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Accuracy of Unenhanced MRI in the Detection of
New Brain Lesions in Multiple Sclerosis
Autor: Paul Eichinger, MD, Simon Schön, MD, Viola Pongratz, MD, Hanni Wiestler, MD, Haike Zhang, Matthias Bussas, MSc, Muna-Miriam Hoshi, MD, Jan Kirschke, MD, Achim Berthele, MD, Claus Zimmer, MD, Bernhard Hemmer, MD, Mark Mühlau, MD, Benedikt Wiestler, MD.
Objetivo Describir la técnica y resultados en cuanto a la mejoría del dolor y
complicaciones al realizar este procedimiento mediante guía por tomografía
computada.
Materiales y Métodos Estudio observacional descriptivo de una serie de 108
pacientes a quienes se les realizó vertebroplastia percutánea guiada por tomografía
computada realizadas en dos hospitales universitarios, entre mayo 2007 y mayo 2017.
Todos los procedimientos se realizaron de forma ambulatoria con anestesia local y se
valoró el dolor mediante la escala visual análoga.
Resultados Se realizaron 125 vertebroplastias, en el 87,9% de los pacientes (n ¼ 95)
se realizó el procedimiento en un cuerpo vertebral, en el 8,3% (n ¼ 9) y 3,7% (n ¼ 4) de
los pacientes se cementaron 2 y 3 vertebras respectivamente. El rango de dolor según
la escala visual análoga (EVA) previo al tratamiento varió entre 5 y 10, donde un 94%
(n ¼ 102) de los pacientes manifestaban una intensidad 10/10. En el postratamiento el
rango de dolor varió entre 0 a 7 donde el 98% de la población reportó un valor menor o
igual a 3. Se presentaron 3 complicaciones: tromboembolismo pulmonar por metilmetacrilato,
extravasación al plexo de Batson y extravasación al espacio interdiscal,
cada una en tres pacientes diferentes.
Conclusión La vertebroplastia percutánea guiada por TC ofrece una indiscutible
mejora inmediata del dolor en pacientes con fractura de uno o más cuerpos
vertebrales, con una baja tasa de complicaciones.
Palabras clave: vertebroplastia, tomografía
computada, multidetector, fractura vertebra.
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Background: Administration of a gadolinium-based contrast material is widely considered obligatory for follow-up imaging of
patients with multiple sclerosis (MS). However, advances in MRI have substantially improved the sensitivity for detecting new or
enlarged lesions in MS.
Purpose: To investigate whether the use of contrast material has an effect on the detection of new or enlarged MS lesions and, consequently, the assessment of interval progression.
Materials and Methods: In this retrospective study based on a local prospective observational cohort, 507 follow-up MR images
obtained in 359 patients with MS (mean age, 38.2 years 6 10.3; 246 women, 113 men) were evaluated. With use of subtraction
maps, nonenhanced images (double inversion recovery [DIR], fluid-attenuated inversion recovery [FLAIR]) and contrast material–enhanced (gadoterate meglumine, 0.1 mmol/kg) T1-weighted images were separately assessed for new or enlarged lesions in
independent readings by two readers blinded to each other’s findings and to clinical information. Primary outcome was the percentage of new or enlarged lesions detected only on contrast-enhanced T1-weighted images and the assessment of interval progression.
Interval progression was defined as at least one new or unequivocally enlarged lesion on follow-up MR images.
Results: Of 507 follow-up images, 264 showed interval progression, with a total of 1992 new or enlarged and 207 contrastenhancing lesions. Four of these lesions (on three MR images) were retrospectively detected on only the nonenhanced images, corresponding to 1.9% (four of 207) of the enhancing and 0.2% (four of 1992) of all new or enlarged lesions. Nine enhancing lesions
were not detected on FLAIR-based subtraction maps (nine of 1442, 0.6%). In none of the 507 images did the contrast-enhanced
sequences reveal interval progression that was missed in the readouts of the nonenhanced sequences, with use of either DIR- or
FLAIR-based subtraction maps. Interrater agreement was high for all three measures, with intraclass correlation coefficients of 0.91
with FLAIR, 0.94 with DIR, and 0.99 with contrast-enhanced T1-weighted imaging.
Conclusion: At 3.0 T, use of a gadolinium-based contrast agent at follow-up MRI did not change the diagnosis of interval disease
progression in patients with multiple sclerosis.
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