AJR Not a Member? Click to Join ARRS!
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hiwatashi, A.
Right arrow Articles by Westesson, P.-L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hiwatashi, A.
Right arrow Articles by Westesson, P.-L.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
DOI:10.2214/AJR.06.0903
AJR 2007; 188:1089-1093
© American Roentgen Ray Society

Original Research

Cement Leakage During Vertebroplasty Can Be Predicted on Preoperative MRI

Akio Hiwatashi1,2, Yoshimitsu Ohgiya1,3, Naoya Kakimoto1,4 and Per-Lennart Westesson1

1 Division of Diagnostic and Interventional Neuroradiology, Department of Imaging Services, University of Rochester Medical Center, Rochester, NY.
2 Present address: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
3 Present address: Department of Radiology, Showa University School of Medicine, Tokyo, Japan.
4 Present address: Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, Osaka University, Osaka, Japan.

Received July 11, 2006; accepted after revision October 11, 2006.

 
Address correspondence to A. Hiwatashi.


Abstract
Top
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
OBJECTIVE. Previous studies have shown that cement leakage into an adjacent disk space is a risk factor for new fracture after vertebroplasty. The purpose of this study was to investigate the use of preoperative MRI for predicting such cement leakage.

MATERIALS AND METHODS. Our institutional review board approved this retrospective study and waived the requirement of informed consent. We studied preoperative MRI of 46 vertebroplasty patients (107 vertebral bodies). Endplate cortical defect, abnormal T2 hyperintensity in adjacent disk space, intravertebral cleft, degree of compression, and wedge angle were correlated to the incidence of cement leakage into the adjacent disk. Patient age, sex, and location of treated vertebral body were also evaluated. We used logistic regression analysis and Fisher's exact probability test to analyze the association between cement leakage and these observations.

RESULTS. Cortical defect in the endplate of the treated vertebral body, abnormal T2 hyperintensity in the adjacent intervertebral disk, and absence of intravertebral cleft were associated with cement leakage into the disk space (p < 0.05). There was no statistically significant association between cement leakage into the disk and degree of compression, wedge angle, location of treated vertebral body, patient age, or sex (p >0.05).

CONCLUSION. Cement leakage into an adjacent disk is more common when there is a cortical defect in the endplate and increased T2 signal in the adjacent disk and is less common if there is an intravertebral cleft.

Keywords: CT • MRI • spine • vertebroplasty


Introduction
Top
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
Percutaneous vertebroplasty is a minimally invasive procedure to provide pain relief and stability for osteoporotic compression fractures [1-29]. The main goal of this technique is to reduce pain for patients who have failed conservative treatment. Previous reports have shown that 8-52% of patients treated with vertebroplasty return with new pain from a new compression fracture. The new fractures often occur in adjacent vertebral bodies [5, 14, 18, 19, 24-27]. Possible explanations for these new fractures are pre-existent bone fragility in an osteoporotic patient, immediate increase in stiffness and strength in the treated vertebral body, and improved mobility that causes a new load on vertebral bodies [5, 12, 14, 18, 19, 24-27]. Cement leakage into the disk space has been shown to increase the risk of new fracture of the adjacent vertebral body [18, 27].

In our clinical work with vertebroplasty, we have often noticed that cement leakage into the disk tends to occur when the vertebral body has a cortical defect and a bnormal signal in the disk. The purpose of this study was to analyze the use of preoperative MRI in predicting the risk of cement leakage into the disk space during vertebroplasty.


Materials and Methods
Top
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
Our institutional review board approved this retrospective study and waived the requirement of informed consent. The study was compliant with the regulations of the Health Insurance Portability and Accountability Act (HIPAA).

Patients
This study was based on 46 patients with painful osteoporotic compression fractures treated with vertebroplasty. There were 33 women and 13 men ranging in age between 45 and 93 years with a mean age of 78 years. A total of 107 vertebral bodies were treated. Most of the fractures were located around the thoracolumbar junction. The locations and numbers of treated vertebral bodies were as follows: T4 (n = 2), T5 (n =2), T6 (n =5), T7 (n = 5), T8 (n =8), T9 (n = 6), T10 (n = 13), T11 (n =14), T12 (n = 10), L1 (n = 16), L2 (n = 11), L3 (n = 6), L4 (n =6), and L5 (n = 3).

