgery is indicated for select patients with mechanical instability, pain, and/or malignant epidural spinal cord compression, with or without neurological compromise. Stereotactic body radiotherapy (SBRT) is an option for durable local control (LC) for metastatic spine disease.

Objective: To determine factors associated with LC and progression-free survival (PFS) for patients receiving postoperative stereotactic spine radiosurgery.

Prevalence and Financial Impact of Claustrophobia, Anxiety, Patient Motion, and Other Patient Events in Magnetic Resonance Imaging.

Claustrophobia, other anxiety reactions, excessive motion, and other unanticipated patient events in magnetic resonance imaging (MRI) not only delay or preclude diagnostic-quality imaging but can also negatively affect the patient experience. In addition, by impeding MRI workflow, they may affect the finances of an imaging practice. This review article offers an overview of the various types of patient-related unanticipated events that occur in MRI, along with estimates of their frequency of occurrence as documented in the available literature.

Dual-Energy CT-Derived Iodine Content and Spectral Attenuation Analysis of Metastatic Versus Nonmetastatic Lymph Nodes in Squamous Cell Carcinoma of the Oropharynx.

The presence of a single nodal metastasis has significant prognostic and treatment implications for patients with head and neck cancer. This study aims to investigate whether dual-energy computed tomography (DECT)-derived iodine content and spectral attenuation curve analysis can improve detection of nodal metastasis in oropharyngeal carcinoma. Eight patients with newly diagnosed oropharyngeal squamous cell carcinoma and pathologically proven nodal metastatic disease (n = 13 metastatic nodes; n = 16 nonmetastatic nodes) who underwent contrast-enhanced DECT of the neck were retrospectively evaluated.

Dual-energy CT cisternography in the evaluation of CSF leaks: A novel approach.

Cerebrospinal fluid leaks pose a serious threat to patients as they represent an unchecked communication between the subarachnoid space and the extracranial environment. Accurate localization of the leakage site is essential for treatment planning. We describe the novel utilization of dual-energy computed tomography technology in cisternography in the evaluation of a patient with a cerebrospinal fluid leak.

Fluoroscopic-Guided Lumbar Spinal Drain Insertion for Thoracic Aortic Aneurysm Surgery.

We retrospectively reviewed the medical records of 11 patients who were referred by anesthesiologists to an interventional neuroradiologist for fluoroscopy-guided lumbar spinal drain insertion for thoracic aortic aneurysm repair between January 2010 and June 2015. Successful drain insertion was achieved in all patients. Three (27.

Clinical Deterioration and Early Imaging Changes after Intravenous Tissue Plasminogen Activator Administration in Acute Ischemic Stroke Patients.

Background And Purpose: Clinical worsening is a known complication following acute ischemic stroke. This study attempted to determine the mechanism of deterioration by correlating clinical findings with changes on computed tomography or magnetic resonance.

Methods: From a single university medical center, 30 consecutive acute ischemic stroke patients who received intravenous tissue plasminogen activator within 3 hours of symptom onset during a 3-year period were identified from a quality database that included all hospitalized patients either admitted with strokes or with in-hospital strokes.

Postoperative cement augmentation after 360-degree fixation for highly unstable vertebral fractures in patients with multiple myeloma: a technical note on delayed trans-instrumentation vertebroplasty.

Background: Although surgical fixation is usually not part of the first-line treatment of spinal lesions in patients with multiple myeloma, there are some unique clinical situations (such as the presence of acute onset of neurological deficits) in which spinal decompression and instrumentation may be required. In such scenario, because of the presence of poor bone quality, the strength of the spinal construct is of paramount importance. Although several studies have demonstrated the benefits of cement augmentation in increasing the pullout strength of pedicle screw fixation, the injection of cement during placement of pedicle screws may hamper the possibility of additional circumferential screw fixation.

Vertebral compression fractures in patients under treatment with denosumab: a contraindication for percutaneous vertebroplasty?

Background Context: Denosumab (XGeva) is a receptor activator of nuclear factor-κB ligand (RANKL)-antibody that was approved by the Food and Drug Administration (FDA) in 2010 for the prevention of skeletal fractures in patients with bone metastases from solid tumors. Although there is a widespread use of such drug in patients under risk of pathological fractures, the compatibility of denosumab therapy with percutaneous vertebroplasty (an interventional procedure commonly used for pain control in such population) has not yet been established.

Purpose: To present the serial imaging findings and technical report of an attempted percutaneous vertebroplasty in a patient with refractory pain and a lytic pathological vertebral fracture related to small cell lung cancer spinal metastasis and who was actively under medical treatment with denosumab.

RF-related heating assessment of extracranial neurosurgical implants at 7T.

