Department of Clinical Radiology, Klinikum der Ludwig-Maximilians-Universität München-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany.
Skeletal Radiol. 2012 Nov;41(11):1391-400. doi: 10.1007/s00256-012-1365-x.
To retrospectively evaluate the incidence and clinical impact of local polymethylmethacrylate (PMMA) leaks and pulmonary cement embolisms occurring under CT fluoroscopy-guided vertebroplasty of symptomatic malignant vertebral osteolyses.
From December 2001 to June 2009, 202 cancer patients (116 women, 86 men; age 63.2±8.6 years) with painful malignant vertebral osteolyses underwent vertebroplasty, with or without vertebral compression fracture. A total of 331 vertebrae were treated in 231 sessions under CT fluoroscopy guidance (120 kV; 10–25 mA; single slice, 4-, 16-, and 128-row CT). In the pre-vertebroplasty CT, the following items were assessed: osteolytic destruction (0, ≤25, ≤50, ≤75, or ≤100%) of vertebral cross-sectional area, posterior wall, and circumference; presence of perivertebral and degree of epidural (no, mild, moderate) soft tissue involvement. Local PMMA leaks were analyzed using the post-vertebroplasty CT. Pulmonary cement embolisms were evaluated in all patients having undergone radiography (CR; n053) or CT (n088) of the chest after vertebroplasty due to their underlying disease. Patient charts were reviewed regarding adverse events.
Of 331 treated vertebrae, 32, 20.2, and 15.7% showed more than 50% osteolytic involvement of the vertebral cross-sectional area, posterior wall, and circumference, respectively. Mild or moderate epidural involvement was seen in 13.0 and 8.4%. Local PMMA leakage rate was 58.6% (194 of 331 vertebrae). Pulmonary cement embolisms (segmental, n010; central, n01) were seen after 7.8% of the procedures with follow-up imaging of the chest. No major complications occurred within a 30-day period after vertebroplasty.
Vertebroplasty of spinal malignancy can be safely performed under CT fluoroscopy guidance even in patients with substantial osteolytic involvement. In our patient collective, PMMA leaks and pulmonary cement embolisms visualized in post-procedural radiography and CT images had no clinical impact.
回顾性评估 CT 透视引导下治疗有症状恶性溶骨性椎体病变椎体成形术时局部聚甲基丙烯酸甲酯（PMMA）渗漏和肺水泥栓塞的发生率和临床影响。
2001 年 12 月至 2009 年 6 月，202 例女性 116 例，男性 86 例；年龄 63.2±8.6 岁）患有疼痛性恶性溶骨性椎体病变的癌症患者，接受了椎体成形术治疗，部分患者同时接受了椎体压缩性骨折治疗。在 CT 透视引导下（120 kV；10-25 mA；单切片、4-、16-和 128 排 CT）共治疗 231 次，331 个椎体。在椎体成形术前 CT 中，评估以下项目：椎体横截面积、后墙和周长的溶骨性破坏（0、≤25、≤50、≤75、≤100%）；椎旁和硬膜外（无、轻度、中度）软组织受累程度。使用椎体成形术后 CT 分析局部 PMMA 渗漏。由于基础疾病，所有接受过椎体成形术后胸部 X 线摄影（CR；n053）或 CT（n088）检查的患者都评估了肺水泥栓塞。查阅病历了解不良事件。
331 个治疗椎体中，32%、20.2%和 15.7%的椎体横截面积、后墙和周长的溶骨性受累超过 50%，分别。13.0%和 8.4%的患者硬膜外受累为轻度或中度。局部 PMMA 渗漏率为 58.6%（331 个椎体中有 194 个）。7.8%的患者在接受椎体成形术后进行胸部随访影像学检查时发现肺水泥栓塞（节段性，n010；中央性，n01）。椎体成形术后 30 天内无重大并发症发生。
即使在严重溶骨性骨破坏的患者中，在 CT 透视引导下进行脊柱恶性肿瘤椎体成形术也可以安全进行。在我们的患者群体中，术后影像学检查显示的 PMMA 渗漏和肺水泥栓塞无临床影响。
