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Yuh WT, Kim JH, Han J, Kim TS, Won YI, Choi Y, Noh HJ, Lee CH, Kim CH, Chung CK. The iterative implementation of a comprehensive enhanced recovery after surgery protocol in all spinal surgery in Korea: a comparative analysis of clinical outcomes and medical costs between primary spinal tumors and degenerative spinal diseases. J Neurosurg Spine 2024; 40:301-311. [PMID: 38064696 DOI: 10.3171/2023.10.spine23512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/13/2023] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Most studies on the enhanced recovery after surgery (ERAS) protocol in spine surgery have focused on patients with degenerative spinal diseases (DSDs), resulting in a lack of evidence for a comprehensive ERAS protocol applicable to patients with primary spine tumors (PSTs) and other spinal diseases. The authors had developed and gradually adopted components of the comprehensive ERAS protocol for all spine surgical procedures from 2003 to 2011, and then the current ERAS protocol was fully implemented in 2012. This study aimed to evaluate the impact and the applicability of the comprehensive ERAS protocol across all spine surgical procedures and to compare outcomes between the PST and DSD groups. METHODS Adult spine surgical procedures were conducted from 2003 to 2021 at the Seoul National University Hospital Spine Center and data were retrospectively reviewed. The author divided the study periods into the developing ERAS (2003-2011) and post-current ERAS (2012-2021) periods, and outcomes were compared between the two periods. Surgical procedures for metastatic cancer, infection, and trauma were excluded. Interrupted time series analysis (ITSA) was used to assess the impact of the ERAS protocol on medical costs and clinical outcomes, including length of stay (LOS) and rates of 30-day readmission, reoperation, and surgical site infection (SSI). Subgroup analyses were conducted on the PST and DSD groups in terms of LOS and medical costs. RESULTS The study included 7143 surgical procedures, comprising 1494 for PSTs, 5340 for DSDs, and 309 for other spinal diseases. After ERAS protocol implementation, spine surgical procedures showed significant reductions in LOS and medical costs by 22% (p = 0.008) and 22% (p < 0.001), respectively. The DSD group demonstrated a 16% (p < 0.001) reduction in LOS, whereas the PST group achieved a 28% (p < 0.001) reduction, noting a more pronounced LOS reduction in PST surgical procedures (p = 0.003). Medical costs decreased by 23% (p < 0.001) in the DSD group and 12% (p = 0.054) in the PST group, with a larger cost reduction for DSD surgical procedures (p = 0.021). No statistically significant differences were found in the rates of 30-day readmission, reoperation, and SSI between the developing and post-current ERAS implementation periods (p = 0.65, p = 0.59, and p = 0.52, respectively). CONCLUSIONS Comprehensive ERAS protocol implementation significantly reduced LOS and medical costs in all spine surgical procedures, while maintaining comparable 30-day readmission, reoperation, and SSI rates. These findings suggest that the ERAS protocol is equally applicable to all spine surgical procedures, with a more pronounced effect on reducing LOS in the PST group and on reducing medical costs in the DSD group.
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Affiliation(s)
- Woon Tak Yuh
- 1Department of Neurosurgery, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea
- 2Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Jun-Hoe Kim
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Junghoon Han
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Tae-Shin Kim
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Young Il Won
- 4Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong-si, Republic of Korea
| | - Yunhee Choi
- 5Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Hyun Jung Noh
- 6Pediatric Intensive Care Unit, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- 7Department of Neurosurgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Chi Heon Kim
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- 7Department of Neurosurgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- 8Department of Medical Device Development, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea; and
| | - Chun Kee Chung
- 3Department of Neurosurgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- 7Department of Neurosurgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
- 9Department of Brain and Cognitive Sciences, Seoul National University, College of Natural Science, Gwanak-gu, Seoul, Republic of Korea
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Yuh WT, Khil EK, Yoon YS, Kim B, Yoon H, Lim J, Lee KY, Yoo YS, An KD. Deep Learning-Assisted Quantitative Measurement of Thoracolumbar Fracture Features on Lateral Radiographs. Neurospine 2024; 21:30-43. [PMID: 38569629 PMCID: PMC10992637 DOI: 10.14245/ns.2347366.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE This study aimed to develop and validate a deep learning (DL) algorithm for the quantitative measurement of thoracolumbar (TL) fracture features, and to evaluate its efficacy across varying levels of clinical expertise. METHODS Using the pretrained Mask Region-Based Convolutional Neural Networks model, originally developed for vertebral body segmentation and fracture detection, we fine-tuned the model and added a new module for measuring fracture metrics-compression rate (CR), Cobb angle (CA), Gardner angle (GA), and sagittal index (SI)-from lumbar spine lateral radiographs. These metrics were derived from six-point labeling by 3 radiologists, forming the ground truth (GT). Training utilized 1,000 nonfractured and 318 fractured radiographs, while validations employed 213 internal and 200 external fractured radiographs. The accuracy of the DL algorithm in quantifying fracture features was evaluated against GT using the intraclass correlation coefficient. Additionally, 4 readers with varying expertise levels, including trainees and an attending spine surgeon, performed measurements with and without DL assistance, and their results were compared to GT and the DL model. RESULTS The DL algorithm demonstrated good to excellent agreement with GT for CR, CA, GA, and SI in both internal (0.860, 0.944, 0.932, and 0.779, respectively) and external (0.836, 0.940, 0.916, and 0.815, respectively) validations. DL-assisted measurements significantly improved most measurement values, particularly for trainees. CONCLUSION The DL algorithm was validated as an accurate tool for quantifying TL fracture features using radiographs. DL-assisted measurement is expected to expedite the diagnostic process and enhance reliability, particularly benefiting less experienced clinicians.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Radiology, Fastbone Orthopedic Hospital, Hwaseong, Korea
| | - Yu Sung Yoon
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | | | | | - Jihe Lim
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Kyoung Yeon Lee
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Yeong Seo Yoo
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Kyeong Deuk An
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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Park S, Kim JH, Ahn Y, Lee CH, Kim YG, Yuh WT, Hyun SJ, Kim CH, Kim KJ, Chung CK. Multi-pose-based convolutional neural network model for diagnosis of patients with central lumbar spinal stenosis. Sci Rep 2024; 14:203. [PMID: 38168665 PMCID: PMC10761871 DOI: 10.1038/s41598-023-50885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
Although the role of plain radiographs in diagnosing lumbar spinal stenosis (LSS) has declined in importance since the advent of magnetic resonance imaging (MRI), diagnostic ability of plain radiographs has improved dramatically when combined with deep learning. Previously, we developed a convolutional neural network (CNN) model using a radiograph for diagnosing LSS. In this study, we aimed to improve and generalize the performance of CNN models and overcome the limitation of the single-pose-based CNN (SP-CNN) model using multi-pose radiographs. Individuals with severe or no LSS, confirmed using MRI, were enrolled. Lateral radiographs of patients in three postures were collected. We developed a multi-pose-based CNN (MP-CNN) model using the encoders of the three SP-CNN model (extension, flexion, and neutral postures). We compared the validation results of the MP-CNN model using four algorithms pretrained with ImageNet. The MP-CNN model underwent additional internal and external validations to measure generalization performance. The ResNet50-based MP-CNN model achieved the largest area under the receiver operating characteristic curve (AUROC) of 91.4% (95% confidence interval [CI] 90.9-91.8%) for internal validation. The AUROC of the MP-CNN model were 91.3% (95% CI 90.7-91.9%) and 79.5% (95% CI 78.2-80.8%) for the extra-internal and external validation, respectively. The MP-CNN based heatmap offered a logical decision-making direction through optimized visualization. This model holds potential as a screening tool for LSS diagnosis, offering an explainable rationale for its prediction.
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Affiliation(s)
- Seyeon Park
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Youngbin Ahn
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Young-Gon Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea.
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongro-Gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Choi S, Kim YJ, Oh H, Yuh WT, Lee CH, Yang SH, Kim CH, Chung CK, Park HP. Factors Associated With Perioperative Hospital Acquired Pressure Injury in Patients Undergoing Spine Surgery in the Prone Position: A Prospective Observational Study. J Neurosurg Anesthesiol 2024; 36:45-52. [PMID: 36006663 DOI: 10.1097/ana.0000000000000867] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospital acquired pressure injury (HAPI) is associated with poor clinical outcomes and high medical costs. Patients undergoing surgery in the prone position are particularly vulnerable to perioperative HAPI. This prospective observational study investigated the factors associated with HAPI in patients undergoing elective spine surgery in the prone position. METHODS Two hundred eighty-seven patients undergoing elective spine surgery participated in this study. Demographics, perioperative vital signs, laboratory findings, surgical data, and intraoperative data were prospectively recorded. The sites and stages of HAPI were investigated on postoperative day 2. The stages of HAPI were evaluated using the pressure injury staging system of the National Pressure Ulcer Advisory Panel. RESULTS Perioperative HAPI was observed in 71 (24.7%) patients (stage 1, 40; stage 2, 31). The most frequent site (number) of HAPI was the upper extremities (33), followed by the chest (32), lower extremities (20), face (18), pelvis (10), and abdomen (9). In multivariate analysis, the duration of prone positioning per hour (odds ratio [95% confidence interval], 1.48 [1.25-1.74]; P <0.001) and intraoperative pH ≤7.35 (1.98 [1.05-3.76]; P =0.036) were associated with perioperative HAPI. CONCLUSIONS The incidence of perioperative HAPI was 24.7% in patients undergoing elective spine surgery in the prone position. Long duration of prone positioning and intraoperative acidosis were associated with increased development of perioperative HAPI.
