Multidetector CT with 3-dimensional volume rendering in the evaluation of the spine in patients with Neurofibromatosis type 1: a retrospective review in 73 patients

Scoliosis

Nandita Guha-Thakurta²  Ian E McCutcheon⁴  John M Slopis³  Leena Ketonen²  Yasser MM Mahfouz¹  James Matthew Debnam² 

[1] Department of Radiology, National Cancer Institute, Cairo, Egypt;Department of Radiology, Section of Neuroradiology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 370, Houston, TX 77030, USA;Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston TX 77030, USA;Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA

关键词: Spine;    Neurofibromatosis 1;    Computer-assisted three dimensional imaging;    Computed tomography;    Abnormalities;   

Others  :  1139620
DOI  :  10.1186/1748-7161-9-15

 received in 2014-08-03, accepted in 2014-09-07,  发布年份 2014

【 摘 要 】

Introduction

Neurofibromatosis type 1 (NF-1) may involve the spine as various abnormalities including bony dysplasia, scoliosis, and nerve sheath tumors. Surgery may be performed for stabilization of the spine. We have seen an increase in requests for multidetector CT (MDCT) imaging with the (three-dimensional) 3D-volume rendered (VR) images in patients evaluated at our institution. We, therefore, investigated how MDCT could be best utilized in this patient population.

Methods

Seventy-three patients with NF-1 were identified in whom MDCT imaging was performed for diagnostic, pre-operative, or post-operative evaluation of spinal abnormalities. True axial source images and two dimensional (2D) orthogonal reconstructed MDCT images, as well as the VR images, were compared with plain radiographs and MRI. In addition, the MDCT study was compared to the VR images. These studies were reviewed to compare assessment of A) bony abnormalities such as remodeling from dural ectasia, dysplasia, and fusion, B) abnormal spinal curvature, C) nerve sheath tumors, and D) surgical instrumentation.

Results

When compared to plain radiographs, the MDCT and VR images were rated as helpful for evaluating the abnormalities of the spine in 19 of 24 patients for a total of 30 findings. This included the following categories A) (n = 6), B) (n = 5), C) (n = 7), and D) (n = 12). Compared to MR, the MDCT and VR study was helpful in evaluating the findings of NF-1 in 24 of 36 patients for a total of 40 findings. This included the following categories A) (n = 12), B) (n = 10), C) (n = 3), and D) (n = 15). When the VR images were compared to the orthogonal MDCT, the VR images was rated as helpful in 41 of 73 patients for a total of 60 findings, including the following categories: A) (n = 11), B) (n = 24), C) (n = 0), and D) (n = 25).

Conclusion

MDCT has distinct advantages over plain radiographs and MR imaging, and the VR images over MDCT in the evaluation of the spine in patients with NF-1, especially for the assessment of bony abnormalities, abnormal spinal curvature, and spinal instrumentation.

【 授权许可】

   
2014 Debnam et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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【 参考文献 】

