Department of Medical Imaging, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10055, Taiwan.
Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan.
Eur Radiol. 2023 Apr;33(4):2638-2646. doi: 10.1007/s00330-022-09276-3. Epub 2022 Nov 30.
Preoperative embolization (PE) for metastatic spinal tumors is a method of minimizing intraoperative blood loss during aggressive surgery. This study specified angiographic standards and investigated the influence of these and other factors on blood loss in patients with spinal metastases and various pathologies.
The cohort comprised 126 consecutive patients receiving PE from 2015 to 2021. Their clinical, surgical, and angiographic characteristics were reviewed. Standard angiographic grading was used for vascularity assessment. Degree of embolization was divided into complete (≥ 90%), near complete (67 to < 90%), and partial (< 67%). Logistic regression analysis was used to investigate factors predictive of massive blood loss (> 2500 mL). A proportional odds model was used to assess factors predictive of the degree of embolization.
Mean intraoperative blood loss was 1676 mL. Among the patients, 62 had hypervascular tumors and 64 had nonhypervascular tumors, according to the angiographic classification. Intraoperative blood loss differed significantly with embolization degree, both overall (p < 0.001) and in the hypervascular and nonhypervascular groups (p = 0.01 and 0.03). Angiographic hypervascularity, spinal metastasis invasiveness index, and embolization degree were significant predictors of massive blood loss in univariate analysis, but only embolization degree was significant in multivariate analysis. Only the presence of the radiculomedullary artery at the target level was significant in both the univariate and multivariate analyses for embolization degree.
In addition to pathological classification, angiographic vascularity assessment is valuable. Although complete embolization is a reasonable goal, it is challenging to achieve in cases of visible radiculomedullary artery.
• Angiography has a supplementary role in vascularity assessment for spinal metastatic surgery. • Better embolization degree is associated with less intraoperative blood loss in both angiographic hypervascular and nonhypervascular groups. • Presence of radiculomedullary artery in the target level causes worse embolization outcome.
转移性脊柱肿瘤的术前栓塞（PE）是一种在积极手术过程中最大程度减少术中失血的方法。本研究指定了血管造影标准，并研究了这些标准和其他因素对不同病理类型脊柱转移瘤患者的出血量的影响。
该队列纳入了 2015 年至 2021 年期间接受 PE 的 126 例连续患者。回顾了他们的临床、手术和血管造影特征。使用标准血管造影分级评估血管生成。栓塞程度分为完全（≥90%）、接近完全（67 至 <90%）和部分（<67%）。使用逻辑回归分析调查了预测大量失血（>2500 毫升）的因素。使用比例优势模型评估了预测栓塞程度的因素。
术中平均失血量为 1676 毫升。根据血管造影分类，患者中有 62 例为高血管肿瘤，64 例为非高血管肿瘤。总体而言，栓塞程度与术中出血量有显著差异（p<0.001），在高血管和非高血管组中也有显著差异（p=0.01 和 0.03）。血管造影高血管性、脊柱转移侵袭指数和栓塞程度在单因素分析中是大量失血的显著预测因素，但在多因素分析中只有栓塞程度是显著的。仅目标水平的脊神经根动脉的存在在单因素和多因素分析中对栓塞程度都是显著的。
除了病理分类外，血管造影血管评估也是有价值的。虽然完全栓塞是一个合理的目标，但在可见脊神经根动脉的情况下，很难实现。
血管造影在脊柱转移瘤手术的血管评估中具有补充作用。
在血管造影高血管性和非高血管性组中，更好的栓塞程度与术中出血量减少相关。
目标水平存在脊神经根动脉会导致栓塞效果更差。