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Affiliation(s)
| | | | | | - Woon Tak Yuh
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hyun Lee
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Heon Yang
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Heon Kim
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kim JH, Yuh WT, Han J, Kim T, Lee CH, Kim CH, Choi Y, Chung CK. Impact of C3 laminectomy on cervical sagittal alignment in cervical laminoplasty: a prospective, randomized controlled trial comparing clinical and radiological outcomes between C3 laminectomy with C4-C6 laminoplasty and C3-C6 laminoplasty. Spine J 2023; 23:1674-1683. [PMID: 37473811 DOI: 10.1016/j.spinee.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/12/2023] [Accepted: 07/01/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND CONTEXT C3 laminectomy in cervical laminoplasty is a modified laminoplasty technique that can preserve the semispinalis cervicis muscle attached to the C2 spinous process. Several previous studies have shown that this technique can lead to better outcomes of postoperative axial neck pain and C2-C3 range of motion (ROM) than conventional cervical laminoplasty. However, there is still a lack of understanding of total and proportional postoperative cervical sagittal alignment outcomes. PURPOSE To assess the effects of C3 laminectomy in cervical laminoplasty on postoperative cervical alignment and clinical outcomes. DESIGN A single-center, patient-blinded, randomized controlled trial. PATIENT SAMPLE We included consecutive 126 patients diagnosed with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) who were scheduled for cervical laminoplasty from March 2017 to January 2020. OUTCOME MEASURES The primary outcome measures were C2-C7 Cobb angle (CA) and neck disability index (NDI). Secondary outcomes measures included other clinical outcomes and radiographic parameters including segmental Cobb angle and presence of C2-C3 interlaminar fusion. METHODS Patients were randomly allocated to either the C3 laminectomy with C4-C6 laminoplasty group (LN group) or the C3-C6 laminoplasty group (LP group) at a 1:1 ratio. Laminoplasty was performed using a unilateral open-door technique and stabilized with titanium mini plates. A linear mixed model analysis was employed to examine the longitudinal data from postoperative 1-year through 3-year. Additional analysis between three types of cervical sagittal alignment morphology was done. RESULTS Among 122 patients who were randomly allocated to one of two groups (LN group, n=61; LP group, n=61), modified intent-to-treat analysis was done for 109 patients (LN group, n=51, LP group, n=58) who had available at least a year of postoperative data. Postoperative C2-C7 CA was not significantly different between the two groups. However, NDI was significantly different between the two groups (12.8±1.0 in the LN group vs 8.6±1.0 in LP group, p=.005), which exceeded the minimum clinically important difference (MCID). The postoperative C2-C3 CA was significantly greater in the LN group (7.1±0.5° in LN group vs 3.2±0.5° in LP group, p<.001) while C4-C7 CA was significantly smaller in the LN group (3.9±0.8° in LN group vs 7.7±0.7° in LP group, p<.001) with greater cSVA in the LN group (31.6±1.4 mm in LN group vs 25.5±1.3 mm in LP group at postoperative 3-year, p=.002). Postoperative Euro-Quality of Life-5 Dimension (EQ-5D), numerical rating scores for neck pain (NRS-N) were significantly better in the LP group than in the LN group (all p<.05) and only EQ-5D surpassed the MCID. The C2-C3 fusion rate was significantly different between the LN group (9.8%) and the LP group (44.8%) (p<.001). The LN group showed a higher prevalence of a specific cervical alignment morphology characterized by a sigmoid shape with proximal lordosis and distal kyphosis (S curve). This S curve demonstrated significantly unfavorable outcomes across multiple outcome variables. CONCLUSION The impact of C3 laminectomy in cervical laminoplasty on postoperative kyphosis among patients with CSM or OPLL did not significantly differ from that of C3-C6 laminoplasty. However, C3 laminectomy in cervical laminoplasty might result in an unfavorable clinical outcome with an unbalanced cervical sagittal alignment characterized by a sigmoid shape with proximal lordosis and distal kyphosis.
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Affiliation(s)
- Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, College of Medicine, Hallym University, 1, Hallymdaehak-gil, Chuncheon, 24252, South Korea; Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, 18450, South Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Taeshin Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Brain and Cognitive Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, South Korea.
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Kim TS, Yuh WT, Han J, Kim J, Lee CH, Kim CH, Chung CK. Is laminectomy necessary for C1-C2 epidural schwannomas? Acta Neurochir (Wien) 2023; 165:3065-3076. [PMID: 37400543 DOI: 10.1007/s00701-023-05707-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/24/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Spinal schwannomas often require laminectomy for gross total resection. However, laminectomy may not be necessary due to the unique anatomy of epidural schwannomas at the C1-2 level, even with the intradural part. This study aimed to determine the need for laminectomy by comparing factors between patients who underwent laminectomy and those who did not and to identify the benefits of not performing laminectomy. METHODS Fifty patients with spinal epidural schwannoma confined to C1-C2 level were retrospectively collected and divided into groups based on whether laminectomy was intended and performed. In all cases where laminectomy was conducted, patients underwent laminoplasty using microplate-and-screws, which deviates from the conventional laminectomy approach. Tumor characteristics were compared, and a cut-off value for laminectomy was determined. Outcomes were compared between groups, and factors influencing laminectomy were identified. Postoperative changes in cervical curves were measured. RESULTS The diameter of the intradural part of the tumor was significantly longer in the laminectomy performed group, with a 14.86 mm cut-off diameter requiring laminectomy. Recurrence rates did not differ significantly between groups. Surgery time was substantially longer for the laminectomy performed group. No significant changes were observed in Cobb's angles of Oc-C2, C1-C2, and Oc-C1 before and after surgery. CONCLUSION The study showed that the diameter of the intradural part of the tumor influenced the decision to perform laminectomy for removing epidural schwannomas at C1-C2. The cut-off value of the diameter of the intradural part of the tumor for the laminectomy was 14.86 mm. Not performing laminectomy can be a viable option with no significant differences in removal and complication rates.
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Affiliation(s)
- Tae-Shin Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-Si, Republic of Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Junhoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Brain and Cognitive Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Han J, Ha CM, Yuh WT, Ko YS, Kim JH, Kim TS, Lee CH, Lee S, Lee SH, Khan A, Chung CK, Kim CH. Surgical treatment of spondylolisthesis by oblique lumbar interbody fusion and transpedicular screw fixation: Comparison between conventional double position versus navigation-assisted single lateral position. PLoS One 2023; 18:e0291114. [PMID: 37708151 PMCID: PMC10501584 DOI: 10.1371/journal.pone.0291114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Oblique lumbar interbody fusion (OLIF) procedures involve anterior insertion of interbody cage in lateral position. Following OLIF, insertion of pedicle screws and rod system is performed in a prone position (OLIF-con). The location of the cage is important for restoration of lumbar lordosis and indirect decompression. However, inserting the cage at the desired location is difficult without reduction of spondylolisthesis, and reduction after insertion of interbody cage may limit the amount of reduction. Recent introduction of spinal navigation enabled both surgical procedures in one lateral position (OLIF-one). Therefore, reduction of spondylolisthesis can be performed prior to insertion of interbody cage. The objective of this study was to compare the reduction of spondylolisthesis and the placement of cage between OLIF-one and OLIF-con. METHODS We retrospectively reviewed 72 consecutive patients with spondylolisthesis for this study; 30 patients underwent OLIF-one and 42 underwent OLIF-con. Spinal navigation system was used for OLIF-one. In OLIF-one, the interbody cage was inserted after reducing spondylolisthesis, whereas in OLIF-con, the cage was inserted before reduction. The following parameters were measured on X-rays: pre- and postoperative spondylolisthesis slippage, reduction degree, and the location of the cage in the disc space. RESULTS Both groups showed significant improvement in back and leg pains (p < .05). Transient motor or sensory changes occurred in three patients after OLIF-con and in two patients after OLIF-one. Pre- and postoperative slips were 26.3±7.7% and 6.6±6.2% in OLIF-one, and 23.1±7.0% and 7.4±5.8% in OLIF-con. The reduction of slippage was 74.4±6.3% after OLIF-one and 65.4±5.7% after OLIF-con, with a significant difference between the two groups (p = .04). The cage was located at 34.2±8.9% after OLIF-one and at 42.8±10.3% after OLIF-con, with a significant difference between the two groups (p = .004). CONCLUSION Switching the sequence of surgical procedures with OLIF-one facilitated both the reduction of spondylolisthesis and the placement of the cage at the desired location.
