title: Prevalence and characteristics of intravertebral enhancement on contrast-enhanced CT scans in cancer patients.
abstract: METHODS
  This was a single center, retrospective observational study.
  
  
  OBJECTIVE
  to investigate-in a cancer population-the prevalence and hallmarks of intravertebral enhancement (IVE) detected on contrast-enhanced CT.
  
  
  BACKGROUND
  Intravertebral enhancements secondary to iodinated contrast stagnation have been described. Cancer patients have an increased risk of perivertebral venous thrombosis or stenosis secondary to several risk factors (cancer or drug induced hypercoagulability, deterioration of venous flow linked to catheter insertion, prolonged immobilization). In case of a high density lesion identified on CT, the diagnostic choice between metastasis and contrast media within bone marrow vessels may be an issue, especially as oncologic follow-up CT scans are usually performed with contrast medium injection.
  
  
  METHODS
  2572 contrast-enhanced body CT scans performed in cancer patients over 3 months in the medical imaging department of a university hospital were retrospectively reviewed. IVE was sought when paravertebral venous collateral circulation was detected and bone metastasis ruled out and classified as linear or nodular. Their locations within vertebra, their relation to the injection side and the predominant collateral venous network side were evaluated.
  
  
  RESULTS
  Sixty-seven (2.8%) patients had a collateral paravertebral venous system and among them 21 had IVE (37%). There were 208 IVE locations involving 75 vertebrae. 199 IVE were linear-shaped (95.7%) and 9 nodular-shaped (4.3%). 80.8% were located between C6 and T4. 88.9% were localized in the vertebral body. 73.1% were located medially or ipsilateral to the injection side.
  
  
  CONCLUSIONS
  Intravertebral enhancement is found in 37% of the patients with paraspinal collateral venous circulation when a CT scan is performed for cancer. The ipsilateral or medial position of the IVE relative to the injection side and the side of the dominant perivertebral venous system, and the possibility of connecting the IVE to a paravertebral vein may be in favor of vascular opacification.
authors.affiliation: Medical Imaging Department and Biostatistics Department, Montpellier University Hospital, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rasselet
authors.affiliation: Medical Imaging Department, Nimes University Hospital, 4 rue du Professeur Robert Debré, 30029 Nîmes, France.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Larbi
authors.affiliation: Medical Imaging Department, Nimes University Hospital, 4 rue du Professeur Robert Debré, 30029 Nîmes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Viala
authors.affiliation: Biostatistics Department, Montpellier University Hospital, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Medical Imaging Department, Montpellier Cancer Institute (ICM), 208 Avenue des Apothicaires, 34298 Montpellier Cedex 5, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Tetreau
authors.affiliation: Medical Imaging Department, Toulouse University Hospital, Place du Docteur Baylac, 31059 Toulouse Cedex 9, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Faruch-Bilfeld
authors.affiliation: Medical Imaging Department and Biostatistics Department, Montpellier University Hospital, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Taourel
authors.affiliation: Medical Imaging Department and Biostatistics Department, Montpellier University Hospital, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5, France. Electronic address: c-cyteval@chu-montpellier.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cyteval
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003097:Collateral Circulation / Q000502:physiology*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000098:blood supply / Q000150:complications* / Q000000981:diagnostic imaging; D015588:Observer Variation; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000556:secondary; D013130:Spinal Stenosis / Q000000981:diagnostic imaging; D013131:Spine / Q000098:blood supply* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D014680:Veins / Q000000981:diagnostic imaging / Q000502:physiology; D020246:Venous Thrombosis / Q000517:prevention & control
chemical_list: D003287:Contrast Media
keywords: CT scan; Collateral circulation; Enhancement; Venous contrast; Vertebra