Purpose: The purpose was to evaluate radiofrequency (RF)-related heating of commonly used extracranial neurosurgical implants in 7-T magnetic resonance imaging (MRI).

Materials And Methods: Experiments were performed using a 7-T MR system equipped with a transmit/receive RF head coil. Four commonly used titanium neurosurgical implants were studied using a test procedure adapted from the American Society for Testing and Materials Standard F2182-11a.

MRI with Magnetic Resonance Spectroscopy of multiple brain abscesses secondary to Scedosporium apiospermum in two immunocompromised patients.

Scedosporium apiospermum is a deadly fungal infection that can infect the central nervous system, particularly in immunocompromised patients. We present two cases of Scedosporium brain abscesses. The first case was fatal and relevant conventional MRI and MR spectroscopy findings are discussed.

Preoperative direct percutaneous embolization of spinal metastasis from renal cell carcinoma.

Preoperative direct percutaneous embolization has been very rarely used in hypervascular metastatic spinal tumors to decrease blood loss during the surgery. A patient is presented with solitary spinal metastasis due to renal cell carcinoma who underwent a two-stage spondylectomy. Transarterial tumor embolization with polyvinyl alcohol (PVA) particles and liquid coil placement, and percutaneous tumor embolization with PVA particles were used before the first and the second stage, respectively.

Endovascular therapy for subclavian artery rupture in von Recklinghausen disease.

Vascular anomalies are extremely rare in patients with von Recklinghausen disease. This report presents a case of an acute spontaneous subclavian artery rupture in a patient with von Recklinghausen disease. A 44-year-old woman with a history of neurofibromatosis type 1, multiple sclerosis, and aortic valve replacement experienced a ''popping sensation'' in her neck.

Intra-arterial thrombolysis within three hours of stroke onset in middle cerebral artery strokes.

Background And Purpose: The Prolyse in Acute Cerebral Thromboembolism II (PROACT II) trial showed improved outcomes in patients with proximal middle cerebral artery (MCA) occlusions treated with intra-arterial (IA) thrombolysis within 6 h of stroke onset. We analyzed outcomes of patients with proximal MCA occlusions treated within 3 h of stroke onset in order to determine the influence of time-to-treatment on clinical and angiographic outcomes in patients receiving IA thrombolysis.

Methods: Thirty-five patients from three academic institutions with angiographically demonstrated proximal MCA occlusions were treated with IA thrombolytics within 3 h of stroke onset.

Primary meningeal CNS lymphoma treated with intra-arterial chemotherapy and blood-brain barrier disruption.

Diffuse large B-cell lymphoma of the meninges is a particularly rare form of primary CNS lymphoma. We report a case of a 63-year-old woman found to have primary meningeal lymphoma (PML) with dural and leptomeningeal involvement whom we treated with multiple cycles of intra-arterial (IA) methotrexate, intravenous (IV) etoposide phosphate, and IV cyclophosphamide after reversible osmotic blood-brain barrier disruption (BBBD). Improvement was evident on gadolinium-enhanced brain MRI one month into therapy.

Qureshi grading scheme predicts subsequent volume of brain infarction following intra-arterial thrombolysis in patients with acute anterior circulation ischemic stroke.

Background: The importance of the site of occlusion and the presence or absence of collaterals on initial angiography in patients with acute ischemic stroke has been recognized. Qureshi recently proposed a scheme that categorizes patients with ischemic stroke based on findings observed on initial angiography.

Methods: We determined the relationship between severity of angiographic occlusion using Qureshi grading scheme and volume of brain infarction on follow-up computed tomography in 55 patients with anterior circulation ischemic stroke who underwent intra-arterial thrombolysis.

Intra-arterial thrombolysis of a distal internal carotid artery occlusion in an adolescent.

Introduction: This article describes the first reported case of an adolescent being treated with intra-arterial urokinase for a distal internal carotid artery occlusion.

Methods: A 15-year-old male presenting with an acute ischemic stroke caused by a distal internal carotid artery occlusion was treated with intra-arterial urokinase at 5 hours and 45 minutes after symptom onset.

Results: The artery completely recanalized, and the patient improved significantly from an admission National Institutes of Health Stroke Scale (NIHSS) score of 28 to a NIHSS score of 8 at a 2.

Clinical and imaging outcomes after stroke with normal angiograms.

Background And Purpose: Information about the prognosis of patients with acute ischemic stroke and normal angiography is limited. We report clinical and imaging outcomes of patients seen within 6 hours of symptom onset who were considered candidates for thrombolysis.

Methods: Between November 1994 and December 1999, patients with stroke onset of less than 6 hours who were thrombolytic candidates underwent cerebral angiography.