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Affiliation(s)
- Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Min Ha
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Young San Ko
- Department of Neurosurgery, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Jun-Hoe Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae-Shin Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungjoon Lee
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Seoul, Republic of Korea
- Department of Neurosurgery, Sungkyunkwan University School of Medicine, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Asfandyar Khan
- School of Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yuh WT, Han J, Lee CH, Kim CH, Kang HS, Chung CK. The Optimal Time between Embolization and Surgery for Hypervascular Spinal Metastatic Tumors : A Systematic Review and Meta-Analysis. J Korean Neurosurg Soc 2023:jkns.2022.0204. [PMID: 37315576 DOI: 10.3340/jkns.2022.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/06/2023] [Indexed: 06/16/2023] Open
Abstract
Objective Preoperative transarterial embolization (TAE) of tumor feeders in hypervascular spine metastasis is known to reduce intraoperative estimated blood loss (EBL) during surgery. The effect of TAE varies for several reasons, and one controllable factor is the timing between embolization and surgery. However, the adequate timing remains unclear. This study aimed to evaluate the timing and other factors that reduce EBL in spinal metastasis surgery through a meta-analysis. Methods A comprehensive database search was performed to identify direct comparative studies of EBL stratified by the timing of surgery after TAE for spinal metastasis. EBL was analyzed according to the timing of surgery and other factors. Subgroup analyses were also performed. The difference in EBL was calculated as the mean difference (MD) and 95% confidence interval (CI). Results Among seven studies, 196 and 194 patients underwent early and late surgery after TAE, respectively. The early surgery was defined as within 1-2 days after TAE, while the late surgery group received surgery at least 1 day after TAE. Overall, the MD in EBL was not different according to the timing of surgery (MD, 86.3 mL; 95% CI, -95.5 to 268.1 mL; p=0.35). A subgroup analysis of the complete embolization group demonstrated that patients who underwent early surgery within 24 hours after TAE had significantly less bleeding (MD, 233.3 mL; 95% CI, 76.0 to 390.5 mL; p=0.004). In cases of partial embolization, EBL was not significantly different regardless of the time interval. Conclusion Complete embolization followed by early spinal surgery within 24 hours may reduce intraoperative bleeding for the patients with hypervascular spinal metastasis.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Sciences, College of Natural Science, Seoul National University, Seoul, Korea
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9
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Yuh WT, Kim M, Choi Y, Han J, Kim J, Kim T, Chung CK, Lee CH, Park SB, Kim KT, Rhee JM, Park MS, Kim CH. Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery. Sci Rep 2023; 13:6317. [PMID: 37072455 PMCID: PMC10113194 DOI: 10.1038/s41598-023-33588-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 04/15/2023] [Indexed: 05/03/2023] Open
Abstract
Surgical outcomes of degenerative cervical spinal disease are dependent on the selection of surgical techniques. Although a standardized decision cannot be made in an actual clinical setting, continued education is provided to standardize the medical practice among surgeons. Therefore, it is necessary to supervise and regularly update overall surgical outcomes. This study aimed to compare the rate of additional surgery between anterior and posterior surgeries for degenerative cervical spinal disease using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) nationwide patient database. The NHIS-NSC is a population-based cohort with about a million participants. This retrospective cohort study included 741 adult patients (> 18 years) who underwent their first cervical spinal surgery for degenerative cervical spinal disease. The median follow-up period was 7.3 years. An event was defined as the registration of any type of cervical spinal surgery during the follow-up period. Event-free survival analysis was used for outcome analysis, and the following factors were used as covariates for adjustment: location of disease, sex, age, type of insurance, disability, type of hospital, Charles comorbidity Index, and osteoporosis. Anterior cervical surgery was selected for 75.0% of the patients, and posterior cervical surgery for the remaining 25.0%. Cervical radiculopathy due to foraminal stenosis, hard disc, or soft disc was the primary diagnosis in 78.0% of the patients, and central spinal stenosis was the primary diagnosis in 22.0% of them. Additional surgery was performed for 5.0% of the patients after anterior cervical surgery and 6.5% of the patients after posterior cervical surgery (adjusted subhazard ratio, 0.83; 95% confidence interval, 0.40-1.74). The rates of additional surgery were not different between anterior and posterior cervical surgeries. The results would be helpful in evaluating current practice as a whole and adjusting the health insurance policy.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Minjung Kim
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Junghoon Han
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Junhoe Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Taeshin Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Brain and Cognitive Sciences, College of Natural Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - John M Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Moon Soo Park
- Department of Orthopedics, Hallym University Dongtan Sacred Heart Hospital, 22 Gwanpyeong-ro 170 Beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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10
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Won YI, Kim CH, Park HP, Chung SG, Yuh WT, Kwon SW, Yang SH, Lee CH, Choi Y, Park SB, Rhee JM, Kim KT, Chung CK. A cost-utility analysis between decompression only and fusion surgery for elderly patients with lumbar spinal stenosis and sagittal imbalance. Sci Rep 2022; 12:20408. [PMID: 36437360 PMCID: PMC9701767 DOI: 10.1038/s41598-022-24784-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Lumbar spinal stenosis (LSS) and sagittal imbalance are relatively common in elderly patients. Although the goals of surgery include both functional and radiological improvements, the criteria of correction may be too strict for elderly patients. If the main symptom of patients is not forward-stooping but neurogenic claudication or pain, lumbar decompression without adding fusion procedure may be a surgical option. We performed cost-utility analysis between lumbar decompression and lumbar fusion surgery for those patients. Elderly patients (age > 60 years) who underwent 1-2 levels lumbar fusion surgery (F-group, n = 31) or decompression surgery (D-group, n = 40) for LSS with sagittal imbalance (C7 sagittal vertical axis, C7-SVA > 40 mm) with follow-up ≥ 2 years were included. Clinical outcomes (Euro-Quality of Life-5 Dimensions, EQ-5D; Oswestry Disability Index, ODI; numerical rating score of pain on the back and leg, NRS-B and NRS-L) and radiological parameters (C7-SVA; lumbar lordosis, LL; the difference between pelvic incidence and lumbar lordosis, PI-LL; pelvic tilt, PT) were assessed. The quality-adjusted life year (QALY) and incremental cost-effective ratio (ICER) were calculated from a utility score of EQ-5D. Postoperatively, both groups attained clinical and radiological improvement in all parameters, but NRS-L was more improved in the F-group (p = 0.048). ICER of F-group over D-group was 49,833 US dollars/QALY. Cost-effective lumbar decompression may be a recommendable surgical option for certain elderly patients, despite less improvement of leg pain than with fusion surgery.
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Affiliation(s)
- Young Il Won
- grid.254230.20000 0001 0722 6377Department of Neurosurgery, Chungnam National University Sejong Hospital, 20, Bodeum 7-ro, Sejong, 30099 Republic of Korea
| | - Chi Heon Kim
- grid.412484.f0000 0001 0302 820XDepartment of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.412484.f0000 0001 0302 820XDepartment of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Hee-Pyoung Park
- grid.31501.360000 0004 0470 5905Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine and Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Sun Gun Chung
- grid.31501.360000 0004 0470 5905Department of Rehabilitation Medicine, Seoul National University College of Medicine and Hospital, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Woon Tak Yuh
- grid.488450.50000 0004 1790 2596Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si, Gyeonggi-do 18450 Republic of Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Incheon Veterans Hospital, 138, Inju-daero, Michuhol-gu, Incheon, 22182 Republic of Korea
| | - Seung Heon Yang
- grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.412480.b0000 0004 0647 3378Department of Neurosurgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620 Republic of Korea
| | - Chang-Hyun Lee
- grid.412484.f0000 0001 0302 820XDepartment of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Yunhee Choi
- grid.412484.f0000 0001 0302 820XDivision of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Sung Bae Park
- grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.412479.dDepartment of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061 Republic of Korea
| | - John M. Rhee
- grid.189967.80000 0001 0941 6502Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA 30322 USA
| | - Kyoung-Tae Kim
- grid.411235.00000 0004 0647 192XDepartment of Neurosurgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea ,grid.258803.40000 0001 0661 1556Department of Neurosurgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Chun Kee Chung
- grid.412484.f0000 0001 0302 820XDepartment of Neurosurgery, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Neurosurgery and Medical Device Development, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Brain and Cognitive Sciences, Seoul National University, 101, 1, Gwanak-ro, Gwanak-gu, Seoul, Republic of Korea
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11
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Yuh WT, Chung CK. Microsurgical Resection of a Spinal Cord Hemangioblastoma With Ventral Pial Attachment Through a Posterior Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e375-e376. [DOI: 10.1227/ons.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/14/2022] [Indexed: 11/05/2022] Open
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12
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Won YI, Lee CH, Yuh WT, Kwon SW, Kim CH, Chung CK. Genetic Odyssey to Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Systematic Review. Neurospine 2022; 19:299-306. [PMID: 35793933 PMCID: PMC9260552 DOI: 10.14245/ns.2244038.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Despite numerous studies, the pathogenesis of ossification of the posterior longitudinal ligament (OPLL) is still unclear. Previous genetic studies proposed variations in genes related to bone and collagen as a cause of OPLL. It is unclear whether the upregulations of those genes are the cause of OPLL or an intermediate result of endochondral ossification process. Causal variations may be in the inflammation-related genes supported by clinical and updated genomic studies. OPLL demonstrates features of genetic diseases but can also be induced by mechanical stress by itself. OPLL may be a combination of various diseases that share ossification as a common pathway and can be divided into genetic and idiopathic. The phenotype of OPLL can be divided into continuous (including mixed) and segmental (including localized) based on the histopathology, prognosis, and appearance. Continuous OPLL shows substantial overexpression of osteoblast-specific genes, frequent upper cervical involvement, common progression, and need for surgery, whereas segmental OPLL shows moderate-to-high expression of these genes and is often clinically silent. Genetic OPLL seems to share clinical features with the continuous type, while idiopathic OPLL shares features with the segmental type. Further genomic studies are needed to elucidate the relationship between genetic OPLL and phenotype of OPLL.
