BACKGROUND Fibrous dysplasia(FD)is a common benign intramedullary fibro-osseous lesion.Involvement of the spine is rare,with the literature including only case reports,and cases of monostotic FD(MFD)in the sacrum are ...BACKGROUND Fibrous dysplasia(FD)is a common benign intramedullary fibro-osseous lesion.Involvement of the spine is rare,with the literature including only case reports,and cases of monostotic FD(MFD)in the sacrum are extremely rare.A correct preoperative diagnosis of spinal MFD is important for clinicians to select proper treatment.CASE SUMMARY We retrospectively assessed a case report of MFD in the sacrum.This patient was examined by computed tomography(CT)and magnetic resonance imaging(MRI),and the diagnosis was confirmed by pathology.A review of the literature was performed to analyze the imaging characteristics and differential diagnoses of spinal MFD.For our patient,the CT scan showed the lesion to be expansile,with ground glass opacity and a sclerotic rim.On MRI,the lesion showed iso-low signal intensity on T1WI and iso-high signal intensity on T2WI.A low signal rim was found on T1WI and T2WI.Our patient was treated by posterior focal excision,decompression,bone grafting,fusion and pedicle screw fixation.A satisfactory result was achieved,with pain disappearance.No complications had occurred at the 1-year follow up.CONCLUSION MFD is an expansile osteolytic change.Ground glass opacity and a sclerotic margin are obvious characteristics.The lesion often involves the vertebral body and posterior element.Knowledge of these imaging characteristics of spinal FD could be helpful for diagnosis and prevent unnecessary procedures.展开更多
Introduction: Osseous eosinophilic granulomas commonly occur in the skull, pelvis, vertebrae, mandible, and ribs. However, the eosinophilic granuloma in the sacrum is rare. Case presentation: We present the case of a ...Introduction: Osseous eosinophilic granulomas commonly occur in the skull, pelvis, vertebrae, mandible, and ribs. However, the eosinophilic granuloma in the sacrum is rare. Case presentation: We present the case of a 13-year-old Japanese boy, who presented with left low-back pain, and was diagnosed with eosinophilic granuloma arising in the sacrum. Computed tomography (CT) and magnetic resonance imaging demonstrated an osteolytic lesion with interruption of the cortex, and signal intensity changes at the left sacral body and wing. Histologic examination indicated an eosinophilic granuloma. Two years after CT-guided biopsy, the tumor had spontaneously healed completely, with no residual pain.Conclusion: The present case was eosiophilic granuloma arising from the rare site of sacrum. The tumor was completely remodeled two years after biopsy.展开更多
The article concerns the commission that was made by the Biennale di Venezia to Stravinsky in the 50s＇ which led to the composition of the Canticum Sacrum. The discovery of the correspondence between the composer, th...The article concerns the commission that was made by the Biennale di Venezia to Stravinsky in the 50s＇ which led to the composition of the Canticum Sacrum. The discovery of the correspondence between the composer, the artistic director Alessandro Piovesan and the organizers of the Venetian Festival allows to reconstruct the events that led Stravinsky to change his initial plans for a Passion selon Saint Marc in favour of a short Canticum. The objections, which concerned above all the limited size of the piece, were repeated several times by Piovesan, but were all disregarded by Stravinsky. In the light of the eight letters deposited in the Archivio Storico delle Arti Contemporanee （ASAC） of Venice （in Appendix）, the circumstances bringing about Stravinsky＇s refusal can be fully understood. The references to recent studies by David H. Smyth, Akane Mori, and Jonathan Kramer regarding the identification of palindromic and proportional structures in the Canticum, offers further proof sustaining Stravinsky＇s declaration that to enlarge the piece would have been impossible. These events confirm the composer＇s unbending determination to undertake a new experimental stylistic direction already tried out in pieces like the Three Songs from William Shakespeare and Agon.展开更多