Vertebroplasty Technique
Vertebroplasty was performed through a transpedicular or parapedicular approach using one or two 13-gauge bone biopsy needles placed into the anterior one third of the vertebral body. The procedure was performed under biplane fluoroscopy with use of conscious sedation and local anesthesia on an outpatient basis.


Figure 1
View larger version (154K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 1A —68-year-old woman with history of long-term steroid use for chronic obstructive lung disease. Sagittal T2-weighted image before vertebroplasty shows compression fracture of T11 vertebral body with concave deformity. Cortical defect is noted in superior endplate (arrow). Hyperintensity is noted in adjacent desiccated intervertebral disks, which is more prominent at T10-T11 (arrowhead).

 


Figure 2
View larger version (95K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 1B —68-year-old woman with history of long-term steroid use for chronic obstructive lung disease. Sagittal reformatted CT image after vertebroplasty shows cement leakage in T10-T11 disk space (arrow) through cortical defect seen on preoperative MR image.

 
Once the needles were placed in the vertebral body, the liquid and powder polymethylmethacrylate were mixed with 12 g of barium sulfate to a dough-like consistency. Under biplane fluoroscopic guidance, the cement was injected through the needles. The injection continued until the vertebral body was filled toward the posterior 25% of the vertebral body or there was leakage. The patient was lying prone on the angiographic table during the injection. After cement injection, the patient remained prone on the angiographic table for 15-30 minutes and was then transferred to a regular bed. The patient remained in the bed until CT had been performed. Thereafter, the patient was discharged as tolerated.

Imaging Technique
MRI was performed with a 1.5-T scanner. At least fast spin-echo sagittal T2-weighted (TR range/TE range, 3,800-4,550/98-123.6; number of excitations [NEX], 2-4), sagittal spin-echo T1-weighted (500-767/8-22), and sagittal spin-echo fat-suppressed contrast-enhanced T1-weighted (567-750/8-23) images were obtained. In some cases, additional sequences were also available. The patients were given an IV injection of 0.2 mmol/kg of gadodiamide. Typical imaging parameters were as follows: field of view, 34-36 x 25.5-36 cm; matrix size, 256-512 x 160-256; section thickness, 3 mm; intersection gap, 0.5-1 mm; and echo-train length, 1-4.

CT scans were obtained using a single-detector or 4-, 6-, 16-, or 40-MDCT scanner. Typical imaging parameters were as follows: collimation, 0.625-3 mm; 3.75-7.5 mm per rotation; field-of view, 18-50 cm; 180-380 mAs; and 120-140 kVp. Reconstructions were performed at 2- to 3-mm slice thickness.

Imaging Assessment
All images were transferred to the PACS. The presence of cortical defect in the fractured endplate, abnormal T2 hyperintensity in the adjacent disk space, and intravertebral cleft was evaluated on preoperative MRI. We defined a cortical defect as a discontinuation of cortical hypointensity on sagittal T2-weighted or fat-suppressed contrast-enhanced T1-weighted images (Fig. 1A, 1B). Abnormal T2 hyperintensity in adjacent disk spaces was defined as higher signal compared with other normal-appearing disks adjacent to nonfractured vertebrae in each patient (Fig. 1A, 1B). Intravertebral cleft was defined as abnormal T2 hyperintensity similar to cerebrospinal fluid (Fig. 2A, 2B). These analyses were based on consensus interpretation between two of the authors without knowledge of postoperative CT findings.


Figure 3
View larger version (153K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 2A —90-year-old woman with lower back pain. Sagittal T2-weighted image before vertebroplasty shows mild compression fracture of T12 vertebral body. No prominent cortical defect or abnormal high signal in adjacent disk is noted. Intravertebral cleft is noted in inferior portion of vertebral body (arrow).

 

Figure 4
View larger version (138K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 2B —90-year-old woman with lower back pain. Sagittal reformatted CT image after vertebroplasty shows sufficient cement filling in T12 vertebral body (arrow). No evidence of cement leakage is noted.

 
The raw MR data were also transferred to a work-station. Preoperative vertebral height was measured in the anterior, central, and posterior portions in the midsagittal plane (Fig. 3). Adjacent nonfractured vertebral body was also measured. Wedge angle was also measured in the same plane, as previously described [30]. The presence of cement leakage into the adjacent intervertebral disk spaces was defined as any contrast enhancement beyond the cortical margin seen on postoperative CT.


