Preoperative deep vein thrombosis in patients with cervical spondylotic myelopathy scheduled for spinal surgery.

INTRODUCTION: The prevalence of deep vein thrombosis (DVT) and its risk factors in patients with cervical spondylotic myelopathy (CSM) before spinal surgery are poorly understood. We investigated this association with a retrospective cross-sectional study. PATIENTS CONCERNS: The study cohort consisted of all consecutive patients with CSM who were scheduled for spinal surgery at our institution from 2013 to 2015. DVT was defined as an intraluminal filling defect in a lower extremity vein identified by Doppler ultrasonography. OUTCOMES: Of the 396 patients with CSM, 16 (4%) had DVT. Compared with patients without preoperative DVT, patients with preoperative DVT were older (62.75 ±â€Š8.79 vs 53.03 ±â€Š10.95 years, P = 0.001), had higher D-dimer concentrations (2.23 ±â€Š4.15 vs 0.43 ±â€Š0.90 mg/L, P = 0.04), had experienced longer duration of CSM (7.56 ±â€Š7.08 vs 4.01 ±â€Š6.37 months, P = 0.03), had lower Japanese Orthopaedic Association lower limb motor dysfunction scores (1.68 ±â€Š1.25 vs 2.54 ±â€Š0.91, P = 0.01), and had a history of ischemic cardiovascular events (33.3% vs 2.1%, P = 0.02). The area under the curve for the ability of D-dimer levels to predict DVT was 0.858 (95% confidence interval: 0.764-0.951; P < 0.0001). A D-dimer level of 0.54 mg/L detected DVT with a sensitivity and specificity of 87.5% and 83.2%, respectively. Abnormal D-dimer levels and ischemic cardiovascular events history were independent predictors of DVT. CONCLUSION: Patients with CSM who were scheduled for surgery often presented with preoperative DVT. Preoperative vascular screening should be considered for patients with CSM, especially for those who are older, have had longer duration of CSM, have poor lower limb mobility, and have a heart disease history. Inferior vena cava filter insertion and anticoagulation treatments should be considered for CSM patients with preoperative DVT.

Intravenous leiomyomatosis: CT findings.

Intravenous leiomyomatosis (IVL) is a rare smooth muscle tumor. Although IVL is histologically benign, it might be aggressive in its behavior and can grow into pelvic veins and the inferior vena cava (IVC) extending into the heart chambers and pulmonary vasculature. Occasionally, it was found to have lung metastasis. We describe four cases of IVL in the IVC with a history of hysterectomy for uterine leiomyoma, one extending into the left renal vein and three growing into the right heart chamber. We report the computed tomography (CT) findings in the four cases and briefly discuss the CT features of IVL in order to help making accurately preoperative diagnosis and improve the rate of surgical resection and survival.

The thin sectional anatomy of the sellar region with MRI correlation.

The purpose of this study was to explore the anatomical complexity and adjacent relationships of the sellar region in thin continuous sections so as to provide intimate morphological data for imaging diagnosis and surgical operations of the diseases in this region. After CT and MR examination verifying no brain lesions, one normal cadaver head was selected for this study from four Chinese adult male cadavers. After being embedded and frozen, the head was sliced into serial sections at 0.1 mm intervals in the transverse plane with SKC 500 computerized freezing milling machine. Then the serial transverse sections were photographed by a high-resolution digital camera and saved in the computer. Subsequently, the anatomic structures of the sellar region on the thin transverse sections were investigated and correlated with the MR images of the specimen as well as in vivo MR images, which were obtained from 20 normal Chinese male adult volunteers by a 3.0 T GE MR scanner. The base lines of the sectioning and the MR scan were all parallel to the AC-PC line. A total of 320 transverse sections and 10-12 transverse MR images related with the sellar region were obtained, respectively. We investigated the sectional anatomy of the sellar region and divided it into three parts: supra hypophysial area, hypophysial area and infra hypophysial area. The cavernous sinus was a venous passage full of blood and it could be divided into four interspaces according to its position relation with the internal carotid artery. The third, fourth, sixth cranial nerves and trigeminal branches ophthalmic nerve, maxillary nerve displayed from the anterior to the posterior in the lateral wall of cavernous sinus in transverse planes. Comparing continuous thin sections with MR images offers a better understanding of the complex anatomical structures and provides practical submillimeter anatomical data for imaging diagnosis and clinical treatment in this region.

Dose performance and image quality: dual source CT versus single source CT in cardiac CT angiography.

OBJECTIVE: To evaluate dose performance and image quality of 64-slice dual source CT (DSCT) in comparison to 64-slice single source CT (SSCT) in cardiac CT angiography (CTA). METHODS: 100 patients examined by DSCT and 60 patients scanned by SSCT were included in this study. Objective indices such as image noise, contrast-to-noise ratio and signal-to-noise ratio were analyzed. Subjective image quality was assessed by two cardiovascular radiologists in consensus using a four-point scale (1=excellent to 4=not acceptable). Estimation of effective dose was performed on the basis of dose length product (DLP). RESULTS: At low heart rates (<70 bpm), image quality of SSCT was equivalent to that of DSCT (P>0.05), but, at high heart rates (>70 bpm), DSCT provided robust image quality (P<0.05). The average effective dose of SSCT was 9.3+/-0.9 mSv at low heart rates (<70 bpm) while, the average estimated effective doses of DSCT were 9.1+/-1.3 mSv, 8.3+/-1.1 mSv, 7.9+/-1.1 mSv, 6.9+/-0.7 mSv, and 5.9+/-1.3 mSv, corresponding to heart rates of 50-59 bpm, 60-69 bpm, 70-79 bpm, 80-89 bpm, and 90-100 bpm. CONCLUSION: For cardiac CTA, both DSCT and SSCT can get good image quality at low heart rates (<70 bpm) with a similar radiation dose, but, at high heart rates (>70 bpm), DSCT is able to provide robust diagnostic image quality at doses far below that of SSCT.

The pineal region: thin sectional anatomy with MR correlation in the coronal plane.

This study was undertaken to explore the anatomic features and adjacent relationships of the pineal region in thin coronal sections. After CT and MR examination verifying no brain lesions, one normal cadaver head was selected for this study from three Chinese adult male cadavers. After being embedded and frozen, the head was sliced into serial sections at 0.1 mm intervals in the coronal plane with SKC 500 computerized freezing milling machine. Then the serial coronal sections were photographed by a high-resolution digital camera and saved in the computer. Subsequently, the anatomic structures of the pineal region on the thin coronal sections were investigated and correlated with in vivo MR images, which were obtained from ten normal Chinese male adult volunteers by a 3.0 T GE scanner. The base lines of the sectioning and the MR scan were all perpendicular to the AC-PC line. A total of 355 coronal sections and 21-23 in vivo coronal MR images related with the pineal region were obtained, respectively. From anterior to posterior, the shape of the pineal region changed from an inverted triangle to a trapezoid and a triangle gradually, and the anatomic details could be depicted clearly in the thin sectional anatomy images in sub-millimeter. Via the comparison, some micro-anatomic structures of the pineal region that cannot be discriminated clearly or missed in the thick sections or MR images were identified. The contrast of the computerized freezing milling technique with the MRI enhanced our ability to comprehend the complex anatomy of the pineal region and to improve the imaging diagnosis and surgical treatments of minute diseases in this region.