As quality and cost effectiveness become essential in clinical practice,an evidencebased evaluation of the utility of imaging orders becomes an important consideration for radiology’s value in patient care.We report ...As quality and cost effectiveness become essential in clinical practice,an evidencebased evaluation of the utility of imaging orders becomes an important consideration for radiology’s value in patient care.We report an institutional quality improvement project including a retrospective review of utility of sacrum magnetic resonance(MR)imaging for low back pain at our institution over a four-year period and follow-up results after physician education intervention.Sacral MR imaging for low back pain and tailbone pain were only positive for major findings in 2/98(2%)cases,and no major changes in patient management related to imaging findings occurred over this period,resulting in almost$500000 cost without significant patient benefit.We distributed these results to the Family Medicine department and clinics that frequently placed this order.An approximately 83%drop in ordering rate occurred over the ensuing 3 mo follow-up period.Sacrum MR imaging for low back pain and tail bone pain has not been a cost-effective diagnostic tool at our institution.Physician education was a useful tool in reducing overutilization of this study,with a remarkable drop in such studies after sharing these findings with primary care physicians at the institution.In conclusion,sacrum MR imaging rarely elucidates the cause of low back/tail pain diagnosed in a primary care setting and is even less likely to result in major changes in management.The practice can be adopted in other institutions for the benefit of their patients and improve cost efficiency.展开更多
Spondylolysis is generally attributed to stress fracture, due to movement of the affected vertebrae relative to the vertebra below and is most common in lower lumbar vertebrae.Since S1 and S2 are fused, spondylolysis ...Spondylolysis is generally attributed to stress fracture, due to movement of the affected vertebrae relative to the vertebra below and is most common in lower lumbar vertebrae.Since S1 and S2 are fused, spondylolysis of S1 due to stress fracture would unlikely to occur. Although there have been some reports of S1 spondylolysis in ancient Alaskan and Canadian lnuit skeletons, no clinical S1 spondylolysis case due to stress fracture has been reported until now. A 17-year-old, female gymnast with incomplete spondylolysis of S1 is presented here.展开更多
This study aimed at evaluating the possibility and effectiveness of osteoinductive bioceramics to fill the tumor cavity following the curettage of sacral giant cell tumor(GCT).Six patients(four females and two males,2...This study aimed at evaluating the possibility and effectiveness of osteoinductive bioceramics to fill the tumor cavity following the curettage of sacral giant cell tumor(GCT).Six patients(four females and two males,25–45 years old)underwent nervesparing surgery,in which the tumor was treated by denosumab,preoperative arterial embolization and extensive curettage.The remaining cavity was filled with commercial osteoinductive calcium phosphate(CaP)bioceramics,whose excellent osteoinductivity was confirmed by intramuscular implantation in beagle canine.All patients were followed by computed tomography(CT)scans postoperatively.According to the modified Neer criterion,five cases obtained Type I healing status,and one case had Type II.At the latest follow-up,no graft-related complications and local recurrence were found.The CT scan indicated a median time of healing initiation of 3months postoperatively,and the median time for relatively complete healing was 12months.The excellent bone regenerative ability of the ceramics was also confirmed by increased CT attenuation value,blurred boundary and cortical rim rebuilding.In conclusion,osteoinductive CaP bioceramics could be an ideal biomaterial to treat the large remaining cavity following extensive curettage of sacral GCT.However,further investigation with more cases and longer follow-up was required to confirm the final clinical effect.展开更多
