Combination of Contrast-enhanced FlAIR and Contrast-enhanced T1WI: A Quick and Efficient Method in Detecting Brain Metastases of Lung Cancers.

BACKGROUND: Some patients with suspected brain metastases (BM) could not tolerate longer scanning examinations according to the standardized MRI protocol. OBJECTIVE: The purpose of this study was to evaluate the clinical value of contrast-enhanced fast fluid-attenuated inversion recovery (CE FLAIR) imaging in combination with contrast-enhanced T1 weighted imaging (CE T1WI) in detecting BM of lung cancer and explore a quick and effective MRI protocol. MATERIAL AND METHODS: In 201 patients with lung cancers and suspected BM, T1WI and FLAIR were performed before and after administration of gadopentetate dimeglumine. Two radiologists reviewed pre- and post-contrast images to determine the presence of abnormal contrast enhancement or signal intensity and decided whether it was metastatic or not on CE T1WI (Group 1) and CE FLAIR (Group 2). The number, locations and features of abnormal findings in two groups were recorded. Receiver Operating Characteristic (ROC) analyses were conducted in three groups: Group 1, 2 and 3(combination of CE FLAIR and CE T1WI). RESULTS: A total of 714 abnormal findings were revealed, of which 672 were considered as BM and 42 nonmetastatic. Superficial and small metastases(≤10mm) in parenchyma and ependyma, leptomeningeal and non-expansive skull metastases were typically better seen on CE FLAIR. The areas under ROC in the three groups were 0.720,0.887 and 0.973, respectively. Group 3 was significantly better in diagnostic efficiency of BMs than Group 1 (p<0.0001) or Group 2 (p=0.0006). CONCLUSION: The combination of CE T1WI and CE FLAIR promotes diagnostic performance and results in better observation and characterization of BM in patients with lung cancers. It provides a quick and efficient way of detecting BM.

Clinical and Imaging Predictors of Surgical Outcome in Multilevel Cervical Ossification of Posterior Longitudinal Ligament: An Analysis of 184 Patients.

OBJECTIVE: To investigate the clinical and imaging predictors of surgical outcomes in patients with ossification of the posterior longitudinal ligament (OPLL). MATERIALS AND METHODS: From May 2010 to April 2012, a total of 200 consecutive patients with cervical OPLL were recruited for this study. Of them, 184 patients (130 men and 54 women) who could be tracked for more than 24 months after surgery were finally included for analysis. Their demographic, clinical and radiological data were collected preoperatively. The recovery ratio in terms of JOA score was used to assess the outcome of the patients preoperatively and at 2 years postoperatively. A JOA recovery rate less than 50% was considered a poor outcome. RESULTS: Compared with good outcome group, an older mean age at operation, a longer mean duration of symptoms, a lower mean pre-operativer JOA score, and a higher proportion of diabetics were observed in poor outcome group. Patients in poor outcome group were more likely to present kyphotic cervical alignment, smaller mean transverse area of the spinal cord, and intramedullary signal abnormalities. The result of multivariate stepwise logistic regression showed that a longer duration of symptoms and the presence of T1 hypo-intensity intramedullary changes on MRI were significant risk factors of lower JOA recovery ratios. CONCLUSION: A longer duration of symptom, T1 hypointensity on MRI and a history of minor trauma were highly predictive of a poor outcome for patients undergoing surgical treatment of OPLL. Age at operation, the history of diabetes, the preoperative JOA score, the transverse area of the spinal cord and T2 hyper-intensity on MRI were also associated with the prognosis of OPLL.

Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy.

The purpose of this study was to compare modified plate-only laminoplasty and laminectomy and fusion to confirm which of the 2 surgical modalities could achieve a better decompression outcome and whether a significant difference was found in postoperative complications. Clinical data were retrospectively reviewed for 141 patients with cervical stenotic myelopathy who underwent plate-only laminoplasty and laminectomy and fusion between November 2007 and June 2010. The extent of decompression was assessed by measuring the cross-sectional area of the dural sac and the distance of spinal cord drift at the 3 most narrowed levels on T2-weighted magnetic resonance imaging. Clinical outcomes and complications were also recorded and compared. Significant enlargement of the dural sac area and spinal cord drift was achieved and well maintained in both groups, but the extent of decompression was greater in patients who underwent laminectomy and fusion; however, a greater decompression did not seem to produce a better clinical outcome. No significant difference was observed in Japanese Orthopaedic Association and Nurick scores between the 2 groups. Patients who underwent plate-only laminoplasty showed a better improvement in Neck Dysfunction Index and visual analog scale scores. In addition, limited decompression, rigid reconstruction of the spinal canal, and preservation of cervical mobility combined with preservation of the posterior structure resulted in a lower rate of postoperative C5 palsy and axial pain in the modified laminoplasty group. For this reason, modified laminoplasty may be a more viable option for patients with cervical stenotic myelopathy.

Stand-alone anchored spacer versus anterior plate for multilevel anterior cervical diskectomy and fusion.

The purpose of this study was to compare the clinical outcomes and radiological changes of 3- and 4-level anterior cervical diskectomy and fusion with stand-alone anchored spacers and with traditional anterior plates. A total of 51 consecutive patients with cervical spondylotic myelopathy who underwent 3- or 4-level anterior cervical diskectomy and fusion were divided into 2 groups: group A (n=23) received anchored spacers and group B (n=28) received an anterior plate. Mean follow-up was 14.6 months. Solid fusion was achieved in all patients at final follow-up. No significant difference existed between multilevel anterior cervical diskectomy and fusion with stand-alone anchored implants and with an anterior cervical plate in achieving clinical symptomatic improvement, fusion rate, and lordotic curvature improvement. The dysphagia rate of group A at 2-month follow-up was significantly lower than that of group B. No statistically significant difference existed between the 2 groups at the other time points. Swallowing Quality of Life of group A at 48 hours and 2 months postoperatively were significantly higher than those of group B. The thickness of the prevetebral soft tissue at 48 hours and 2 months postoperatively were significantly lower in group A than in group B. Compared with using an anterior plate, anterior cervical diskectomy and fusion with a stand-alone anchored spacer achieved a similar clinical outcome with less irritation to the prevertebral soft tissue and a lower dysphagia rate in the first 2 months.