Image-Guided Right T10 Costotransverse Joint Resection for Costotransversitis: Operative Technique and Nuances: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Gaetano De Biase ◽  
Kelly Gassie ◽  
Kingsley Abode-Iyamah ◽  
Eric Nottmeier
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Preoperative Evaluation ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
X Rays ◽  
Ct Guided ◽  
Image Guided ◽  
Spect Scan ◽  
The Right

Abstract We describe the operative approach and management for costotransverse joint inflammation in a 49-yr-old man with worsening midthoracic pain radiating to the right paraspinal area. He underwent physical therapy with no relief of his symptoms. Thoracic spine magnetic resonance imaging (MRI) revealed severe arthritic changes involving the right T10 costotransverse joint. Scoliosis X-rays showed a dextroconvex curvature in the midthoracic spine, without any significant imbalance. Single-photon emission computed tomography (SPECT) scan revealed focal increased uptake of the right T10 costotransverse joint. T10 costotransverse joint lidocaine injection did not provide any relief. We performed a computed tomography (CT)-guided biopsy, which was negative for malignancy and also cultures were negative. MRI revealed a significant enhancement in this area and the patient's C-reactive Protein was elevated. Decision was made to perform open biopsy and costotransverse joint resection. We present a case of minimally invasive, image-guided costotransverse joint resection, which has not been described in the literature. The right T10 costotransverse joint was dissected out with the image-guided dilator, and tubular retractors were inserted. Under the microscope, using the image-guided drill, the right T10 costotransverse joint was drilled out. The lateral aspect of the right T10 process was drilled out as well as the medial-dorsal aspect of the right T10 rib. The patient recovered from surgery well with abatement of his preoperative thoracic pain, which remained abated at 6-mo follow-up. This case highlights the complex technical nuances of this procedure, and the importance of a thorough preoperative evaluation with a bone SPECT scan to help localize the pain generator. Patient consented for the procedures and for the publication of the video.

scholarly journals Shifting of global aphasia to Wernicke’s aphasia in a patient with intact motor function: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ya-Chi Chuang ◽  
Chuan-Ching Liu ◽  
I-Ching Yu ◽  
Yu-Lin Tsai ◽  
Shin-Tsu Chang
Keyword(s):  
Computed Tomography ◽  
Right Hemisphere ◽  
Single Photon ◽  
Ct Perfusion ◽  
Single Case ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Speech Fluency ◽  
Language Functions ◽  
The Right

Abstract Background Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the dissociation of motor and language functions. Here, we present a case of GAWH with the patient later regaining speech fluency. Case presentation A 73-year-old man was admitted to our emergency department immediately after an episode of syncope. On arrival, we noted his global aphasia but without any focal neurologic signs. Computed tomography (CT) perfusion scans showed a large hypodense region over his left perisylvian area. Under the impression of acute ischaemic stroke, he received recombinant tissue plasminogen activator (rtPA) injection and was treated as an inpatient. The patient was later discharged with GAWH status and received regular speech rehabilitation. After 14 months of rehabilitation, the patient gradually recovered his language expression ability. The degree of aphasia was evaluated with the Concise Chinese Aphasia Test (CCAT), and we obtained brain single photon emission computed tomography (SPECT) scans to assess cerebral blood flow. Conclusion A patient with severe impairments of Broca’s and Wernicke’s areas was able to talk fluently despite being unintelligible. SPECT revealed relative high level of radioactivity uptake in the right frontal lobe, suggesting the deficits in speech fluency could have been compensated by the right hemisphere. Although this is a single case demonstration, the results may strengthen the role of the right hemisphere in GAWH patients and suggests additional study that examines the possible benefits of stimulating activity at right homologous regions for recovering language function after global aphasia.

scholarly journals Image-Guided Biopsy for Relapsed Neuroblastoma: Focus on Safety, Adequacy for Genetic Sequencing, and Correlation of Tumor Cell Percent With Quantitative Lesion MIBG Uptake

2021 ◽  
pp. 275-285
Author(s):  
Andrew Samoyedny ◽  
Abhay Srinivasan ◽  
Lisa States ◽  
Yael P. Mosse ◽  
Emma Alai ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Soft Tissue ◽  
Tumor Cell ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Mibg Uptake ◽  
Genetic Sequencing ◽  
Image Guided ◽  
Guided Biopsy