目的对国人经第1第2骶椎骶髂(sacral alar-iliac,SAI)螺钉固定钉道各参数进行CT测量,比较S1AI和S2AI螺钉钉道解剖参数差异。方法随机选取2015年4-10月本院影像归档和通信系统中60例骨骼发育成熟且骨盆正常国人的三维计算机断层扫描(3DCT...目的对国人经第1第2骶椎骶髂(sacral alar-iliac,SAI)螺钉固定钉道各参数进行CT测量,比较S1AI和S2AI螺钉钉道解剖参数差异。方法随机选取2015年4-10月本院影像归档和通信系统中60例骨骼发育成熟且骨盆正常国人的三维计算机断层扫描(3DCT)重建数据进行分析。S1和S2骶髂骨螺钉钉道参数中最大长度和宽度的轨迹通过旋转并截取三维骨盆获得。对长度和角度参数进行评估和比较。结果 S1AI置钉较S2AI置钉尾向倾角大,男性平均增加约26°,女性平均增加约24°[男性S1(57.25±4.37)°vs S2(31.02±7.43)°,女性S1(58.61±5.11)°vs S2(34.16±6.02)°;P<0.05];外倾稍小,男性、女性皆平均减少2°[男性S1(38.14±3.10)°vs S2(40.25±2.84)°,女性S1(37.24±2.96°)vs S2(39.25±2.64°);P<0.05];最长钉道长度:男性S1(119.46±3.77)mm vs S2(120.04±6.52)mm(P=0.551),女性S1(108.21±5.24)mm vs S2(109.47±4.63)mm(P=0.434);骶骨内钉道长度:男性S1(43.12±4.63)mm vs S2(35.75±5.03)mm(P<0.05),女性S1(39.73±5.85)mm vs S2(32.16±5.28)mm(P<0.05);髂骨内宽度:男性S1(22.05±4.91)mm vs S2(21.49±3.22)mm(P=0.672),女性S1(16.93±2.12)mm vs S2(15.35±2.71)mm(P=0.366);骨皮质距离:男性S1(9.42±2.41)mm vs S2(9.01±2.33)mm(P=0.352),女性S1(5.92±1.48)mm vs S2(6.34±1.26)mm(P=0.837)。S1AI与S2AI的入钉点比较,距皮肤距离、距中线距离、距髂后上棘距离均有统计学差异。结论国人成人骨盆存在最佳骶髂骨螺钉置钉钉道时,S1AI及S2AI螺钉均具有可行性。S1AI螺钉较S2AI螺钉置钉角度尾向倾角男性平均增加约26°,女性平均增加约24°,外倾稍小,男性女性皆平均减少2°,最长置钉长度基本相同,S1AI的入钉点距皮肤和髂后上棘更深,距中线稍远。临床操作中应注意S1和S2骶髂骨螺钉置钉角度、钉道长度及入钉点的差异。展开更多
文摘BACKGROUND Fibrous dysplasia(FD)is a common benign intramedullary fibro-osseous lesion.Involvement of the spine is rare,with the literature including only case reports,and cases of monostotic FD(MFD)in the sacrum are extremely rare.A correct preoperative diagnosis of spinal MFD is important for clinicians to select proper treatment.CASE SUMMARY We retrospectively assessed a case report of MFD in the sacrum.This patient was examined by computed tomography(CT)and magnetic resonance imaging(MRI),and the diagnosis was confirmed by pathology.A review of the literature was performed to analyze the imaging characteristics and differential diagnoses of spinal MFD.For our patient,the CT scan showed the lesion to be expansile,with ground glass opacity and a sclerotic rim.On MRI,the lesion showed iso-low signal intensity on T1WI and iso-high signal intensity on T2WI.A low signal rim was found on T1WI and T2WI.Our patient was treated by posterior focal excision,decompression,bone grafting,fusion and pedicle screw fixation.A satisfactory result was achieved,with pain disappearance.No complications had occurred at the 1-year follow up.CONCLUSION MFD is an expansile osteolytic change.Ground glass opacity and a sclerotic margin are obvious characteristics.The lesion often involves the vertebral body and posterior element.Knowledge of these imaging characteristics of spinal FD could be helpful for diagnosis and prevent unnecessary procedures.
文摘Introduction: Osseous eosinophilic granulomas commonly occur in the skull, pelvis, vertebrae, mandible, and ribs. However, the eosinophilic granuloma in the sacrum is rare. Case presentation: We present the case of a 13-year-old Japanese boy, who presented with left low-back pain, and was diagnosed with eosinophilic granuloma arising in the sacrum. Computed tomography (CT) and magnetic resonance imaging demonstrated an osteolytic lesion with interruption of the cortex, and signal intensity changes at the left sacral body and wing. Histologic examination indicated an eosinophilic granuloma. Two years after CT-guided biopsy, the tumor had spontaneously healed completely, with no residual pain.Conclusion: The present case was eosiophilic granuloma arising from the rare site of sacrum. The tumor was completely remodeled two years after biopsy.
