Prognostic Factors for Surgically Managed Spontaneous Spinal Epidural Hematoma: A Single-Center Case Series of 18 Patients.

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare pathology, which carries a significant morbidity. OBJECTIVE: To review our institutional experience of surgically managed patients with SSEH, seeking to better understand clinical prognostic factors related to postoperative outcomes and thereby improve counseling of patients before treatment. METHODS: All patients who underwent surgical management of SSEH between September 2011 and 2021. Baseline and postoperative clinical and radiological characteristics are presented, including the American Spinal Injury Association grade (ASIA). Statistical analyses were performed using Stata 13.1. RESULTS: Eighteen patients were identified in total (11 male patients and 7 female patients) with a median age of 59.5 (range 3-83) years. The most common spinal region affected was cervicothoracic (33.3%). Limb weakness (94.4%) and urinary dysfunction (83.3%) represented the most common presenting symptoms. Preoperatively, the presence of spinal cord edema on imaging was associated with worse preoperative Medical Research Council (MRC) grade ( P = .033), female sex was associated with preserved saddle sensation ( P = .04), and patients receiving antiplatelet medication were associated with a higher risk of preoperative axial back pain ( P = .005). Higher postoperative MRC grade was associated with higher preoperative ASIA ( P = .012) and MRC grade ( P = .005), and preservation of saddle sensation ( P = .018). Postoperative improvements in axial back pain were associated with higher preoperative ASIA grade ( P = .035) and anticoagulation treatment ( P = .029). CONCLUSION: Neurosurgical intervention for SSEH yields positive outcomes and benefits patients. Patients with higher preoperative ASIA, MRC grade, and those presenting with preserved saddle sensation may experience further improved clinical outcomes after intervention.

High impact of FDG-PET/CT in diagnostic strategies for ovarian cancer.

BACKGROUND: Ovarian cancer has the highest mortality of all gynecologic malignancies. FDG-PET/CT was proven to be accurate for identification of primary ovarian tumors, regional lymph nodes, and distant metastases. PURPOSE: To evaluate ovarian masses at FDG-PET/CT in correlation with histopathologic findings. MATERIAL AND METHODS: Ninety-eight patients underwent whole body FDG-PET/CT examination. Eighty-six patients with primary ovarian cancer and 12 patients with metastatic disease to the ovaries were included. RESULTS: PET/CT imaging was true-positive in 87/94 patients with malignant tumors. In 4/4 patients with benign tumors, PET/CT results were true-negative, with sensitivity of 92.6%, specificity 100%, total test accuracy 92.9%. Fifty-seven patients were diagnosed as stage IV ovarian cancer with distant metastasis. CONCLUSION: The anatomical/functional examination by FDG-PET/CT was proven to be valuable in increasing the diagnostic accuracy that can help improve patient management.

Ultrasound detection of heel enthesitis: a comparison with magnetic resonance imaging.

OBJECTIVE: Seronegative arthropathies are associated with inflammatory enthesopathy. The involvement of Achilles tendon and plantar aponeurosis is common, with strong tendency toward fibrosis and calcification. This study tests the diagnostic efficacy of ultrasound (US) in depicting enthesitis, and compares sonographic images with magnetic resonance images (MRI). METHODS: We studied 32 patients with a diagnosis of seronegative arthropathies, 22 men, 10 women, mean age 29 years. They had heel enthesopathy without typical conventional radiographic evidence. T1 and T2 weighted and short-tau inversion recovery (STIR) MRI sequences were obtained in axial and sagittal planes. An HDI 3000 ATL US device equipped with 12 MHz linear transducer was used to examine the enthesis. Three independent observers assessed the reliability of sonographic images by using video recording of the US examinations. RESULTS: US images of enthesitis showed loss of normal fibrillar echotexture of tendon (100%), lacking the homogeneous pattern, with blurring of tendon margins (56.2%) and irregular fusiform thickening (84.3%). The affected tendons showed intratendinous lesions with ill defined focal tendon defects filled with a mixture of fluid, fat, and/or granulation tissue, with loss of their tightly packed echogenic dots. MRI showed tendon enlargement (62.5%) with loss of the normal flattened hypointense appearance, focal thickening and rounded configuration at the insertion site (31.2%), intermediate T1 and high T2 signals, and diminished signals within the pre-Achilles fat pad due to inflammatory edema. Among all patients, 40.6% developed osteitis. CONCLUSION: MRI was not sensitive compared to US in detecting early changes of enthesopathy. Fatty degeneration appeared late in MRI, while it was detected earlier using US. MRI was not able to detect any calcification process at the insertion site, while US images clearly showed the very early signs of the calcification process. We recommend use of US for early diagnosis and in treatment and followup of patients with tendon enthesopathy, to accurately identify and diagnose different pathologic and biomechanical changes.