Figure 5
View larger version (10K):
[in this window]
[in a new window]
[as a PowerPoint slide]
  		Fig. 3 —Diagram illustrates areas used to measure vertebral body height in midsagittal plane. Wedge angle was measured in angle in lines along with superior and inferior endplates. (A=anterior, C=central, P=posterior.)

 
Statistical Analysis
The relevant clinical characteristics were entered into a logistic regression analysis to determine predictors of cement leakage. Degree of compression was calculated as follows; (degree of compression) = (sum of anterior, central, and posterior heights of fractured vertebral body)/(sum of anterior, central, and posterior heights of nonfractured adjacent vertebral body) x 100. Cortical defect in the endplate, abnormal T2 signal in the adjacent intervertebral disk, intravertebral cleft, degree of compression, wedge angle, the level treated, patient age, and sex were considered independent variables. Statistical analysis was performed with commercially available software. Fisher's exact probability test was also performed for categoric variables. A p value of less than 0.05 was considered statistically significant.


Results
Top
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
Cement leakage into the adjacent disk space during vertebroplasty occurred in 51 (24%) of 214 disk spaces. Leakage was associated with cortical defect in the endplate (p < 0.001), abnormal T2 hyperintensity in the adjacent intervertebral disk (p < 0.01), and absence of intravertebral cleft (p < 0.05).

Cortical defect was seen in 71 (33%) of the 214 endplates and cement leakage was seen in 46 (65%) of these 71 (Table 1). Abnormal T2 hyperintensity in the adjacent intervertebral disk was seen in 95 (44%) of the 214 disks and was associated with cement leakage in 44 (46%) instances of these 95 (Table 1). Intravertebral cleft adjacent to the endplate was not seen in 94 (44%) of the 214 disks, and its absence was associated with cement leakage in 31 instances (33%) of these 94 (Table 1). There was no statistically significant association between cement leakage into the disk space and degree of compression, wedge angle, location of the treated vertebral bodies, patient age, or sex (p > 0.05).


View this table:
[in this window]
[in a new window]

  		TABLE 1: Assessment of Cement Leakage

 

The mean interval between preoperative MRI and treatment was 7 days. All postoperative CT was performed within 24 hours after the procedure.


Discussion
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
This study has shown that a vertebral compression fracture with cortical defect and abnormal T2 high signal in the adjacent disk has an increased risk for cement leakage into the disk space during vertebroplasty when compared with those without these features. This probably reflects the fact that the more comminuted the fracture is the more likely that cement will leak through a defect in the endplate into the disk space.

Cement leakage into the adjacent disk is usually asymptomatic but may have longterm mechanical consequences on the adjacent vertebral body [3]. Thus, Lin et al. [18] evaluated postoperative CT scans and found that cement leakage into the disk increases the risk for fractures of the adjacent vertebral bodies. These findings were confirmed by Komemushi et al. [27], who found that cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty. This observation is contradicted by Syed et al. [24], who used radiographs and reported that cement leakage into the disk with low-volume cement filling in the treated vertebral body did not increase the risk for a new fracture. However, Syed et al. based their observations on radiographs and CT scans are probably more accurate [15, 22].

Earlier studies discussed the risk for cement leakage [1, 7, 9, 19, 21]. Cotten et al. [1] reported that intradisk leak was associated with cortical fracture or osteolysis of the endplates. Our results are concurrent with their results regarding association between cement leakage and cortical defect. Nakano et al. [21] found patient age, sex, bone marrow density, or short interval between injury and surgery to be associated with increased risk of cement leakage. We could not evaluate the age of the fracture and volume of cement injected because this information was not accurately available to us at the time of the study.

Tearing of disk substance and edema can cause T2 high signal in disks adjacent to acute vertebral fractures [31]. This high signal is better appreciated in the degenerated disk, which causes T2 low signal [32]. We found a relationship between cement leakage and T2 high signal in disks. Traumatic change in an adjacent disk may not prevent leakage.

We also found less cement leakage in the vertebral fracture with an intravertebral cleft. Intravertebral cleft probably represents fracture nonunion. Lane et al. [13] recommended cement filling of the cleft to obtain greater pain relief. Oka et al. [23] reported solid cement distribution in the intravertebral cleft and surrounding nonenhancing vertebral body. This is probably because there is less resistance during cement injection in the cleft than in enhancing solid vertebral body, and it may prevent cement leakage.

