Vascular malformations of the orbit: classification and the role of imaging in diagnosis and treatment strategies*.

PURPOSE: To describe the authors' experience with orbital vascular malformations using the International Society for the Study of Vascular Anomalies (ISSVA) classification and the preferred radiologic techniques. METHODS: Review of clinical and radiologic experience from 1976 to 2012. This article presents the findings from several studies conducted on vascular malformations of the orbit, all of which received institutional review board approval when needed. RESULTS: The orbital vascular malformations can be evaluated, classified, and managed according to the ISSVA classification to provide a common language of communication between specialties, which takes into account flow dynamics. CONCLUSIONS: The ISSVA can be applied for vascular malformations of the orbit.

Malignant degeneration of a lumbar osteochondroma into a chondrosarcoma which mimicked a large retropertioneal mass.

We report a case of a lumbar spinal osteochondroma that transformed into a large chondrosarcoma in a 39-year-old male who presented with an abdominal mass and back pain. This mass was also associated with a fracture of the stalk, which on cross-sectional imaging mimicked a mass of retroperitoneal origin. The diagnosis of chondrosarcoma transforming from a lumbar osteochondroma became apparent when comparison was made with previous studies.

Imaging in adult scoliosis: preoperative assessment and postoperative complications.

Adult scoliosis rates range from 2 to 32%. Surgery for scoliosis is common. Accurate and surgically relevant information should be provided to the referring surgeon from pre- and postoperative imaging. There are various methods to correct scoliosis surgically with the end points correction of the curve and relief of symptoms. This is achieved through the placement of spinal instrumentation with a goal of osseous fusion across the instrumented levels. There are many potential postoperative complications. The initial and postoperative imaging, types of surgery, and hardware are reviewed along with the common early and late complications with relevant illustrations.

Plain radiograph assessment of spinal hardware.

The frequency and variety of spinal instrumentation has increased tremendously over the past 100 years, and imaging plays an important role in evaluating the postoperative spine. Although assessment of spinal hardware often involves a multimodality approach, plain radiographs are the most commonly used modality, given accessibility, cost, relatively low radiation dose compared with computed tomography, and provision of positional information. An approach to assessment of plain radiographs of the postoperative spine is discussed, and examples of common postoperative complications are provided, including infection, hardware failure, incomplete fusion, and junctional failure.

Relationship of neural axis level of injury to motor recovery and health-related quality of life in patients with a thoracolumbar spinal injury.

BACKGROUND: Outcomes following traumatic conus medullaris and cauda equina injuries are typically predicted on the basis of the vertebral level of injury. This may be misleading as it is based on the assumption that the conus medullaris terminates at L1 despite its variable location. Our primary objective was to determine whether the neural axis level of injury (the spinal cord, conus medullaris, or cauda equina) as determined with magnetic resonance imaging is better than the vertebral level of injury for prediction of motor improvement in patients with a neurological deficit secondary to a thoracolumbar spinal injury. METHODS: Patients diagnosed with a motor deficit secondary to a thoracolumbar spinal injury, and who met the inclusion criteria, were contacted. Each patient had a magnetic resonance imaging scan that was reviewed by a spine surgeon and a neuroradiologist to determine the termination of the conus medullaris and the neural axis level of injury. Patient demographic data were collected prospectively at the time of admission. Admission and follow-up neurological assessments were performed by formally trained dedicated spine physiotherapists. RESULTS: Fifty-one patients were evaluated at a median of 6.2 years (range, 2.7 to 12.3 years) postinjury. The final motor scores differed significantly according to whether the patient had a spinal cord injury (mean, 62.8 points; 95% confidence interval, 55.4 to 70.2), conus medullaris injury (mean, 78.6 points; 95% confidence interval, 70.3 to 86.9), or cauda equina injury (mean, 88.8 points; 95% confidence interval, 78.9 to 98.7) (p = 0.0007). A univariate analysis showed the improvement in the motor scores after the cauda equina injuries (mean, 17.1 points; 95% confidence interval, 8.3 to 25.9) to be significantly greater than that after the spinal cord injuries (mean, 7.7 points; 95% confidence interval, 3.1 to 12.3) (p = 0.03). A multivariate analysis showed that an absence of initial sacral sensation had a negative effect on motor recovery by a factor of 13.2 points (95% confidence interval, 4.2 to 22.1). When compared with classifying our patients on the basis of the neural axis level of injury, reclassifying them on the basis of the vertebral level of injury resulted in a misclassification rate of 33%. CONCLUSIONS: The motor recovery of patients with a thoracolumbar spinal injury and a neurological deficit is affected by both the neural axis level of injury as well as the initial motor score. The results of this study can help the clinician to determine a prognosis for patients who sustain these common injuries provided that he or she evaluates the precise level of neural axis injury utilizing magnetic resonance imaging.

Neuroimaging features of heroin inhalation toxicity: "chasing the dragon".

OBJECTIVE: Our objective was to illustrate the dramatic neuroimaging findings of toxic leukoencephalopathy caused by heroin vapor inhalation. CONCLUSION: Symmetric abnormality involving the cerebellar white matter and posterior limb of the internal capsule is characteristic of heroin vapor inhalation toxicity, although involvement may be more extensive, depending on the severity of the condition. MR imaging and CT appear to be essential for making this diagnosis because clinical history is often unreliable and findings at physical examination are nonspecific.