• [1]Friedman JM: Epidemiology of neurofibromatosis type 1. Am J Med Genet 1999, 89:1-6.
• [2]Thakkar SD, Feigen U, Mautner VF: Spinal tumors in neurofibromatosis type 1: an MRI study of frequency, multiplicity and variety. Neuroradiology 1999, 41:625-629.
• [3]Tsirikos AI, Saifuddin A, Noordeen MH: Spinal deformity in neurofibromatosis type-1: diagnosis and treatment. Eur Spine J 2005, 14:427-439.
• [4]National Institute of Health Consensus Development Conference: Neurofibromatosis: Conference Statement. Arch Neurol 1998, 45:575-578.
• [5]Kim HW, Weinstein SL: The management of scoliosis in neurofibromatosis. Spine 1997, 22:2770-2776.
• [6]Winter RB: Spontaneous dislocation of a vertebra in a patient who had neurofibromatosis. J Bone Joint Surg 1991, 73:1402-1404.
• [7]Stone JW, Birdwell KH, Shackelford GD, Abramson CL: Dural ectasia associated with spontaneous dislocation of the upper part of the thoracic spine in neurofibromatosis. J Bone Joint Surg 1987, 69:1079-1083.
• [8]Alwan S, Tredwell SJ, Friedman JM: Is osseous dysplasia a primary feature of neurofibromatosis 1 (NF1)? Clin Genet 2005, 67:378-390.
• [9]Crawford AH: Pitfalls of spinal deformities associated with neurofibromatosis in children. Clin Orthop 1989, 245:29-42.
• [10]Slone RM, MacMillan M, Montgomery WJ: Spinal fixation, part 3. Complications of spinal instrumentation. Radiographics 1993, 13:797-816.
• [11]Tsirikos AI, Ramachandran M, Lee J, Saifuddin A: Assessment of vertebral scalloping in neurofibromatosis type 1 with plain radiography and MRI. Clin Radiol 2004, 59:1009-1017.
• [12]Cardoso M, Keating RF: Neurosurgical management of spinal dysraphism and neurogenic scoliosis. Spine 2009, 34:1775-1782.
• [13]Adam CJ, Izatt MT, Harvey JR, Askin GN: Variability of Cobb angle measurements using reformatted computerized tomography scans. Spine 2005, 30:1664-1669.
• [14]Street J, Lenehan B, Albietz J, Bishop P, Dvorak M, Fisher C: Intraobserver and interobserver reliabilty of measures of kyphosis in thoracolumbar fractures. Spine J 2009, 9:464-469.
• [15]Gocen S, Havitcioglu H, Alici E: A new method to measure vertebral rotation from CT scans. Eur Spine J 1999, 8:261-265.
• [16]Krismer M, Sterzinger W, Haid C, Frischhut B, Bauer R: Axial rotation measurement of scoliotic vertebrae by means of computed tomography scans. Spine 1996, 21:576-581.
• [17]Kamimura M, Kinoshita T, Itoh H, Yuzawa Y, Takahashi J, Hirabayashi H, Nakamura I: Preoperative CT examination for accurate and safe anterior spinal instrumentation surgery with endoscopic approach. J Spinal Disord Tech 2002, 15:47-51.
• [18]Slone RM, McEnery KW, Bridwell KH, Montgomery WJ: Principles and imaging of spinal instrumentation. Radiol Clin North Am 1985, 33:189-211.
• [19]Kim H, Kim HS, Moon ES, Yoon CS, Chung TS, Song HT, Suh JS, Lee YH, Kim S: Scoliosis imaging: what radiologists should know. Radiographics 2010, 30:1823-1842.
• [20]Debnam JM, Ketonen L, Guha-Thakurta N: Three-Dimensional Volume-Rendered Series Complements 2D Orthogonal Multidetector Computed Tomography in the Evaluation of Abnormal Spinal Curvature in Patients at a Major Cancer Center: A Retrospective Review. ISRN Orthop 2012, 2012:639189.
• [21]Novelline RA, Rhea JT, Rao PM, Stuk JL: Helical CT in emergency radiology. Radiology 1999, 213:321-329.
• [22]Wintermark M, Poletti PA, Becker CD, Schnyder P: Traumatic injuries: organization and ergonomics of imaging in the emergency environment. Eur Radiol 2002, 12:959-968.
• [23]Casselman ES, Mandell GA: Vertebral scalloping in neurofibromatosis. Radiology 1979, 131:89-94.
• [24]Egelhoff JC, Bates DJ, Ross JS, Rothner AD, Cohen BH: Spinal MR findings in neurofibromatosis types 1 and 2. AJNR Am J Neuroradiol 1992, 13:1071-1077.