There is controversy regarding intraosseous venography before cement injection. Jensen et al. [2] initially reported its benefit to decrease potential complications associated with needle placement. This was followed by McGraw et al. [8]. However, because of the difference of viscosity between contrast material and cement, some investigators claimed a lack of benefit in antecedent venography [10, 11, 28]. Other proponents used carbon dioxide to avoid obscuring cement distribution with contrast material [29]. However, we did not routinely use venography for vertebroplasty.

The subjective assessment of imaging is a possible limitation of this study. An objective way would have been preferable, but it was not available to us. The second is a lack of measurement of the amount of cement injected and the shape and direction of the tip of the needles. We routinely did not record the amount of cement and the tip of the needles used. The third is a lack of assessment of leakage into the venous system, spinal canal, or neural foramen. Preoperative MR evaluation of the venous system was initially attempted in this study; however, it was technically difficult in cases with vertebral fractures. We did not perform assessment of epidural or foraminal leakage because we did not encounter any neurologic deficit after vertebroplasty.

In conclusion, this study has shown that endplate cortical abnormal T2 hyperintensity in an adjacent disk and absence of an intravertebral cleft are predictors of cement leakage into the adjacent disk space during vertebroplasty. We probably need careful cement injection in these vertebral bodies to reduce cement leakage.