PURPOSE Many novel therapies for relapsed and refractory neuroblastoma require tumor tissue for genomic sequencing. We analyze our experience with image-guided biopsy in these patients, focusing on safety, yield, adequacy for next-generation sequencing (NGS), and correlation of tumor cell percent (TC%) with quantitative uptake on 123I-meta-iodobenzylguanidine (MIBG) single-photon emission computed tomography with computed tomography (SPECT/CT). MATERIALS AND METHODS An 11-year retrospective review of image-guided biopsy on 66 patients (30 female), with a median age of 8.7 years (range, 0.9-49 years), who underwent 95 biopsies (55 bone and 40 soft tissue) of relapsed or refractory neuroblastoma lesions was performed. RESULTS There were seven minor complications (7%) and one major complication (1%). Neuroblastoma was detected in 88% of MIBG- or fluorodeoxyglucose-avid foci. The overall NGS adequacy was 69% (64% in bone and 74% in soft tissue, P = .37). NGS adequacy within neuroblastoma-positive biopsies was 88% (82% bone and 96% soft tissue, P = .11). NGS-adequate biopsies had a greater mean TC% than inadequates (51% v 18%, P = .03). NGS-adequate biopsies had a higher mean number of needle passes (7.5 v 3.4, P = .0002). The mean tissue volume from NGS-adequate soft-tissue lesions was 0.16 cm3 ± 0.12. Lesion:liver and lesion:psoas MIBG uptake ratios correlated with TC% (r = 0.74, r = 0.72, and n = 14). Mean TC% in NGS-adequate samples was 51%, corresponding to a lesion:liver ratio of 2.9 and a lesion:psoas ratio of 9.0. Thirty percent of biopsies showed an actionable ALK mutation or other therapeutically relevant variant. CONCLUSION Image-guided biopsy for relapsed or refractory neuroblastoma was safe and likely to provide NGS data to guide therapy decisions. A lesion:liver MIBG uptake ratio of ≥ 3 or a lesion:psoas ratio of > 9 was associated with a TC% sufficient to deliver NGS results.

scholarly journals Evaluation of the Diagnostic Value of SPECT/CT in Defining Foot and Ankle Pathologies

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0006
Author(s):  
Ippokratis Pountos ◽  
Christel Charpail ◽  
Nazzar Tellisi
Keyword(s):  
Computed Tomography ◽  
Single Photon ◽  
Photon Emission ◽  
Diagnostic Value ◽  
Emission Computed Tomography ◽  
Imaging Method ◽  
Foot And Ankle ◽  
Diagnostic Specificity ◽  
Ct Guided ◽  
Complex Anatomy

Category: Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: The precise localisation of degenerative or inflammatory pathologies in foot and ankle can be difficult due to the complex anatomy of the joints. MRI plays a vital diagnostic role in these scenarios aiding the diagnosis and preoperative planning. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) is a relatively new imaging technology that combines the sensitivity of nuclear medicine examinations with the anatomical detail of CT. The aim of this study is to analyse the diagnostic effectiveness of SPECT/CT in evaluating foot and ankle pathologies. Methods: The authors retrospectively reviewed the medical records of all patients with a foot and/or ankle -related complaint that received SPECT/CT. Exclusion criteria included patients with inadequate follow-up and those that were not initially assessed by a senior foot and ankle surgeon. Collected data included demographic information, results from imaging, clinical progress and outcomes. Results: 272 included in the study comprised of 156 females and 116 males with a mean age of 52,8 years (range 17-92 years). The acquisition of a SPECT/CT changed the initial diagnosis (from either clinical or radiographs or MRI) in 55% of the cases. SPECT/CT finding correlated with MRI only in 34% of the cases. From the remaining cases SPECT/CT partially correlated with MRI in 26% of cases no correlation was noted in 40%. In regards to patients that undergone a USS or CT guided injection following the finding of a SPECT/CT, 86% reported a transient or long-term improvement in the pain. Overall, the SPECT/CT added confidence to the clinical diagnosis in 89% of the cases while reduced the need of further investigations in 93%. Conclusion: SPECT/CT is a valuable tool in depicting foot and ankle pathologies. It was able to provide additional diagnostic value by demonstrating co-existing pathologies as a potential cause of pain. SPECT/CT and MRI exhibit different diagnostic specificity and the limitations of each scan should be taken into consideration. This study strongly supports the use of SPECT/CT as a complementary imaging method to MRI for enhancing diagnostic specificity and outcomes.

Usefulness of 123I-iomazenil single-photon emission computed tomography in discriminating between mesial and lateral temporal lobe epilepsy in patients in whom magnetic resonance imaging demonstrates normal findings

2007 ◽  
Vol 107 (2) ◽  
pp. 352-363 ◽  
Author(s):  
Shuichi Umeoka ◽  
Kazumi Matsuda ◽  
Koichi Baba ◽  
Naotaka Usui ◽  
Takayasu Tottori ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Temporal Lobe ◽  
Single Photon ◽  
Preoperative Evaluation ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Epileptogenic Zone ◽  
Single Photon Emission ◽  
Single Photon Emission Computed ◽  
Photon Emission Computed Tomography

