title: Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors.
abstract: OBJECTIVE
  To prospectively evaluate the incidence of, characteristics of, and risk factors for pulmonary cement embolism after percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (VCFs).
  
  
  METHODS
  Institutional review board approval and written informed consent were obtained. From June 2006 to September 2007, 75 patients (57 women, 18 men; mean age, 74.78 years; range, 48-93 years) who underwent 78 PVP sessions at 119 levels for osteoporotic VCFs were prospectively enrolled in this study. Computed tomographic (CT) scans of the chest and treated vertebrae were obtained after PVP. The presence, location, involved pulmonary arteries, number, and size of each pulmonary cement embolus were analyzed at CT. Possible risk factors were analyzed as follows: Age, injected cement volumes, and numbers of treated vertebrae were analyzed by using the Mann-Whitney U test; operators (radiologist or nonradiologist), level of treated vertebrae, guidance equipment, approach (uni- or bipedicular), presence of intravertebral vacuum clefts, and presence of paravertebral venous leakage were analyzed by using Pearson chi(2) and Fisher exact tests.
  
  
  RESULTS
  Pulmonary cement emboli developed in 18 (23%) of 78 PVP sessions and were detected in the distal to third-order pulmonary arteries. Only cement leakage into the inferior vena cava showed a statistically significant relationship to pulmonary cement embolism (P = .03). A higher frequency of pulmonary cement embolism was noted for the absence of intravertebral vacuum clefts, for the bipedicular approach, and for a nonradiologist operator with C-arm fluoroscopy (P > .05).
  
  
  CONCLUSIONS
  In osteoporotic VCFs, pulmonary cement embolism was detected in 23% of PVP sessions, developed in the distal to third-order pulmonary arteries, and was related to leakage into the inferior vena cava.
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeongi-do 463-707, South Korea.
authors.forename: Yeo Ju
authors.initials: YJ
authors.lastname: Kim
authors.forename: Joon Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Kun Woo
authors.initials: KW
authors.lastname: Park
authors.forename: Jin-Seob
authors.initials: JS
authors.lastname: Yeom
authors.forename: Hee Sun
authors.initials: HS
authors.lastname: Jeong
authors.forename: Jeong Mi
authors.initials: JM
authors.lastname: Park
authors.forename: Heung Sik
authors.initials: HS
authors.lastname: Kang