References
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Cotten A, Dewatre F, Cortet B, et al. Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 1996;200 : 525-530[Abstract/Free Full Text]
  2. Jensen ME, Evans AJ, Mathis JM, et al. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. Am J Neuroradiol 1997; 18:1897 -1904[Abstract]
  3. Deramond H, Depriester C, Galibert P, et al. Percutaneous vertebroplasty with polymethylmethacrylate: technique, indications, and results. Radiol Clin North Am 1998;36 : 533-546[CrossRef][Medline]
  4. Cyteval C, Sarrabere MP, Roux JO, et al. Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients. AJR 1999;173 : 1685-1690[Abstract]
  5. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford)2000; 39:1410 -1414[CrossRef][Medline]
  6. Do HM. Magnetic resonance imaging in the evaluation of patients for percutaneous vertebroplasty. Top Magn Reson Imaging2000; 11:235 -244[CrossRef][Medline]
  7. Ryu KS, Park CK, Kim MC, Kang JK. Dose-dependent epidural leakage of polymethylmethacrylate after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. J Neurosurg 2002; 96:56 -61[Medline]
  8. McGraw JK, Heatwole EV, Strnad BT, Silber JS, Patzilk SB, Boorstein JM. Predictive value of intraosseous venography before percutaneous vertebroplasty. J Vasc Interv Radiol2002; 13:149 -153[Medline]
  9. Peh WC, Gilula LA, Peck DD. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 2002;223 : 121-126[Abstract/Free Full Text]
  10. Gaughen JR Jr, Jensen ME, Schweickert PA, Kaufmann TJ, Marx WF, Kallmes DF. Relevance of antecedent venography in percutaneous vertebroplasty for the treatment of osteoporotic compression fractures. Am J Neuroradiol 2002; 23:594 -600[Abstract/Free Full Text]
  11. Vasconcelos C, Gailloud P, Beauchamp NJ, Heck DV, Murphy KJ. Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutive procedures. Am J Neuroradiol2002; 23:913 -917[Abstract/Free Full Text]
  12. Berlemann U, Ferguson SJ, Nolte LP, Heini PF. Adjacent vertebral failure after vertebroplasty: a biomechanical investigation. J Bone Joint Surg Br 2002; 84:748 -752[CrossRef][Medline]
  13. Lane JI, Maus TP, Wald JT, Thielen KR, Bobra S, Luetmer PH. Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. Am J Neuroradiol 2002; 23:1642 -1646[Abstract/Free Full Text]
  14. Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 2003;226 : 119-124[Abstract/Free Full Text]
  15. Yeom JS, Kim WJ, Choy WS, Lee CK, Chang BS, Kang JW. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br2003; 85:83 -89[CrossRef][Medline]
  16. Hiwatashi A, Moritani T, Numaguchi Y, Westesson PL. Increase in vertebral body height after vertebroplasty. Am J Neuroradiol 2003; 24:185 -189[Abstract/Free Full Text]
  17. Mousavi P, Roth S, Finkelstein J, Cheung G, Whyne C. Volumetric quantification of cement leakage following percutaneous vertebroplasty in metastatic and osteoporotic vertebrae. J Neurosurg2003; 99:56 -59[Medline]
  18. Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. Am J Neuroradiol 2004;25 : 175-180[Abstract/Free Full Text]
  19. Kim SH, Kang HS, Choi JA, Ahn JM. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 2004;45 : 440-445[CrossRef][Medline]
  20. Nussbaum DA, Gailloud P, Murphy K. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol 2004; 15:1185 -1192[CrossRef][Medline]
  21. Nakano M, Hirano N, Ishihara H, Kawaguchi Y, Matsuura K. Calcium phosphate cement leakage after percutaneous vertebroplasty for osteoporotic vertebral fractures: risk factor analysis for cement leakage. J Neurosurg Spine 2005; 2:27 -33[Medline]
  22. Schmidt R, Cakir B, Mattes T, Wegener M, Puhl W, Richter M. Cement leakage during vertebroplasty: an underestimated problem? Eur Spine J 2005; 14:466 -473[CrossRef][Medline]
  23. Oka M, Matsusako M, Kobayashi N, Uemura A, Numaguchi Y. Intravertebral cleft sign on fat-suppressed contrast-enhanced MR: correlation with cement distribution pattern on percutaneous vertebroplasty. Acad Radiol 2005;12 : 992-999[CrossRef][Medline]
  24. Syed MI, Patel NA, Jan S, Harron MS, Morar K, Shaikh A. Intradiskal extravasation with low-volume cement filling in percutaneous vertebroplasty. Am J Neuroradiol 2005;26 : 2397-2401[Abstract/Free Full Text]
  25. Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. Am J Neuroradiol 2006; 27:217 -223[Abstract/Free Full Text]
  26. Voormolen MH, Lohle PN, Juttmann JR, Graaf Y, Fransen H, Lampmann LE. The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol 2006; 17:71 -76[CrossRef][Medline]
  27. Komemushi A, Tanigawa N, Kariya S, et al. Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Intervent Radiol 2006; 29:580 -585[CrossRef][Medline]
  28. Wong W, Mathis J. Is intraosseous venography a significant safety measure in performance of vertebroplasty? J Vasc Interv Radiol 2002; 13:137 -138[Medline]
  29. Tanigawa N, Komemushi A, Kariya S, Kojima H, Sawada S. Intraosseous venography with carbon dioxide contrast agent in percutaneous vertebroplasty. AJR 2005; 184:567 -570[Abstract/Free Full Text]
  30. Hiwatashi A, Sidhu R, Lee RK, deGuzman RR, Piekut DT, Westesson PL. Kyphoplasty versus vertebroplasty to increase vertebral body height: a cadaveric study. Radiology 2005;237 : 1115-1119[Abstract/Free Full Text]
  31. Flanders AE, Schaefer DM, Doan HT, Mishkin MM, Gonzalez CF, Northrup BE. Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit. Radiology1990; 177:25 -33[Abstract/Free Full Text]
  32. Modic MT, Pavlicek W, Weinstein MA, et al. Magnetic resonance imaging of intervertebral disk disease: clinical and pulse sequence considerations. Radiology 1984;152 : 103-111[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Am. J. Roentgenol.Home page
A. Hiwatashi and P.-L. Westesson
Reply to Preoperative MR Findings Predictive of Cement Leakage During Vertebroplasty: Low Signal Intensity Linear Lesion in Intervertebral Disk
Am. J. Roentgenol., February 1, 2008; 190(2): W165 - W165.
[Full Text] [PDF]

Home page
 Am. J. Roentgenol.Home page
D. S. Yoo, Y. M. Kim, and Y. S. Lee
Preoperative MR Findings Predictive of Cement Leakage During Vertebroplasty: Low Signal Intensity Linear Lesion in Intervertebral Disk
Am. J. Roentgenol., November 1, 2007; 189(5): W302 - W302.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hiwatashi, A.
Right arrow Articles by Westesson, P.-L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hiwatashi, A.
Right arrow Articles by Westesson, P.-L.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS