title: Incidence of pulmonary cement embolism after real-time CT fluoroscopy-guided vertebroplasty.
abstract: OBJECTIVE
  To prospectively evaluate the incidence of pulmonary cement embolism (PCE) after vertebroplasty in procedures performed under real-time computed tomographic (CT) fluoroscopy guidance.
  
  
  METHODS
  A total of 85 vertebroplasties were performed in 51 consecutive patients (31 women, 20 men; mean age, 71.9 y; range, 48-92 y) in 51 sessions. The needle was inserted with guidance from intermittent single-shot CT scans, and intermittent CT fluoroscopy was used during cement injection only. To reduce the risk of extravertebral or extraosseous leakage, several procedures (cement injection stopping/slowing, needle position changes) were employed. The chest and treated bone were scanned immediately after vertebroplasty. These CT images included the entire thorax as well as the treated vertebrae.
  
  
  RESULTS
  No cement emboli were observed on CT after vertebroplasty. After 85 vertebroplasty procedures, 44 extravertebral leaks were detected. Epidural leaks were observed on CT in six treated vertebrae (7%), in 12 cases in the anterior external venous plexus (14.1%), in five in the azygos vein (5.8%), in 19 in the disc space (22%), and in two in the foraminal space (2.3%). On a per-patient basis, the odds of leaks increased with the number of vertebroplasties (P = .05) and the volume of cement used (P = .0412). There was also a higher probability of leak (P < .05) for osteoporotic vertebral compression fractures (67.9%; 95% confidence interval, 47.7%-84.1%) than osteolytic spinal metastases (34.8%; 16.4%-57.3%).
  
  
  CONCLUSIONS
  PCE did not occur after vertebroplasty under CT fluoroscopy guidance. Further larger prospective vertebroplasty studies are needed to compare the rates of PCE for CT versus conventional fluoroscopic guidance.
authors: Radiology Department, Percy Military Hospital, Avenue Henri Barbusse, 92140 Clamart, France. Electronic address: potet_julien@yahoo.fr.
authors: Julien
authors: J
authors: Potet
authors: Gabrielle
authors: G
authors: Weber-Donat
authors: Emmanuel
authors: E
authors: Curis
authors: François-Xavier
authors: FX
authors: Arnaud
authors: Alphonse
authors: A
authors: Thome
authors: Laura
authors: L
authors: Valbousquet
authors: Evelyne
authors: E
authors: Peroux
authors: Yann
authors: Y
authors: Geffroy
authors: Caroline
authors: C
authors: Bouzad
authors: Yann
authors: Y
authors: Kervella
authors: Marion
authors: M
authors: Lahutte
authors: Elsa
authors: E
authors: Ukkola-Pons
authors: Jacques
authors: J
authors: Baccialone
authors: Christophe A
authors: CA
authors: Teriitehau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D005471:Fluoroscopy; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000453:epidemiology*; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016017:Odds Ratio; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology*; D015641:Radiography, Interventional / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000009:adverse effects*
chemical_list: D001843:Bone Cements
keywords: CI; OVCF; PCE; PMMA; VAS; confidence interval; osteoporotic vertebral compression fracture; polymethylmethacrylate; pulmonary cement embolism; visual analog scale