• [25]Flood BM, Butt WP, Dickson RA: Rib penetration of the intervertebral foraminae in neurofibromatosis. Spine 1986, 11:172-174.
• [26]Major MR, Huizenga BA: Spinal cord compression by displaced ribs in neurofibromatosis. A report of three cases. J Bone Joint Surg 1988, 70:1100-1102.
• [27]Chee CP: Lateral thoracic meningocele associated with neurofibromatosis: total excision by posterolateral extradural approach. A case report. Spine 1989, 14:129-131.
• [28]Maiuri F, Corriero G, Giampaglia F, Simonetti L: Lateral thoracic meningocele. Surg Neurol 1986, 26:409-412.
• [29]Rainov RG, Heidecke V, Burkert W: Thoracic and lumbar meningocele in neurofibromatosis type 1. Report of two cases and review of the literature. Neurosurg Rev 1995, 18:127-134.
• [30]Hunt JC, Pugh DG: Skeletal lesions in neurofibromatosis. Radiology 1961, 76:1-2.
• [31]Winter RB, Moe JH, Bradford DS, Lonstein JE, Pedras CV, Weber AH: Spine deformity in neurofibromatosis. A review of one hundred and two patients. J Bone Joint Surg 1979, 61:677-694.
• [32]Vitale MG, Guha A, Skaggs DL: Orthopaedic manifestations of neurofibromatosis in children: an update. Clin Orthop 2002, 401:107-118.
• [33]Crawford AH, Bagamery N: Osseous manifestations of neurofibromatosis in childhood. J Pediatr Orthop 1986, 6:72-88.
• [34]Sirois JL, Drennan JC: Dystrophic spinal deformity in neurofibromatosis. J Pediatr Othrop 1990, 10:522-526.
• [35]Betz RR, Iorio R, Lombardi AV, Clancy M, Steel HH: Scoliosis surgery in neurofibromatosis. Clin Orthop Relat Res 1989, 245:53-56.
• [36]Calvert PT, Edgar MA, Webb PJ: Scoliosis in neurofibromatosis. The natural history with and without operation. J Bone Joint Surg (Br) 1989, 712:246-251.
• [37]Wilde PH, Upadhyay SS, Leong JC: Deterioration of operative correction in dystrophic spinal neurofibromatosis. Spine 1911, 1994:1264-1270.
• [38]Parisini P, Di Silvestre M, Greggi T, Paderni S, Cervellati S, Savini R: Surgical correction of dystrophic spinal curves in neurofibromatosis. A review of 56 patients. Spine 1999, 24:2247-2253.
• [39]Shufflebarger HL: Cotrel-Dubousset instrumentation in neurofibromatosis spinal problems. Clin Orthop Relat Res 1989, 245:24-28.
• [40]Lin J, Martel W: Cross-sectional imaging of peripheral nerve sheath tumors: characteristic signs on CT, MR imaging, and sonography. AJR Am J Roentgenol 2001, 176:75-82.
• [41]Woodruff JM: Pathology of tumors of the peripheral nerve sheath in type 1 neurofibromatosis. Am J Med Genet 1999, 89:23-30.
• [42]Riccardi VM: Neurofibromatosis: an overview and new directions in clinical investigations. Adv Neurol 1981, 29:1-9.
• [43]Hajdu SI: Peripheral nerve sheath tumors. Histogenesis, classification, and prognosis. Cancer 1993, 72:3549-3552.
• [44]Ogose A, Hotta T, Morita T, Yamamura S, Hosaka N, Kobayashi H, Hirata Y: Tumors of peripheral nerves: correlation of symptoms, clinical signs, imaging features, and histologic diagnosis. Skeletal Radiol 1999, 28:183-188.
• [45]Buchwalter KA, Rydberg J, Kopecky KK, Crow K, Yang EL: Musculoskeletal imaging with multislice CT. AJR Am J Roentgenol 2001, 176:979-986.
• [46]Pretorius ES, Fishman EK: Volume-rendered three-dimensional spiral CT; musculoskeletal applications. RadioGraphics 1999, 19:1143-1160.
• [47]Mulkens TH, Marchal P, Daineffe S, Salgado R, Bellinck P, te Rijdt B, Kegelaers B, Termote JL: Comparison of low-dose with standard-dose multidetector CT in cervical spine trauma. AJNR Am J Neuroradiol 2007, 28:1444-1450.
• [48]Tack D, Jahnen A, Kohler S, Harpes N, De Maertelaer V, Back C, Gevenois PA: Multidetector CT radiation dose optimisation in adults: short- and long-term effects of a clinical audit. Eur Radiol 2014, 24:169-175.