Analysis of Magnetic Resonance Imaging Perfusion Parameters for the Identification of Spinal Metastatic Tumors with Rich Blood Supply.

PURPOSE: To determine the reliability of dynamic magnetic resonance imaging (MRI) perfusion parameters for the evaluation of blood supply to spinal metastatic tumors. METHODS: A total of 36 patients with spinal metastasis who underwent dynamic contrast-enhanced magnetic resonance spinal perfusion imaging at Tianjin Hospital from December 2018 to December 2020 were reviewed. Subsequently, the patients underwent corresponding preoperative examination using digital subtraction angiography of the spine at the hospital and were divided into 2 groups accordingly. Differences in dynamic MRI perfusion parameters between the 2 groups were analyzed. RESULTS: There were statistically significant differences between the 2 groups in the quantitative dynamic contrast-enhanced MRI perfusion parameters vascular permeability and plasma volume, as well as semi-quantitative peak enhancement and blood flow ratio parameters. CONCLUSIONS: Dynamic MRI perfusion may distinguish spinal metastatic lesions with rich blood supply from those with poor blood supply and may help clinicians identify patients that can benefit from invasive spinal angiography and preoperative embolization. This technique may also provide guidance on decision taking for surgery basing on dynamic MRI perfusion parameters.

Effectiveness of bisphosphonates on bone mineral density in osteopenic postmenopausal women: A systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND: Various bisphosphonate agents have been proven to be effective in preventing bone loss and fracture in osteopenic postmenopausal women. This study was designed to compare the effectiveness of various BPs on preventing the loss of bone mineral density (BMD) for postmenopausal women with osteopenia. METHODS: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were screened up to identify randomized controlled trails comparing effectiveness of BPs or placebo on the BMD of postmenopausal women with osteopenia. Network meta-analysis and standard pair-wise meta-analyses were performed. The main outcomes include the percentage changes of 6-, 12-, 24-, and 36-month BMD at lumbar, total hip and femoral neck, and frequencies of new fractures and severe adverse events. RESULTS: Fourteen randomized controlled trials were eligible, involving 11,540 participants. No significant difference was presented among the available interventions for the 6-month BMD at 3 different sites, but the magnitudes of differences among the treatment regimens became gradually increased along with the extending of follow-up periods. Daily aledronate of more than 5 mg provided the maximal percentage increase on BMD of femoral neck and lumbar spine, while zoledronate provided maximal change on BMD of total hip, at different follow-up periods. This network meta-analysis also demonstrated similar frequencies of new clinical fractures and severe adverse events among different interventions. CONCLUSIONS: A ranking spectrum depicting the effectiveness on BMD percentage change following interventions with different bisphosphonate regimens was provided. Generally, regimens with zoledronate and aledronate were found to be the most effective interventions in the 3 sites at different end points.

Surgical treatment of distal radius giant cell tumors.

We aimed to evaluate the effectiveness of surgical methods commonly used for the clinical treatment of giant cell tumors (GCT) of the distal radius. From 2010 to 2018, 32 patients with GCT of the distal radius who underwent surgical treatment were eligible for the study. Among them, 21 patients with available pathological results, complete imaging data and at least 18 months of follow-up were enrolled in the study. Eleven of the patients underwent en bloc resection and non-vascularized autologous fibula reconstruction (Group A), while 10 patients underwent microwave ablation, lesion curettage, and internal fixation with bone cement (Group B). Imaging was carried out to understand the effect of the surgical treatment and postoperative complications. Variables of interested included operation time and blood loss, preoperative and postoperative wrist joint mobility, and postoperative complications during follow-up. The operation time and intraoperative blood loss in group A were higher than in group B, and the difference between groups was statistically significant. The wrist range of motion before and after surgery was statistically significant both in Group A and Group B (p < 0.05). The scale deviation and MSTS scores of group A were better than group B (p > 0.05), flexion, extension, radial deviation index in group B was better than group A (p < 0.05). By evaluating the postoperative functional outcomes of the operated wrist in the two groups, we found that both surgical methods are reliable for treating GCT of the distal radius, with satisfactory postoperative functional recovery and a low incidence of postoperative recurrence (only 1 of 10 patients in group B). The two surgical methods have their own advantages and disadvantages and provide surgeons with one more choice in the clinical context.

A Novel Prediction Tool for Overall Survival of Patients Living with Spinal Metastatic Disease.

OBJECTIVE: To identify the significant prognostic factors for overall survival in patients with spinal metastases and to establish an online widget for predicting survival with an interactive visual approach. METHODS: Patients operated for spinal metastases between 2010 and 2018 were retrospectively enrolled and were randomly divided into training and validation samples with a ratio of 7:3. Patients' characteristics were analyzed with univariate and multivariate Cox analyses to identify independent prognostic factors basing on the training sample. A shiny web tool was developed by transforming the fitted multivariable Cox model into a visual interface. Time-dependent area under the curve plot and calibration curve were generated to assess the discrimination ability and consistency of the novel model, both for the training and validation samples. RESULTS: A total of 265 consecutive patients were finally included, with 185 in the training sample and 80 in the validation sample. The primary tumor types, lesion site of metastasis, visceral metastasis, Frankel grade, operation category, number of surgical segments, and the preoperative percentage of lymphocyte were demonstrated to be significantly associated with overall survival. A novel shiny model (https://yang1209xg.shinyapps.io/predictspinalmetastasis/) that could provide predicted survival curve and median survival time was established, with favorable discrimination ability and consistency between predicted and actual survival both in internal and external data, according to time-dependent area under the curve plots and calibration curves. CONCLUSIONS: A user-friendly shiny app with favorable discrimination ability and consistency was released online for predicting the survival of patients with spinal metastases. A continuous survival curve and the predicted median survival time are available to guide the treatment planning.