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Affiliation(s)
- Young Il Won
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Corresponding Author Chang-Hyun Lee Department of Neurosurgery, Seoul National University Hospital, 101 Daehakro, Jongro-gu, Seoul 03080, Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
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13
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Won YI, Choi Y, Yuh WT, Kwon SW, Kim CH, Yang SH, Chung CK. Validity of magnetic resonance imaging (MRI) in the primary spinal cord tumors in routine clinical setting. Sci Rep 2022; 12:10151. [PMID: 35710920 PMCID: PMC9203586 DOI: 10.1038/s41598-022-13881-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
MRI is the primary diagnostic modality for spinal cord tumors. However, its validity has never been vigorously scrutinized in daily routine clinical practice, where MRI tissue diagnosis is usually not a single one but multiple ones with several differential diagnoses. Here, we aimed to assess the validity of MRI in terms of predicting the pathology and location of the tumor in routine clinical settings. We analyzed 820 patients with primary spinal cord tumors, who have a pathological diagnosis and location in the operation record which were confirmed. We modified traditional measures for validity based upon a set of diagnoses instead of a single diagnosis. Sensitivity and specificity and positive and negative predictabilities were evaluated for the tumor location and pathology. For tumor location, 456 were intradural extramedullary; 165 were intramedullary, and 156 were extradural. The overall sensitivity and specificity were over 90.0%. However, the sensitivity became lower when the tumor resided simultaneously in two spaces such as in the intradural-and-extradural or intramedullary-and-extramedullary space (54.6% and 30.0%, respectively). Most common pathology was schwannoma (n = 416), followed by meningioma (114) and ependymoma (87). Sensitivities were 93.3%, 90.4%, and 89.7%, respectively. Specificities were 70.8%, 82.9%, and 76.0%. In rare tumors such as neurofibromas, and diffuse midline gliomas, the sensitivity was much lower (less than 30%). For common locations and pathologies, the validity of MRI is generally acceptable. However, for rare locations and pathologies, MRI diagnosis still needs some improvement.
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Affiliation(s)
- Young Il Won
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea.
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14
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Kwon SW, Chung CK, Won YI, Yuh WT, Park SB, Yang SH, Lee CH, Rhee JM, Kim KT, Kim CH. Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery. Neurospine 2022; 19:146-154. [PMID: 35378588 PMCID: PMC8987538 DOI: 10.14245/ns.2244092.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Total en bloc spondylectomy (TES) is a curative surgical method for spinal tumors. After resecting the 3 spinal columns, reconstruction is of paramount importance. We present cases of mechanical failure and suggest strategies for salvage surgery.
Methods The medical records of 19 patients who underwent TES (9 for primary tumors and 10 for metastatic tumors) were retrospectively reviewed. Previously reported surgical techniques were used, and the surgical extent was 1 level in 16 patients and 2 levels in 3 patients. A titanium-based mesh-type interbody spacer filled with autologous and cadaveric bone was used for anterior support, and a pedicle screw/rod system was used for posterior support. Radiotherapy was performed in 11 patients (pre-TES, 5; post-TES, 6). They were followed up for 59 ± 38 months (range, 11–133 months).
Results During follow-up, 8 of 9 primary tumor patients (89%) and 5 of 10 metastatic tumor patients (50%) survived (mean survival time, 124 ± 8 months vs. 51 ± 13 months; p=0.11). Mechanical failure occurred in 3 patients (33%) with primary tumors and 2 patients (20%) with metastatic tumors (p=0.63). The mechanical failure-free time was 94.4 ± 14 months (primary tumors, 95 ± 18 months; metastatic tumors, 68 ± 16 months; p=0.90). Revision surgery was performed in 4 of 5 patients, and bilateral broken rods were replaced with dual cobalt-chromium alloy rods. Repeated rod fractures occurred in 1 of 4 patients 2 years later, and the third operation (with multiple cobalt-chromium alloy rods) was successful for over 6 years.
Conclusion Considering the difficulty of reoperation and patients’ suffering, preemptive use of a multiple-rod system may be advisable.
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Affiliation(s)
- Shin Won Kwon
- Department of Neurosurgery, Incheon Veterans Hospital, Incheon, Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Korea
| | - Young Il Won
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, Seoul, Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - John M. Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Corresponding Author Chi Heon Kim https://orcid.org/0000-0003-0497-1130 Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea
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15
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Won YI, Yuh WT, Kwon SW, Kim CH, Yang SH, Kim KT, Chung CK. Interlaminar Endoscopic Lumbar Discectomy: A Narrative Review. Int J Spine Surg 2022; 15:S47-S53. [PMID: 34974420 DOI: 10.14444/8163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND When pain caused by lumbar disc herniation (LDH) is not relieved after 4 to 6 weeks of conservative treatment, surgery is recommended. Open microdiscectomy is a standard surgical technique, but surgical endoscopy enables endoscopic lumbar surgery with clinical outcomes similar to those of standard microdiscectomy. Endoscopic lumbar discectomy is largely divided into transforaminal endoscopic lumbar discectomy (TELD) and interlaminar endoscopic lumbar discectomy (IELD). TELD was introduced about 10 years earlier than IELD and seems to be more popular than IELD. OBJECTIVE The present article reviews the surgical technique, indications, and outcomes of IELD. Although much is still unknown, potential future perspectives are reviewed. SUMMARY Although improved surgical techniques enable TELD to be versatile, IELD is still specifically beneficial for patients with highly migrated LDH and a high iliac crest. There is a large body of literature indicating favorable outcomes with both TELD and IELD. Currently, the selection of TELD or IELD is at the discretion of the surgeon, but the IELD surgical technique is useful for further applying endoscopic lumbar surgery for lumbar decompression or lumbar interbody fusion. The techniques can be assisted by advanced technologies such as artificial intelligence, surgical robots, and artificial reality, and a precise and systematic approach to decision-making and surgical techniques is required to combine these technologies effectively.
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Affiliation(s)
- Young Il Won
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Won Kwon
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea .,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, South Korea.,Department of Neurosurgery, School of Medicine, Kyungpook National University, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
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16
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Lee SW, Yuh WT, Yang JM, Cho YS, Yoo IK, Koh HY, Marshall D, Oh D, Ha EK, Han MY, Yon DK. Nationwide Results of COVID-19 Contact Tracing in South Korea: Individual Participant Data From an Epidemiological Survey. JMIR Med Inform 2020; 8:e20992. [PMID: 32784189 PMCID: PMC7470235 DOI: 10.2196/20992] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023] Open
Abstract
Background Evidence regarding the effectiveness of contact tracing of COVID-19 and the related social distancing is limited and inconclusive. Objective This study aims to investigate the epidemiological characteristics of SARS-CoV-2 transmission in South Korea and evaluate whether a social distancing campaign is effective in mitigating the spread of COVID-19. Methods We used contract tracing data to investigate the epidemic characteristics of SARS-CoV-2 transmission in South Korea and evaluate whether a social distancing campaign was effective in mitigating the spread of COVID-19. We calculated the mortality rate for COVID-19 by infection type (cluster vs noncluster) and tested whether new confirmed COVID-19 trends changed after a social distancing campaign. Results There were 2537 patients with confirmed COVID-19 who completed the epidemiologic survey: 1305 (51.4%) cluster cases and 1232 (48.6%) noncluster cases. The mortality rate was significantly higher in cluster cases linked to medical facilities (11/143, 7.70% vs 5/1232, 0.41%; adjusted percentage difference 7.99%; 95% CI 5.83 to 10.14) and long-term care facilities (19/221, 8.60% vs 5/1232, 0.41%; adjusted percentage difference 7.56%; 95% CI 5.66 to 9.47) than in noncluster cases. The change in trends of newly confirmed COVID-19 cases before and after the social distancing campaign was significantly negative in the entire cohort (adjusted trend difference –2.28; 95% CI –3.88 to –0.68) and the cluster infection group (adjusted trend difference –0.96; 95% CI –1.83 to –0.09). Conclusions In a nationwide contact tracing study in South Korea, COVID-19 linked to medical and long-term care facilities significantly increased the risk of mortality compared to noncluster COVID-19. A social distancing campaign decreased the spread of COVID-19 in South Korea and differentially affected cluster infections of SARS-CoV-2.
