Skeletal radiology · 2018
Spondylodiscitis following endovascular abdominal aortic aneurysm repair: imaging perspectives from a single centre's experience.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Mandegaran Ramin, Tang Christopher S W, Pereira Erlick A C, Zavareh Ali
Аннотация
OBJECTIVE: Very few reports have previously described spondylodiscitis as a potential complication of endovascular aortic aneurysm repair (EVAR). We present to our knowledge the first case series of spondylodiscitis following EVAR based on our institution's experience over an 11-year period. Particular attention is paid to the key imaging features and challenges encountered when performing spinal imaging in this complex patient group.
MATERIALS AND METHODS: Of 1,847 patients who underwent EVAR at our institution between January 2006 and January 2017, a total of 9 patients were identified with imaging features of spondylodiscitis (0.5%). All cross-sectional studies before and after EVAR were assessed by a Consultant Musculoskeletal Radiologist and a Musculoskeletal Radiology Fellow to evaluate for features of spondylodiscitis.
RESULTS: All 9 patients had single-level spondylodiscitis involving lumbosacral levels adjacent to the aortic/iliac stent graft. Eight out of nine patients had an extensive anterior paravertebral phlegmon/abscess that was contiguous with the infected stent graft and native aneurysm sac ± anterior vertebral body erosion. Epidural disease was present in only 3 out of 9 patients and was a minor feature. MRI was non-diagnostic in 3 out of 9 patients owing to susceptibility artefact. 18F-FDG PET/CT accurately depicted the spinal level involved and adjacent paravertebral disease in patients with non-diagnostic MRI and was adopted as the follow-up modality in 3 out of 5 surviving patients.
CONCLUSION: Spondylodiscitis is a rare complication post-EVAR. Imaging features of disproportionate anterior paravertebral disease and anterior vertebral body bony involvement suggest direct spread of infection posteriorly to the adjacent vertebral column. Use of MRI versus 18F-FDG PET/CT as the optimal imaging modality should be directed by the type of stent graft deployed.
MATERIALS AND METHODS: Of 1,847 patients who underwent EVAR at our institution between January 2006 and January 2017, a total of 9 patients were identified with imaging features of spondylodiscitis (0.5%). All cross-sectional studies before and after EVAR were assessed by a Consultant Musculoskeletal Radiologist and a Musculoskeletal Radiology Fellow to evaluate for features of spondylodiscitis.
RESULTS: All 9 patients had single-level spondylodiscitis involving lumbosacral levels adjacent to the aortic/iliac stent graft. Eight out of nine patients had an extensive anterior paravertebral phlegmon/abscess that was contiguous with the infected stent graft and native aneurysm sac ± anterior vertebral body erosion. Epidural disease was present in only 3 out of 9 patients and was a minor feature. MRI was non-diagnostic in 3 out of 9 patients owing to susceptibility artefact. 18F-FDG PET/CT accurately depicted the spinal level involved and adjacent paravertebral disease in patients with non-diagnostic MRI and was adopted as the follow-up modality in 3 out of 5 surviving patients.
CONCLUSION: Spondylodiscitis is a rare complication post-EVAR. Imaging features of disproportionate anterior paravertebral disease and anterior vertebral body bony involvement suggest direct spread of infection posteriorly to the adjacent vertebral column. Use of MRI versus 18F-FDG PET/CT as the optimal imaging modality should be directed by the type of stent graft deployed.