Die Kernspintomographie im Vergleich zur Skelettszintigraphie nach traumatischen Wirbelkörperfrakturen

Allgayer, B; Flierdt, E. van de; Gumppenberg, S. von; Heuck, A.; Matzner, Michael; Lukas, Pierre; Luttke, G.

doi:10.1055/s-2008-1046947

Cited by 6 publications

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“…Other factors determining the prognosis include: [2] the general conditon of the patient, [3] the number of extraspinal bone metastases, [4] the number of metastases in the vertebral bodies, [5] metastases to the major internal organs, and [ 6] the severity of spinal cord palsy.…”

Section: Prognosis Of Metastatic Bone Disease and Metastatic Epiduralmentioning

confidence: 99%

Diagnostic Imaging of Vertebral Metastases

Algra

1995

Rivista di Neuroradiologia

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Metastatic diseaseCancer is the second leading cause of death and the incidence of cancer is still rising. Currently available therapy can now cure approximately 50% of cancer patients. The majority of patients die of the effects of metastatic disease. Following lung and liver, the skeletal system is the third most common site of metastasis. Up to 80% of all cancer patients will have skeletal disease at autopsy. Metastatic neoplasms vastly outnumber primary tumors of the skeleton. Excluding multiple myeloma, primary bone tumors account for only 0.3% of all malignancies.The spine is the most common site of bone metastases, irrespective of the primary tumor that is involved.Vertebral metastases have a major clinical significance. It is not only an indicator of poor prognosis, but also a major cause of suffering in patients with cancer by producing severe pain, vertebral instability, and disruption of neural function with loss of urinary or sphincter control or complete paralysis.These facts, coupled with increasing financial pressures to optimize the use of diagnostic resources, have led to scrutinize the use of radiologic procedures and radiologists and oncologists to look systematically at the benefits of a variety of staging procedures. Distribution of bone metastasesThe distribution of metastases throughout the skeleton has been the subject of study of many authors since a long period of time. The distribution of bone metastases as assessed by different authors varies widely. The reasons for this variability are, amongst others, patient selection and the techniques used, e.g. autopsy findings versus radiographic survey versus bone scintigraphy. There is general agreement, however, that metastatic disease predominantly occurs in the axial or central skeleton. This is most probably related to the fact that the axial skeleton contains the majority of the red marrow.The distribution of metastases over the vertebral column is, in order of frequency, lumbar, lower thoracic, upper thoracic, sacral and cervical spine. The lower thoracic and lumbar spine are also the most common sites of myelomatous bone lesions. Clinical symptoms and signs of spinal metastasesPain is usually the initial symptom in patients with vertebral metastases. The pain can be radicular, local or both. The mechanism of pain involves stretching or compression of pain conducting nerve fibers, which are situated in the anterior and posterior spinal ligaments, in the annulus of the intervertebral disk, and in the dura and apophyseal joints.Motor deficit is the second most frequent initial symptom. This can be due to compression of the cord, the cauda or spinal roots. Motor weakness and sensory loss are indicative for medullary or radicular compression. The sensory level is an unreliable indicator of the level of compression of the spinal cord, and usually is recorded as several segments below a myelographically demonstrable subarachnoid block.. R_e~ex changes can be present, as hyperreflexia, d1mm1shed or absent reflexes. Sphincter dysfunc-165

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Section: Prognosis Of Metastatic Bone Disease and Metastatic Epiduralmentioning

confidence: 99%

Diagnostic Imaging of Vertebral Metastases

Algra

1995

Rivista di Neuroradiologia

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Spine

Buitrago-Téllez¹,

Ferstl²,

Langer³

2000

Radiology of Trauma

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A review of the recent advances in magnetic resonance imaging in the assessment of osteoporosis

Majumdar

Genant

1995

Osteoporosis Int

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Osteoporosis is a common metabolic disorder with considerable associated morbidity and mortality. The loss of bone mineral integrity and the resultant occurrence of atraumatic fractures are typically symptomatic of the disease. Currently skeletal status is commonly assessed using non-invasive conventional radiography and scintigraphy as well as densitometric techniques such as quantitative computed tomography and dual-energy X-ray absorptiometry. But, apart from gross bone mineral density, the fine structure of trabecular bone also plays an important role in defining the biomechanical competence of the skeleton. Recently attention has been focused on deriving measures that provide information about not only trabecular bone density but also microstructure. Magnetic resonance imaging (MRI) is one such new technique which potentially may provide information pertaining to bone density and structure as well as to occult fracture detection. Cortical bone produces a signal void in MR images, due to the fact that it contains very few mobile protons that give rise to a signal in MRI; also the MR relaxation time T2 of these protons is very short which produces a very fast decay of the MR signal during image acquisition. However, the trabecular bone network affects the MR properties of bone marrow. The difference in the magnetic properties of trabecular bone and bone marrow generates local imperfections in the magnetic field. The MR signal from bone marrow is modified due to these imperfections and the MR relaxation time T2 of marrow is shortened. The extent of relaxation time shortening and hence loss of signal intensity is proportional to the density of trabecular bone and marrow interfaces and their spatial architecture. Recent investigation in this area include studies aimed at quantifying marrow relaxation times and establishing their relationship to trabecular bone density and structure. In addition, with advances in imaging software and hardware, MR images at in-plane resolutions of 78-200 microns may be obtained. The trabecular bone structure is clearly revealed in such images and studies aimed at the development of high-resolution MRI techniques combined with quantitative image analysis techniques are currently under way. These potentially useful techniques for assessing osteoporosis and predicting fracture risk are reviewed in this paper.

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Die Kernspintomographie im Vergleich zur Skelettszintigraphie nach traumatischen Wirbelkörperfrakturen

Cited by 6 publications

References 0 publications

Diagnostic Imaging of Vertebral Metastases

Diagnostic Imaging of Vertebral Metastases

Spine

A review of the recent advances in magnetic resonance imaging in the assessment of osteoporosis

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