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Affiliation(s)
- Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
| | - Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jee Myung Yang
- Department of Ophthalmology, Asan Medical Center, Seoul, Republic of Korea
| | - Yoon-Sik Cho
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
| | - In Kyung Yoo
- Department of Gastroenterology, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Hyun Yong Koh
- FM Kirby Neurobiology Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Dominic Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom
| | - Donghwan Oh
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.,Armed Force Medical Command, Republic of Korea Armed Forces, Seongnam, Republic of Korea
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Abstract
OBJECTIVE A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas. METHODS We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions. RESULTS The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89). CONCLUSION Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Science, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Korea
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Yuh WT, Kim CH, Chung CK, Kim HJ, Jahng TA, Park SB. Surgical Outcome of Adult Idiopathic Chiari Malformation Type 1. J Korean Neurosurg Soc 2016; 59:512-7. [PMID: 27651871 PMCID: PMC5028613 DOI: 10.3340/jkns.2016.59.5.512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The pathophysiology of idiopathic Chiari malformation (CM) type 1 is disturbance of free cerebrospinal fluid (CSF) flow and restoration of normal CSF flow is the mainstay of treatment. Additional migration of the medulla oblongata in pediatric patients is referred to as CM type 1.5, but its significance in adult patients is unknown. This study is to compare surgical outcomes of adult idiopathic CM type 1.5 with that of type 1. METHODS Thirty-eight consecutive adult patients (M : F=11 : 27; median, 33.5; range, 18-63) with syringomyelia due to idiopathic CM type 1 were reviewed. Migration of the medulla oblongata was noted in 13 patients. The modified McCormick scale (MMS) was used to evaluate functional status before and one year after surgery. All patients underwent foramen magnum decompression and duroplasty. Factors related to radiological success (≥50% decrease in the diameter of the syrinx) were investigated. The follow-up period was 72.7±55.6 months. RESULTS Preoperative functional status were MMS I in 11 patients and MMS II in 14 of CM type 1 and MMS I in 8 and II in 5 of CM type 1.5. Of patients with MMS II, 5/14 patients in group A and 3/5 patients in group B showed improvement and there was no case of deterioration. Radiological success was achieved in 32 (84%) patients and restoration of the cisterna magna (p=0.01; OR, 46.5) was the only significant factor. CONCLUSION Migration of the medulla oblongata did not make a difference in the surgical outcome when the cisterna magna was restored.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Korea
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Yuh WT, Chung CK, Park SH. Primary Spinal Cord Oligodendroglioma with Postoperative Adjuvant Radiotherapy: A Case Report. Korean J Spine 2015; 12:160-4. [PMID: 26512274 PMCID: PMC4623174 DOI: 10.14245/kjs.2015.12.3.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 11/19/2022]
Abstract
Primary spinal cord oligodendrogliomas are rare tumors comprising two percent of all spinal cord tumors. Although a treatment guideline has yet to be established, maximal surgical resection is primary in the treatment of spinal cord oligodendrogliomas. Adjuvant radiotherapy has remained controversial, and it is unclear whether chemotherapy adds any benefit. In this case report, the authors present a 24-year-old male who had a seven-year history of left leg weakness and a radiating pain in both legs. Magnetic resonance image (MRI) showed an intramedullary mass at the T4-T8 level. He underwent subtotal removal of the tumor and pathologic diagnosis revealed a WHO grade II oligodendroglioma. The patient was treated with radiotherapy postoperatively and followed up with MRI annually. Clinical and radiological status of the patient had been stationary for four years after the surgery. The five-year follow-up MRI showed an increase in the size and extent of the residual tumor. Despite radiological progression, considering that symptoms and the performance status of the patient had remained unchanged, further treatment has not been performed. Given the clinical outcome of this patient, close observation after subtotal removal with adjuvant radiotherapy is one of the acceptable treatment options for WHO grade II spinal cord oligodendrogliomas.
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Affiliation(s)
- Woon Tak Yuh
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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Taoka T, Mayr NA, Lee HJ, Yuh WT, Simonson TM, Rezai K, Berbaum KS. Factors Influencing Visualization of Vertebral Metastases on MR Imaging Versus Bone Scintigraphy. AJR Am J Roentgenol 2001; 176:1525-30. [PMID: 11373226 DOI: 10.2214/ajr.176.6.1761525] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether the location and size of vertebral body metastases influence the difference in detection rates between MR imaging and bone scintigraphy. MATERIALS AND METHODS We retrospectively evaluated the vertebral body lesions detected on MR imaging in 74 patients with known widely disseminated metastatic disease. Three radiologists independently reviewed the MR images and bone scintigraphs. MR imaging findings included lesion size and its spatial relationship to the bony cortex (intramedullary, subcortical, and transcortical) and results were correlated with those of planar technetium 99m bone scintigraphy. RESULTS Findings on bone scans were negative for all intramedullary lesions without cortical involvement shown on MR imaging, regardless of their size. Findings on bone scans (71.3% for transcortical and 33.8% for subcortical) were frequently positive for lesions with cortical involvement (trans- or subcortical), and the probability of positive findings on bone scans was also influenced by the lesion size. Statistical analysis showed a positive correlation among cortical involvement, lesion size, and positive findings on bone scintigraphy (p < 0.0001). CONCLUSION Location (the presence of cortical bone involvement on MR imaging) and size of the vertebral body metastases appear to be important contributing factors to the difference in detection rates between MR imaging and bone scintigraphy. Cortical involvement is likely the cause of positive findings on bone scans. Early vertebral metastases tend to be small and located in the medullary cavity without cortical involvement, and therefore, findings may be positive on MR images but negative on bone scans.
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Affiliation(s)
- T Taoka
- Department of Radiology, Magnetic Resonance Imaging Center, University of Iowa College of Medicine, 200 Hawkins Dr., Iowa City, IA 52242, USA
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Abstract
RATIONALE AND OBJECTIVES The authors investigated the use of magnetic resonance (MR) imaging of the brain in adult patients with a primary complaint of chronic headache and no other neurologic symptoms or findings and determined the yield and MR predictors of major abnormalities in these patients. MATERIALS AND METHODS The medical records and MR images of 402 adult patients with chronic headache were retrospectively reviewed. All patients had been evaluated and referred by the neurology service. The findings were categorized as either negative or positive for major abnormality. Multivariate analysis with a linear logistic regression technique was performed on the clinical data, which included patient age, patient sex, and headache type. RESULTS Major abnormalities were found in 15 patients (3.7%), consisting of seven women (2.4%) and eight men (6.9%). Major abnormalities were found in 0.6% of those with migraine headaches, 1.4% with tension headaches, none with mixed migraine and tension headaches, 14.1% with atypical headaches, and 3.8% with other types of headaches. Multivariate analysis showed that the atypical headache type was the most significant predictor of major abnormality. CONCLUSION The yield of major abnormalities found with brain MR imaging in patients with isolated chronic headache is low. However, those patients with atypical headaches have a higher yield of major abnormalities and may benefit from imaging.
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Affiliation(s)
- H Z Wang
- Department of Radiology, University of Rochester Medical Center, NY 14642-8648, USA
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Taoka T, Yuh WT, White ML, Quets JP, Maley JE, Ueda T. Sulcal hyperintensity on fluid-attenuated inversion recovery mr images in patients without apparent cerebrospinal fluid abnormality. AJR Am J Roentgenol 2001; 176:519-24. [PMID: 11159107 DOI: 10.2214/ajr.176.2.1760519] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Failure to suppress cerebrospinal fluid (CSF) signal intensity (sulcal hyperintensity) on fluid-attenuated inversion recovery (FLAIR) images has been reported in patients with abnormal CSF, such as those with meningitis and subarachnoid hemorrhage. Our study investigates the clinical history and MR findings associated with sulcal hyperintensity on FLAIR images in patients without apparent CSF abnormality. SUBJECTS AND METHODS Three hundred consecutive MR imaging examinations were prospectively screened for patients with sulcal hyperintensity on FLAIR images. Nine patients with clinical, CT, or laboratory evidence suggesting abnormal CSF were excluded. The distribution of sulcal hyperintensity on FLAIR images and associated abnormal enhancement were evaluated. The presence of the "dirty CSF" sign (mild increase in CSF signal on unenhanced T1-weighted images or mild decrease on T2-weighted images) in the corresponding hyperintense sulcus was also assessed. RESULTS Twenty-six (8.9%) of the 291 patients had sulcal hyperintensity (16 focal, 10 diffuse) associated with 18 masses (6.1%) and eight vascular abnormalities (2.7%). Sulcal hyperintensity was frequently associated with the dirty CSF sign (69.2%) and abnormal contrast enhancement (overall, 96.2%; 88.5%, leptomeningeal; 53.8%, vascular enhancement). CONCLUSION Our study shows that sulcal hyperintensity on FLAIR imaging can occur in patients without apparent CSF abnormality. Its frequent association with mass effect, vascular disease, abnormal vascular enhancement, and dirty CSF sign suggests that an increase in blood pool, a small amount of protein leakage, and the "flow-entering" phenomenon of the congested blood may contribute to sulcal hyperintensity on FLAIR images.
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Affiliation(s)
- T Taoka
- Department of Radiology, Magnetic Resonance Imaging Center, University of Iowa College of Medicine, 200 Hawkins Dr., Iowa City, IA 52242, USA
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Runge VM, Armstrong MR, Barr RG, Berger BL, Czervionke LF, Gonzalez CF, Halford HH, Kanal E, Kuhn MJ, Levin JM, Low RN, Tanenbaum LN, Wang AM, Wong W, Yuh WT, Zoarski GH. A clinical comparison of the safety and efficacy of MultiHance (gadobenate dimeglumine) and Omniscan (Gadodiamide) in magnetic resonance imaging in patients with central nervous system pathology. Invest Radiol 2001; 36:65-71. [PMID: 11224753 DOI: 10.1097/00004424-200102000-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES The safety and diagnostic efficacy of MultiHance (gadobenate dimeglumine) in the central nervous system (CNS) were evaluated in a double-blind, multicenter, phase III clinical trial. METHODS Two hundred five patients highly suspected of having a CNS lesion (by previous imaging exam) were enrolled at 16 sites in the United States. Patients were randomized to one of three incremental dosing regimens. Magnetic resonance imaging with Omniscan (gadodiamide) at doses of 0.1 and 0.3 mmol/kg was compared with MultiHance (gadobenate dimeglumine) at doses of 0.05 and 0.15 mmol/kg and at 0.1 and 0.2 mmol/kg. RESULTS Compared with predose images alone, efficacy was demonstrated in each of the gadobenate dimeglumine and gadodiamide groups (single and cumulative doses) as indicated by the level of diagnostic information, number of lesions detected, and contrast-to-noise ratio measurements. The level of diagnostic information from gadobenate dimeglumine at 0.1 mmol/kg was equivalent to that with gadodiamide at the same dose. One of the two blinded reviewers found equivalence between the gadobenate dimeglumine 0.05 mmol/kg dose and gadodiamide at 0.1 mmol/kg. Both reviewers found the level of diagnostic information to be equivalent after the second dose of contrast for all three dosing regimens. The cumulative doses of gadobenate dimeglumine were well tolerated and as safe as gadodiamide. CONCLUSIONS Gadobenate dimeglumine is comparable to gadodiamide in terms of safety and efficacy for imaging of CNS lesions, with a possible advantage in imaging applications owing to enhanced T1 relaxivity.
