• Julien Potet, Gabrielle Weber-Donat, Emmanuel Curis, François-Xavier Arnaud, Alphonse Thome, Laura Valbousquet, Evelyne Peroux, Yann Geffroy, Caroline Bouzad, Yann Kervella, Marion Lahutte, Elsa Ukkola-Pons, Jacques Baccialone, and Christophe A Teriitehau.
• Radiology Department, Percy Military Hospital, Avenue Henri Barbusse, 92140 Clamart, France. Electronic address: potet_julien@yahoo.fr.
• J Vasc Interv Radiol. 2013 Dec 1; 24 (12): 1853-60.

PurposeTo prospectively evaluate the incidence of pulmonary cement embolism (PCE) after vertebroplasty in procedures performed under real-time computed tomographic (CT) fluoroscopy guidance.Materials And MethodsA 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.ResultsNo 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%).ConclusionsPCE 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.Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

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