Interventional Spine

Nicholas, J, Satovick, MD, MPH
Lubdha, M, Shah, MD, Non ASSR Member

Poster

Purpose

To review the spectrum of MRI findings status post percutaneous vertebroplasty / kyphoplasty. Limited studies have described the short and long term imaging findings of polymethylmethacrylate (PMM) bone cement on MRI and, more importantly, the imaging features of tissues exposed to this widely used medical substance. PMM has various physical and chemical properties which can not only affect handling but also affect the tissues and their appearance on follow-up imaging.

Methods & Materials

Under IRB protocol, 95 cases of vertebroplasty / kyphoplasty were retrospectively reviewed, 38 with post procedural MRI were included in final analysis. Sagital T1and STIR sequences were reviewed on all patients. T1 post contrast imaging, when available, was evaluated. The time range of imaging after procedure was 1 day to 3 years with an average of 6 months.

Results

Diffuse STIR hyperintensity and T1 hypointensity reflecting bone edema decreases or resolves between 4-8 months post procedure. A persistent rim of STIR signal surrounding the material and along the trocar tracts is commonly seen as long as 8 months post procedure. Similarly, post contrast enhancement along the trocar tracts and the PMM abated but persisted in 8 cases (1 osteoporotic and 7 pathologic). In 1 case there was extension of PMM into the paravertebral and/or epidural space, which resulted in an enhancing soft tissue component.

Conclusion

Edema and enhancement post vertebroplasty/kyphoplasty surrounding the polymethylmethacrylate and along the trocar tracts may persist for as long as 8 months post procedure.

References/Financial Disclosures

1. David M. Dansie, Patrick H. Luetmer, John I. Lane, Kent R. Thielen, John T. Wald, and David F. Kallmes. MRI Findings after Successful Vertebroplasty AJNR Am. J. Neuroradiol., Jun 2005; 26: 1595 – 1600

2. Haas SS, Brauer GM, Dickson G. A characterization of polymethylmethacrylate bone cement. J Bone Joint Surg Am. 1975;57:380-91.

No financial disclosures