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Affiliation(s)
- V M Runge
- University of Kentucky, Department of Diagnostic Radiology, Lexington 40536, USA.
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Mayr NA, Yuh WT, Oberley LW, Spitz D, Sorosky JI, Buatti JM. Serial changes in tumor oxygenation during the early phase of radiation therapy in cervical cancer-are we quantitating hypoxia change? Re: Lying et al., IJROBP 2000; 46:935-946. Int J Radiat Oncol Biol Phys 2001; 49:282-9. [PMID: 11271075 DOI: 10.1016/s0360-3016(00)00794-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
The aim of this study was to investigate the morphologic changes of the pituitary gland in patients with the clinical diagnosis of idiopathic intracranial hypertension (IIH). Qualitative and quantitative analyses of pituitary morphology were performed in normal subjects (n = 23), patients with the clinical diagnosis of IIH (n = 40), and patients with acute increased intracranial pressure (AICP; n = 37) caused by acute head trauma. The loss of pituitary height (concavity) on the sagittal T1-weighted image was classified into five categories: I = normal, II = superior concavity that was mild (<(1/3) the height of the sella), III = moderate (between (1/3) and (2/3) concavity of height of sella), IV = severe (>(2/3) concavity of height of sella), and V = empty sella. The area ratio of pituitary gland to sella turcica measured in the midsagittal plane was quantified. Clinical records were retrospectively reviewed to correlate with magnetic resonance (MR) findings. Using moderate concavity (>(1/3)) as the minimum criterion for abnormality, IIH patients had an 85% incidence of morphologic changes with 80% sensitivity and 92% specificity. Empty sella (almost complete concavity of the sella) was found in only 2.5% of patients with IIH. Quantitative analysis of the pituitary gland/sella turcica area ratio showed a significant decrease in patients with IIH (P < 0.0001) but no significant difference between the normal subjects and AICP patients. A posterior deviation of the pituitary stalk was seen in 43% of patients. No enlargement of the ventricles or sulcal effacement was seen in IIH patients. Routine brain MR examination of patients with IIH frequently shows morphologic changes of the pituitary gland ranging from various degrees of concavity to (rarely) the extreme case of an empty sella. The etiology is unknown and may be related to the severity and duration of elevated CSF pressure. Such findings may be useful to facilitate the diagnosis of IIH, particularly in patients with equivocal clinical findings or when IIH is not suspected. J. Magn. Reson. Imaging 2000;12:808-813.
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Affiliation(s)
- W T Yuh
- Department of Radiology, The University of Iowa College of Medicine, Iowa City, Iowa 52242, USA.
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Mayr NA, Yuh WT, Arnholt JC, Ehrhardt JC, Sorosky JI, Magnotta VA, Berbaum KS, Zhen W, Paulino AC, Oberley LW, Sood AK, Buatti JM. Pixel analysis of MR perfusion imaging in predicting radiation therapy outcome in cervical cancer. J Magn Reson Imaging 2000; 12:1027-33. [PMID: 11105046 DOI: 10.1002/1522-2586(200012)12:6<1027::aid-jmri31>3.0.co;2-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to assess heterogeneity of tumor microcirculation determined by dynamic contrast-enhanced magnetic resonance (MR) imaging and its prognostic value for tumor radiosensitivity and long-term tumor control using pixel-by-pixel analysis of the dynamic contrast enhancement. Sixteen patients with advanced cervical cancer were examined with dynamic contrast-enhanced MR imaging at the time of radiation therapy. Pixel-by-pixel statistical analysis of the ratio of post- to precontrast relative signal intensity (RSI) values in the tumor region was performed to generate pixel RSI distributions of dynamic enhancement patterns. Histogram parameters were correlated with subsequent tumor control based on long-term cancer follow-up (median follow-up 4.6 years; range 3.8-5.2 years). The RSI distribution histograms showed a wide spectrum of heterogeneity in the dynamic enhancement pattern within the tumor. The quantity of low-enhancement regions (10th percentile RSI < 2.5) significantly predicted subsequent tumor recurrence (88% vs. 0%, P = 0.0004). Discriminant analysis based on both 10th percentile RSI and pixel number (reflective of tumor size) further improved the prediction rate (100% correct prediction of subsequent tumor control vs. recurrence). These preliminary results suggest that quantification of the extent of poor vascularity regions within the tumor may be useful in predicting long-term tumor control and treatment outcome in cervical cancer. J. Magn. Reson. Imaging 2000;12:1027-1033.
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Affiliation(s)
- N A Mayr
- Division of Radiation Oncology, Department of Radiology, The University of Iowa College of Medicine, Iowa City, Iowa 52242, USA.
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Mayr NA, Taoka T, Yuh WT, Zhen WK, Paulino AC, Sorosky JI, Buatti JM. Magnetic resonance imaging in the assessment of radiation response in cervical cancer: regarding Hatano K et al. IJROBP 1999; 45:399-344. Int J Radiat Oncol Biol Phys 2000; 48:910-2. [PMID: 11183740 DOI: 10.1016/s0360-3016(00)00665-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hoffman HT, Quets J, Toshiaki T, Funk GF, McCulloch TM, Graham SM, Robinson RA, Schuster ME, Yuh WT. Functional magnetic resonance imaging using iron oxide particles in characterizing head and neck adenopathy. Laryngoscope 2000; 110:1425-30. [PMID: 10983936 DOI: 10.1097/00005537-200009000-00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In lymph nodes harboring metastases the reticuloendothelial system is replaced by tumor cells and does not concentrate iron particles. This study assesses the value of contrast magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide particles (Combidex, Advanced Magnetics, Inc., Cambridge, MA) to characterize and stage neck nodes. STUDY DESIGN Prospective analysis of neck imaging by Combidex MRI, with correlation from pathological assessment of resected lymph nodes. METHODS Nine patients underwent MRI and subsequent bilateral neck dissections (three), unilateral neck dissections (five) or fine-needle aspiration (one). Each case was evaluated for the number, location, MRI characteristics, and pathological assessment of lymph nodes. RESULTS Forty-nine separate nodal levels were evaluated with both Combidex MRI and pathological assessment. The presence of metastatic nodal involvement among 45 levels was correctly assessed by the Combidex MRI (three false-negative results, one false-positive result; sensitivity, 84%; specificity, 97%). Analysis was possible for 101 of the individual lymph nodes identified by MRI that could be correlated with individual nodes pathologically examined. Combidex MRI assessment was correct for 99 nodes (one-false positive result, one false-negative result; sensitivity, 95%, specificity, 99%). Standard MRI interpretation without Combidex identified that 12 of 18 nodes (67%) that were greater than or equal to 10 mm (greatest dimension) contained tumor, whereas 9 of 83 nodes (ll%) that were less than 10 mm contained tumor. CONCLUSIONS Combidex MRI provides functional information to characterize lymph nodes in the clinical staging of squamous cell carcinoma of the head and neck. The inability of MRI to identify small lymph nodes restricts the usefulness of this technique.
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Affiliation(s)
- H T Hoffman
- Department of Otolaryngology, Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1078, USA
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Sharafuddin MJ, Wroblicka JT, Sun S, Essig M, Schoenberg SO, Yuh WT. Percutaneous vascular intervention based on gadolinium-enhanced MR angiography. J Vasc Interv Radiol 2000; 11:739-46. [PMID: 10877419 DOI: 10.1016/s1051-0443(07)61633-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine if gadolinium-enhanced magnetic resonance angiography (Gd-MRA) could be used to reliably plan percutaneous vascular procedures. PATIENTS AND METHODS Over the course of 13 months, 31 patients underwent attempted percutaneous intervention solely on the basis of a preceding Gd-MRA study. A total of 49 arterial segments were targeted (28 extremities, 21 visceral). Five segments in four patients were not treated (less impressive disease severity on conventional catheter angiography [CA] in four segments, diffuse intrarenal atherosclerosis in one segment). Interventions attempted were percutaneous transluminal angioplasty (n = 10), angioplasty with stent placement (n = 29), and thrombolysis (n = 3). Interventions were successful in all segments, except two because of the inability to cross an occlusion. RESULTS Good to strong correlation was noted between Gd-MRA and CA regarding stenosis severity and length and the presence of poststenotic dilatation. MRA underestimated the complexity of stenosis. Subjective quality and preintervention confidence were excellent in the majority of MRA studies and satisfactory in the rest. The overall value in "procedural planning" was judged high in 40 segments, satisfactory in five segments, and poor in four segments. The procedural planning and positive predictive values of MRA were significantly lower for visceral arteries compared to iliac and peripheral arteries. CONCLUSION In most cases, Gd-MRA reliably yielded the anatomic and diagnostic information necessary to plan percutaneous vascular interventions noninvasively and without iodinated contrast. In the authors' practice, Gd-MRA is becoming a key imaging modality in the workup of patients in whom percutaneous intervention is anticipated.