Object To provide greater accuracy in determining the epileptogenic zone during preoperative evaluation, the authors retrospectively examined 123I-iomazenil single-photon emission computed tomography (IMZ SPECT) studies obtained in patients with temporal lobe epilepsy (TLE) in whom there was no evidence of an abnormality on magnetic resonance (MR) images. Methods Twelve patients, seven with mesial TLE (MTLE) and five with lateral TLE (LTLE), satisfied the criteria for inclusion in the study. The IMZ SPECT findings in these patients were reviewed retrospectively, and a comparison was made between findings in patients with MTLE and those in patients with LTLE. Results The IMZ SPECT studies demonstrated decreased IMZ uptake in the ipsilateral mesial temporal region and the anterobasal temporal lobe in all patients who had MTLE on only one side. On the other hand, IMZ SPECT examinations revealed low IMZ uptake in the ipsilateral lateral temporal lobe in four of five patients with LTLE in whom abnormal findings were restricted to the lateral neocortex. In the remaining patient with LTLE, abnormally low IMZ uptake was found in both mesial and lateral temporal lobes, although pure LTLE was diagnosed by an invasive electroencephalographic evaluation; this patient's habitual seizures continued even after temporal lobectomy, although his mesial structures were spared. Conclusions The authors report characteristics of IMZ SPECT findings that differed between patients with MTLE and those with LTLE. The IMZ SPECT examinations proved useful for preoperative evaluation and, to a certain extent, for discrimination between MTLE and LTLE in cases in which MR imaging demonstrated normal findings. The results of this study suggest that IMZ SPECT findings may reflect localization of the epileptogenic zone.

scholarly journals Asymmetrical Blood Flow in the Temporal Lobe in the Charles Bonnet Syndrome: Serial Neuroimaging Study

1994 ◽  
Vol 7 (2) ◽  
pp. 97-99 ◽  
Author(s):  
N. Adachi ◽  
M. Nagayama ◽  
K. Anami ◽  
K. Arima ◽  
H. Matsuda
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Temporal Region ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Clinical features and results of neuroimagings of an 86 year old woman with the Charles Bonnet syndrome are reported. She had become completely blind bilaterally due to cataracts and glaucoma. Shortly after an operation for cataracts, she developed visual hallucinations which lasted for 22 years. She had no deterioration of intelligence. Computed tomography (CT) and magnetic resonance imaging (MRI) showed moderate generalized atrophy, particularly of the temporal lobes. A serial single photon emission computed tomography (SPECT) study during visual hallucinations demonstrated hyperperfusion in the left temporal region and the basal ganglia and hypoperfusion in the right temporal region. These findings suggest that asymmetrical blood flow, particularly in the temporal regions, may be correlated with visual hallucination in the Charles Bonnet syndrome.

Correlation between Computed Tomography and Bone Single Photon Emission-Computed Tomography Scintigraphy in Patients with Chronic Rhinosinusitis

2007 ◽  
Vol 21 (4) ◽  
pp. 433-438 ◽  
Author(s):  
Peter J. Catalano ◽  
Spencer C. Payne ◽  
Ellen Choi ◽  
Rashmikant Shah
Keyword(s):  
Computed Tomography ◽  
Chronic Rhinosinusitis ◽  
Single Photon ◽  
Photon Emission ◽  
Mucosal Inflammation ◽  
Emission Computed Tomography ◽  
Single Photon Emission ◽  
Single Photon Emission Computed ◽  
Spect Scan ◽  
Photon Emission Computed Tomography

Background Computed tomography (CT) has been the imaging study of choice for evaluating chronic rhinosinusitis (CRS). 99mTc-MDP bone single photon emission-computed tomography (SPECT) has proven useful at identifying inflammation of bone and its use in CRS has been discussed recently. No studies, however, have documented the correlation between these two imaging modalities in CRS. Methods A retrospective analysis was performed of 30 patients with CRS who underwent CT and SPECT scan of the paranasal sinuses. Increased radiotracer uptake during SPECT scan was compared with CT findings graded on the Lund-Mackay score (LMS). The findings of the two imaging modalities were compared and evaluated for standard correlative statistics for diagnostic tests. Results SPECT imaging was abnormal in 25/30 patients, and CT was abnormal in 27/30 patients. Correlation between the two was highest for the ethmoid sinuses at 73.3%. SPECT had a high positive predictive value for mucosal inflammation on CT of 84.1%. Approximately 25% of individual sinuses with a positive SPECT in patients without prior surgery were not positive in corresponding sinuses on CT. There was a positive correlation between the LMS and the number of SPECT positive sinuses within the same patient (r = 0.486; p = 0.006). Conclusion 99mTc-MDP SPECT scan in patients with CRS is shown to be a useful indicator of bone involvement. The relatively high rate of bone involvement in the absence of mucosal inflammation as seen in this study warrants additional research and the potential need for different therapies than are currently available.

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