Dynamic contrast-enhanced magnetic resonance perfusion compared with digital subtraction angiography for the evaluation of extradural spinal metastases: a pilot study.

STUDY DESIGN: This was a retrospective study comparing dynamic contrast-enhanced magnetic resonance (DCE-MR) perfusion with digital subtraction angiography (DSA) in determining the vascularity of spinal tumors. OBJECTIVE: To report on the efficacy of DCE-MR perfusion as a potential noninvasive surrogate for measuring vascularity and thus determine the need for preoperative embolization. SUMMARY OF BACKGROUND DATA: Although primary spinal tumors are rare, spine metastases are relatively common and symptomatic in approximately 14% of patients. Symptomatic patients require palliation with radiotherapy and/or surgery, with possible preoperative endovascular embolization of the tumor. METHODS: A retrospective review revealed 10 patients with 11 diseased vertebral bodies who had received spine DCE-MR perfusion studies and subsequently underwent spinal DSA. Processed MR data were used to calculate a blood flow ratio comparing blood flow with a diseased and an adjacent normal vertebral body. Spinal tumor vascularity was graded on the basis of angiographic tumor blush from 0 (decreased enhancement compared with a normal vertebral body) to 4 (marked tumor blush with early arteriovenous shunting). RESULTS: Eight vertebral bodies demonstrated increased vascularity on DSA with blood flow ratios of greater than 1.8, 2 vertebral bodies demonstrated normal enhancement on DSA with cerebral blood flow (CBF) ratio of 0.55 to 1.14, and 1 vertebral body level had decreased enhancement on DSA, with a CBF ratio of 0.43. There was a strong correlation between CBF ratio and DSA score, with Spearman ρ = 0.87 (P = 0.00012). CONCLUSION: These data show a statistically significant correlation between CBF ratio and DSA and suggest that DCE-MR perfusion can serve as a surrogate to DSA for determining tumor vascularity in patients with extramedullary spinal metastases.

Intramuscular nodular fasciitis of the rectus abdominis muscle in an 11-year-old girl.

Nodular fasciitis is a benign rapidly proliferating fibrous tumor that is common in adults but relatively uncommon in children. When present in children, nodular fasciitis is typically subcutaneous in location and involves the head and neck. We present a case of intramuscular nodular fasciitis involving the rectus abdominis muscle in an 11-year-old girl and discuss the importance of distinguishing this rare but benign lesion from a more aggressive sarcomatous process.

Balloon-assisted coil embolization of intracranial aneurysms is not associated with increased periprocedural complications.

BACKGROUND: The balloon-assisted coil embolization (BACE) technique represents an effective tool for the treatment of complex wide-necked intracranial aneurysms; however, its safety is a matter of debate. This study presents the authors' institutional experience regarding the safety of the BACE technique. METHODS: 428 consecutive patients with 491 intracranial aneurysms (274 acutely ruptured and 217 unruptured) treated with conventional coil embolization (CCE) or with BACE were retrospectively reviewed. All procedure-related adverse events were reported, regardless of clinical outcome. Thromboembolic events, intraprocedural aneurysm ruptures, device-related complications, morbidity and mortality were compared between the CCE and BACE groups. RESULTS: The total rate of procedural and periprocedural adverse events was 9.6% (47/491 embolizations). Thromboembolic events, intraprocedural aneurysmal rupture and device-related complications occurred in 2.4%, 3.9% and 3.3% of procedures, respectively. The risk of thromboembolic events and device-related problems was similar between the CCE and BACE groups. A trend towards a higher risk of intraprocedural aneurysm rupture was observed in the BACE group (not statistically significant). The total cumulative morbidity and mortality for both groups was 2.6% (11/428 patients) and there was no statistically significant difference in the morbidity, mortality and cumulative morbidity and mortality rates between the two groups. CONCLUSION: In this series of patients with acutely ruptured and unruptured aneurysms, the BACE technique allowed treatment of aneurysms with unfavorable anatomic characteristics without increasing the incidence of procedural complications.

Facial recognition software success rates for the identification of 3D surface reconstructed facial images: implications for patient privacy and security.

Image de-identification has focused on the removal of textual protected health information (PHI). Surface reconstructions of the face have the potential to reveal a subject's identity even when textual PHI is absent. This study assessed the ability of a computer application to match research subjects' 3D facial reconstructions with conventional photographs of their face. In a prospective study, 29 subjects underwent CT scans of the head and had frontal digital photographs of their face taken. Facial reconstructions of each CT dataset were generated on a 3D workstation. In phase 1, photographs of the 29 subjects undergoing CT scans were added to a digital directory and tested for recognition using facial recognition software. In phases 2-4, additional photographs were added in groups of 50 to increase the pool of possible matches and the test for recognition was repeated. As an internal control, photographs of all subjects were tested for recognition against an identical photograph. Of 3D reconstructions, 27.5% were matched correctly to corresponding photographs (95% upper CL, 40.1%). All study subject photographs were matched correctly to identical photographs (95% lower CL, 88.6%). Of 3D reconstructions, 96.6% were recognized simply as a face by the software (95% lower CL, 83.5%). Facial recognition software has the potential to recognize features on 3D CT surface reconstructions and match these with photographs, with implications for PHI.

Fluorescent 1,10-phenanthroline-containing oligonucleotides distinguish between perfect and mismatched base pairing.

[structure: see text] A fluorescent deoxyuridine analogue is sensitive to the polarity of its environment and exhibits a distinct emission profile in single- vs double-stranded oligonucleotides. Emission-monitored denaturation curves of internally modified dU(phen) duplexes are characteristic of the base opposite dU(phen) and distinguish between perfect and mismatched complementary oligonucleotides.