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Affiliation(s)
- M J Sharafuddin
- Department of Radiology, the University of Iowa Hospitals and Clinics, Iowa City 52242-1077, USA.
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Magnotta VA, Gold S, Andreasen NC, Ehrhardt JC, Yuh WT. Visualization of subthalamic nuclei with cortex attenuated inversion recovery MR imaging. Neuroimage 2000; 11:341-6. [PMID: 10725190 DOI: 10.1006/nimg.2000.0552] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
There is a significant amount of interest in studying the thalamus because of its central location in the brain and its role as a gatekeeper to higher centers of cognition. Imaging and measuring of the individual subnuclei of the thalamus has proven extremely difficult in MR because of the contrast-to-noise (CNR) of the MR sequences used. This report describes a novel MR pulse sequence known as cortex attenuated inversion recovery (CAIR), which increases the CNR in images and allows the individual subnuclei of the thalamus to be visualized by selectively nulling the gray matter in the brain using an inversion recovery sequence with an inversion time of 700 ms at 1.5 T.
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Affiliation(s)
- V A Magnotta
- Department of Radiology, Mental Health Clinical Research Center, The University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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Yuh WT, Taoka T, Ueda T, Chaloupka JC. Imaging helps identify who benefits from stroke intervention. Diagn Imaging (San Franc) 1999; 21:77-82. [PMID: 10724845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- W T Yuh
- Radiology Department, University of Iowa, Iowa City, USA
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Ueda T, Yuh WT, Maley JE, Otake S, Quets JP, Taoka T, Hahn PY, White ML. Current and future imaging of acute cerebral ischemia: assessment of tissue viability by perfusion imaging. J Comput Assist Tomogr 1999; 23 Suppl 1:S3-7. [PMID: 10608392 DOI: 10.1097/00004728-199911001-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With the advances and availability of new imaging modalities, the role of imaging of acute stroke has been broadened from making diagnosis to providing valuable information for patient management. We need to have rapid diagnostic modalities that distinguish reversible ischemic tissue from irreversibly damaged tissue for successful thrombolytic therapy. Although diffusion imaging has been reported to have both high sensitivity and specificity for acute ischemia in clinical studies, previous reports do not conclude whether the diffusion abnormality is indicative of reversibly or irreversibly injured tissue. Perfusion imaging such as perfusion magnetic resonance imaging and single-photon emission computed tomography may have the potential for providing useful information that determines tissue viability and/or reversibility. Cerebral blood flow thresholds evaluated by pretreatment single-photon emission computed tomography provide important information that is potentially useful in the management of acute stroke patients with intra-arterial thrombolysis. Perfusion imaging, when combined with diffusion imaging, may thus be potentially useful in improving patient selection for thrombolytic therapy.
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Affiliation(s)
- T Ueda
- Department of Radiology, The University of Iowa Hospitals and Clinics, USA.
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Ueda T, Yuh WT. Direct angioplasty for acute occlusion of intracranial artery. AJNR Am J Neuroradiol 1999; 20:2021-3. [PMID: 10588139 PMCID: PMC7657804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Yuh WT, Ueda T, White M, Schuster ME, Taoka T. The need for objective assessment of the new imaging techniques and understanding the expanding roles of stroke imaging. AJNR Am J Neuroradiol 1999; 20:1779-84. [PMID: 10588097 PMCID: PMC7657776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- W T Yuh
- Department of Radiology, University of Iowa Hospital, Iowa City 52242, USA
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Ueda T, Yuh WT. Safety of angioplasty for intracranial artery. AJNR Am J Neuroradiol 1999; 20:2021. [PMID: 10588138 PMCID: PMC7657811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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Abstract
With the advances in new neuroimaging modalities, the role of imaging of acute ischemic stroke has broadened and progressed from making diagnoses to providing valuable information for patient management. The goal of thrombolytic therapy for acute ischemic stroke should be to salvage the ischemic tissue reversibility that can respond to recanalization and avoid reperfusion of the dead (nonviable) tissue. It is essential to have rapid diagnostic modalities that can distinguish viable ischemic tissue from irreversibly damaged tissue, because there is a risk of reperfusion injury such as hemorrhagic complications with early intervention. Although diffusion magnetic resonance (MR) imaging has been reported to have a high sensitivity and specificity for acute ischemia in acute stroke patients without early reperfusion therapy, the capability to differentiate reversible from irreversible ischemia by diffusion MR imaging has not been established. Perfusion MR imaging techniques provide direct information on parenchymal perfusion status (adequacy of the collateral circulation) and may have the potential for providing important information about tissue viability and/or reversibility for selecting appropriate patients for thrombolytic therapy.
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Affiliation(s)
- T Ueda
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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Mayr NA, Hawighorst H, Yuh WT, Essig M, Magnotta VA, Knopp MV. MR microcirculation assessment in cervical cancer: correlations with histomorphological tumor markers and clinical outcome. J Magn Reson Imaging 1999; 10:267-76. [PMID: 10508286 DOI: 10.1002/(sici)1522-2586(199909)10:3<267::aid-jmri7>3.0.co;2-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This article reviews the experience available to date on microcirculation assessment in cancer of the cervix including correlation studies of magnetic resonance (MR) microcirculatory parameters with histo-morphometric predictors and direct correlation with patient outcome. The data suggest that MR microcirculation parameters do not always correlate with histo-morphometric parameters, while there is evidence that MR parameters predict patients' treatment outcome. These observations raise the issue that perhaps the histo-morphometric parameters, accepted gold standards for tumor angiogenesis and prognostic factors, reflect anatomical information at a "static" single time point and may not always provide sufficient information on the "dynamic" microcirculation function of the tumor. MR microcirculation assessment reflects both anatomical and functional information and may provide this additional information on the "dynamic" angiogenic and metabolic status of a tumor. Therefore, assessment of tumor microcirculation may augment the individual risk profile in cervical cancer patients and has the potential to impact on therapy selection and treatment outcome.
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Affiliation(s)
- N A Mayr
- Division of Radiation Oncology, Department of Radiology, The University of Iowa College of Medicine, Iowa City, Iowa 52242, USA
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Abstract
Functional imaging may come to play an important role in the evaluation of CNS vasculitis by demonstrating pathology on the microcirculatory level. A positive finding of microvascular ischemia may assist in the diagnosis of CNS vasculitis. More importantly, the demonstration of normal microcirculation may reliably exclude CNS vasculitis.
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Affiliation(s)
- W T Yuh
- Department of Radiology, The University of Iowa College of Medicine, Iowa City, Iowa 52241, USA.
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Ueda T, Yuh WT, Maley JE, Quets JP, Hahn PY, Magnotta VA. Outcome of acute ischemic lesions evaluated by diffusion and perfusion MR imaging. AJNR Am J Neuroradiol 1999; 20:983-9. [PMID: 10445433 PMCID: PMC7056244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND PURPOSE Diffusion and perfusion MR imaging have been reported to be valuable in the diagnosis of acute ischemia. Our purpose was to ascertain the value of these techniques in the prediction of ischemic injury and estimation of infarction size, as determined on follow-up examinations. METHODS We studied 18 patients with acute ischemic stroke who underwent echo-planar perfusion and diffusion imaging within 72 hours of symptom onset. Quantitative volume measurements of ischemic lesions were derived from relative mean transit time (rMTT) maps, relative cerebral blood volume (rCBV) maps, and/or apparent diffusion coefficient (ADC) maps. Follow-up examinations were performed to verify clinical suspicion of infarction and to calculate the true infarction size. RESULTS Twenty-five ischemic lesions were detected during the acute phase, and 14 of these were confirmed as infarcts on follow-up images. Both ADC and rMTT maps had a higher sensitivity (86%) than the rCBV map (79%), and the rCBV map had the highest specificity (91%) for detection of infarction as judged on follow-up images. The rMTT and ADC maps tended to overestimate infarction size (by 282% and 182%, respectively), whereas the rCBV map appeared to be more precise (117%). Significant differences were found between ADC and rMTT maps, and between rCBV and rMTT maps. CONCLUSION Our data indicate that all three techniques are sensitive in detecting early ischemic injury within 72 hours of symptom onset but tend to overestimate the true infarction size. The best methods for detecting ischemic injury and for estimating infarction size appear to be the ADC map and the rCBV map, respectively, and the diffusion abnormality may indicate early changes of both reversible and irreversible ischemia.
