| Digital subtraction in contrast-enhanced MR imaging of the postoperative lumbar spine. | |
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MedLine Citation:
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PMID: 8141014 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The objective of this study was to evaluate the routine use of digital image subtraction as an adjunct to standard MR sequences in patients with failed lumbar spine surgery. MATERIALS AND METHODS: Unenhanced and contrast-enhanced T1-weighted MR images of 112 consecutive patients with failed back surgery were reviewed, and corresponding axial images at the level of previous surgery were digitally subtracted by using standard software. The technique was successful in 96 patients and was abandoned in 16 owing to patient motion. Two radiologists independently assessed the subtracted images for areas of enhancement not seen on T1-weighted images, and suggested a diagnosis based on a combination of the findings on standard and subtracted images. This diagnosis was compared with the original MR diagnosis, and surgical findings were sought in cases of conflict. RESULTS: Enhancement was best seen on the subtracted images in muscle fascial planes (100%), anterior epidural fibrosis (55%), spinal canal fat (31%), posterior epidural fibrosis (27%), types I and II marrow change (24%), and facet joints (17%). Subtraction improved the homogeneity of contrast enhancement, thereby improving the visualization of nerve roots lying in scar tissue (16%), and better defined the extent of epidural fibrosis, particularly when the fibrosis was contiguous with fat. The subtracted image increased diagnostic confidence in 25% of cases, but altered final diagnosis in only two patients. CONCLUSION: Although digital subtraction revealed areas of enhancement not seen on standard spin-echo MR images, it rarely altered final diagnosis and does not appear to be useful for routine imaging of patients with failed lumbar spine surgery. It might, however, be useful for increasing diagnostic confidence or as a problem-solving technique in selected patients. |
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Authors:
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J G Murray; J P Stack; J T Ennis; M Behan |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: AJR. American journal of roentgenology Volume: 162 ISSN: 0361-803X ISO Abbreviation: AJR Am J Roentgenol Publication Date: 1994 Apr |
Date Detail:
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Created Date: 1994-04-28 Completed Date: 1994-04-28 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 7708173 Medline TA: AJR Am J Roentgenol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 893-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Radiology, Mater Misericordiae Hospital, Dublin 7, Ireland. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Contrast Media Drug Combinations Epidural Space / pathology Female Fibrosis Gadolinium DTPA Humans Intervertebral Disk Displacement / diagnosis Lumbar Vertebrae / pathology*, surgery Magnetic Resonance Imaging / methods* Male Meglumine / diagnostic use Organometallic Compounds / diagnostic use Pentetic Acid / analogs & derivatives, diagnostic use Postoperative Complications / diagnosis* Subtraction Technique Treatment Failure |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media; 0/Drug Combinations; 0/Organometallic Compounds; 6284-40-8/Meglumine; 67-43-6/Pentetic Acid; 80529-93-7/Gadolinium DTPA |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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