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Affiliation(s)
- T Ueda
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City 52242, USA
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Magnotta VA, Heckel D, Andreasen NC, Cizadlo T, Corson PW, Ehrhardt JC, Yuh WT. Measurement of brain structures with artificial neural networks: two- and three-dimensional applications. Radiology 1999; 211:781-90. [PMID: 10352607 DOI: 10.1148/radiology.211.3.r99ma07781] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the ability of an artificial neural network (ANN) to identify brain structures. This ANN was applied to postprocessed magnetic resonance (MR) images to segment various brain structures in both two- and three-dimensional applications. MATERIALS AND METHODS An ANN was designed that learned from experience to define the corpus callosum, whole brain, caudate, and putamen. Manual segmentation was used as a training set for the ANN. The ANN was trained on two-thirds of the manually segmented images and was tested on the remaining one-third. The reliability of the ANN was compared against manual segmentations by two technicians. RESULTS The ANN was able to identify the brain structures as readily and as well as did the two technicians. Reliability of the ANN compared with the technicians was 0.96 for the corpus callosum, 0.95 for the whole brain, 0.86 (right) and 0.93 (left) for the caudate, and 0.71 (right) and 0.88 (left) for the putamen. CONCLUSION The ANN was able to identify the structures used in this study as well as did the two technicians. The ANN could do this much more rapidly and without rater drift. Several other cortical and subcortical structures could also be readily identified with this method.
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Affiliation(s)
- V A Magnotta
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Ueda T, Yuh WT. Direct angioplasty for acute occlusion of intracranial artery. AJNR Am J Neuroradiol 1999; 20:945-6. [PMID: 10369373 PMCID: PMC7056147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Maeda M, Yuh WT, Ueda T, Maley JE, Crosby DL, Zhu MW, Magnotta VA. Severe occlusive carotid artery disease: hemodynamic assessment by MR perfusion imaging in symptomatic patients. AJNR Am J Neuroradiol 1999; 20:43-51. [PMID: 9974057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral hemodynamic status has been reported to influence the occurrence and outcome of acute stroke. The purpose of this study was to assess hemodynamic compromise in symptomatic patients with severe occlusive disease of the carotid artery by the use of echo-planar perfusion imaging. METHODS Spin-echo echo-planar perfusion imaging was performed in 11 patients (two had bilateral disease) with severe stenosis or occlusion of the carotid artery who had experienced either a recent transient ischemic attack or minor stroke. Relative cerebral blood volume (rCBV) maps and relative mean transit time (rMTT) maps were generated from the time-concentration curve. Findings on T2-weighted images, angiograms, rCBV maps, and rMTT maps were compared and assessed qualitatively and quantitatively. RESULTS Although the abnormalities on T2-weighted images were absent, minimal, and/or unrelated to the degree of stenosis or collateral circulation, rMTT maps showed much larger and more distinct perfusion abnormalities along the vascular distribution of the affected vessels in all 13 vascular territories of the 11 patients. Despite obvious abnormalities on rMTT maps, none of the patients had evidence of decreased rCBV in the affected brain tissue (increased in three, normal in eight). A statistically significant difference in rMTT values was found between the affected and unaffected brain tissue, whereas no significant difference was seen in rCBV values. CONCLUSION Echo-planar perfusion imaging is a noninvasive and rapid method for evaluating the hemodynamics in severe occlusive carotid artery disease and the compensatory vascular changes, and it may be useful in patient management.
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Affiliation(s)
- M Maeda
- Department of Radiology, University of Iowa College of Medicine, Iowa City 52242, USA
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Yuh WT, Ueda T, Maley JE. Perfusion and diffusion imaging: a potential tool for improved diagnosis of CNS vasculitis. AJNR Am J Neuroradiol 1999; 20:87-9. [PMID: 9974061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- W T Yuh
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa City 52242, USA
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Ueda T, Sakaki S, Yuh WT, Nochide I, Ohta S. Outcome in acute stroke with successful intra-arterial thrombolysis and predictive value of initial single-photon emission-computed tomography. J Cereb Blood Flow Metab 1999; 19:99-108. [PMID: 9886360 DOI: 10.1097/00004647-199901000-00011] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study investigates retrospectively, in selected patients, the ischemic outcome (reversible ischemia, infarction, and hemorrhage) and neurologic outcome of acute stroke treated with intra-arterial thrombolysis and the predictive value of pretreatment single-photon emission-computed tomography (SPECT). Thirty patients with complete recanalization within 12 hours were analyzed. The extent of ischemia was outlined on SPECT, and two CBF parameters were calculated: the ratio of ischemic regional activity to CBF in the cerebellum and the asymmetry index. Reversible ischemia, infarction, and hemorrhage were identified by comparing SPECT and follow-up computed tomography. Nine patients (30%) had no or small infarction, 14 (47%) had medium or large infarction, and seven (23%) had hemorrhage. Forty-two lesions were identified (22 reversible ischemia, 13 infarction, and 7 hemorrhage). Duration of ischemia, urokinase dose, disease type, and occlusion site were nonsignificant factors, whereas neurologic outcome and CBF parameters were significant among the three patient groups and three types of ischemic lesions. Ischemic tissue with CBF greater than 55% of cerebellar flow still may be salvageable, even with treatment initiated 6 hours after onset of symptoms. Ischemic tissue with CBF greater than 35% of cerebellar flow still may be salvageable with early treatment (less than 5 hours). Ischemic tissue with with CBF less than 35% of cerebellar flow may be at risk for hemorrhage within the critical time window. Pretreatment SPECT can provide useful parameters to increase the efficacy of thrombolysis by reducing hemorrhagic complications and improving neurologic outcome.
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Affiliation(s)
- T Ueda
- Department of Neurological Surgery, Ehime University School of Medicine, Japan
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Watters MR, Stears JC, Osborn AG, Turner GE, Burton BS, Lillehei K, Yuh WT. Transdural spinal cord herniation: imaging and clinical spectra. AJNR Am J Neuroradiol 1998; 19:1337-44. [PMID: 9726479 PMCID: PMC8332200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Transdural herniation of the spinal cord is a rarely reported clinical entity, and many of the existing reports were published before the advent of MR imaging. We describe five current cases and compare them with findings in 25 cases reported in the literature to delineate the clinical and imaging spectra of transdural spinal cord herniation. METHODS MR imaging, CT myelography, and conventional myelography were performed in five patients with transdural herniation of the spinal cord. These studies, along with clinical findings, are described. Intraoperative photographs are included for one case. The salient features of both the current and previously reported cases are summarized in tabular form. RESULTS In three cases, transdural spinal cord herniation occurred posttraumatically, in one case the cause was iatrogenic and in the others the herniation occurred spontaneously. Imaging features not previously reported include dorsally directed herniations at thoracolumbar levels (two patients), apparent (lacking surgical confirmation) syringomeyelia (one case), a vertebral body nuclear trail sign (one case), and intramedullary hyperintensities on MR images (two cases). Clinical features not previously reported include unilateral pyramidal-sensory deficits (one case) and isolated unilateral pyramidal signs (one case). Clinical findings similar to previous reports include progressive paraparesis (two cases) and progressive Brown-Séquard syndrome (one case). CONCLUSION Our five cases illustrate certain clinical and imaging findings not previously reported, and, together with the established features of the 25 cases in the literature, delineate the spectra of transdural spinal cord herniation.
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Affiliation(s)
- M R Watters
- Division of Neurology, University of Hawaii School of Medicine, USA
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Grossman R, Kuhn MJ, Maravilla K, Lee D, Schild H, Ethier R, Reiser M, Yuh WT, Olukotun AY. Multicenter evaluation of the safety, tolerance, and efficacy of OptiMARK in magnetic resonance imaging of the brain and spine. Acad Radiol 1998; 5 Suppl 1:S154-5; discussion S156. [PMID: 9561068 DOI: 10.1016/s1076-6332(98)80089-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R Grossman
- Department of Neuroradiology, University of Pennsylvania Medical Center, Philadelphia, USA
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Maley JE, Yuh WT. Contrast dosage in the neuroimaging of brain tumors. Principles and indications. Magn Reson Imaging Clin N Am 1998; 6:113-24. [PMID: 9449743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
No single dose of MR contrast agent is optimal or adequate for the evaluation of all types of CNS lesions. This article discusses the fundamental principles and various background suppression techniques for lesion detection and delineation. An understanding of all factors influencing lesion conspicuity is important in deciding the optimal dose, if any, of contrast agent and the technique necessary for the procedure.
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Affiliation(s)
- J E Maley
- Department of Radiology, The University of Iowa College of Medicine, Iowa City, Iowa 52242, USA
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Abstract
This presentation reviews the issue of contrast media dosing and imaging protocols for the optimal MR imaging detection and characterization of pathology. The cumulative clinical experience gained in performing contrast-enhanced MR examinations with gadolinium chelates indicates that a dose of 0.1 mmol/kg body weight provides safe and effective enhancement of most CNS pathology. Doses lower than 0.1 mmol/kg have been shown to be inadequate for delineating all but selected types of CNS pathology, such as masses with a high lesion to background ratio on post-contrast images (acoustic neuromas) or lesions located in areas in which the normal tissue very rapidly takes up contrast agent (e. g. microadenomas in the pituitary gland). Recent clinical studies have suggested a role for high dose gadolinium administration (up to 0.3 mmol/kg) for the optimal detection and delineation of cerebral metastases or other small or poorly enhancing lesions. Differences in the histopathologic characteristics (capillary permeability, vascularity, location, size) of specific diseased tissues may require varying doses or even a different contrast agent to be used for optimal imaging results. As new MR contrast agents and new scanning techniques are introduced, the specific diagnostic question posed will likely determine the choice of pulse sequence, contrast agent and dose used.
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Affiliation(s)
- W T Yuh
- Department of Radiology/MRI, 0417 JCP Newton Road, University of Iowa Hospitals and Clinics, Iowa City IA 52242, USA
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