文摘The article concerns the commission that was made by the Biennale di Venezia to Stravinsky in the 50s＇ which led to the composition of the Canticum Sacrum. The discovery of the correspondence between the composer, the artistic director Alessandro Piovesan and the organizers of the Venetian Festival allows to reconstruct the events that led Stravinsky to change his initial plans for a Passion selon Saint Marc in favour of a short Canticum. The objections, which concerned above all the limited size of the piece, were repeated several times by Piovesan, but were all disregarded by Stravinsky. In the light of the eight letters deposited in the Archivio Storico delle Arti Contemporanee （ASAC） of Venice （in Appendix）, the circumstances bringing about Stravinsky＇s refusal can be fully understood. The references to recent studies by David H. Smyth, Akane Mori, and Jonathan Kramer regarding the identification of palindromic and proportional structures in the Canticum, offers further proof sustaining Stravinsky＇s declaration that to enlarge the piece would have been impossible. These events confirm the composer＇s unbending determination to undertake a new experimental stylistic direction already tried out in pieces like the Three Songs from William Shakespeare and Agon.
文摘As quality and cost effectiveness become essential in clinical practice,an evidencebased evaluation of the utility of imaging orders becomes an important consideration for radiology’s value in patient care.We report an institutional quality improvement project including a retrospective review of utility of sacrum magnetic resonance(MR)imaging for low back pain at our institution over a four-year period and follow-up results after physician education intervention.Sacral MR imaging for low back pain and tailbone pain were only positive for major findings in 2/98(2%)cases,and no major changes in patient management related to imaging findings occurred over this period,resulting in almost$500000 cost without significant patient benefit.We distributed these results to the Family Medicine department and clinics that frequently placed this order.An approximately 83%drop in ordering rate occurred over the ensuing 3 mo follow-up period.Sacrum MR imaging for low back pain and tail bone pain has not been a cost-effective diagnostic tool at our institution.Physician education was a useful tool in reducing overutilization of this study,with a remarkable drop in such studies after sharing these findings with primary care physicians at the institution.In conclusion,sacrum MR imaging rarely elucidates the cause of low back/tail pain diagnosed in a primary care setting and is even less likely to result in major changes in management.The practice can be adopted in other institutions for the benefit of their patients and improve cost efficiency.
文摘Spondylolysis is generally attributed to stress fracture, due to movement of the affected vertebrae relative to the vertebra below and is most common in lower lumbar vertebrae.Since S1 and S2 are fused, spondylolysis of S1 due to stress fracture would unlikely to occur. Although there have been some reports of S1 spondylolysis in ancient Alaskan and Canadian lnuit skeletons, no clinical S1 spondylolysis case due to stress fracture has been reported until now. A 17-year-old, female gymnast with incomplete spondylolysis of S1 is presented here.
文摘This study aimed at evaluating the possibility and effectiveness of osteoinductive bioceramics to fill the tumor cavity following the curettage of sacral giant cell tumor(GCT).Six patients(four females and two males,25–45 years old)underwent nervesparing surgery,in which the tumor was treated by denosumab,preoperative arterial embolization and extensive curettage.The remaining cavity was filled with commercial osteoinductive calcium phosphate(CaP)bioceramics,whose excellent osteoinductivity was confirmed by intramuscular implantation in beagle canine.All patients were followed by computed tomography(CT)scans postoperatively.According to the modified Neer criterion,five cases obtained Type I healing status,and one case had Type II.At the latest follow-up,no graft-related complications and local recurrence were found.The CT scan indicated a median time of healing initiation of 3months postoperatively,and the median time for relatively complete healing was 12months.The excellent bone regenerative ability of the ceramics was also confirmed by increased CT attenuation value,blurred boundary and cortical rim rebuilding.In conclusion,osteoinductive CaP bioceramics could be an ideal biomaterial to treat the large remaining cavity following extensive curettage of sacral GCT.However,further investigation with more cases and longer follow-up was required to confirm the final clinical effect.
文摘目的对国人经第1第2骶椎骶髂(sacral alar-iliac,SAI)螺钉固定钉道各参数进行CT测量,比较S1AI和S2AI螺钉钉道解剖参数差异。方法随机选取2015年4-10月本院影像归档和通信系统中60例骨骼发育成熟且骨盆正常国人的三维计算机断层扫描(3DCT)重建数据进行分析。S1和S2骶髂骨螺钉钉道参数中最大长度和宽度的轨迹通过旋转并截取三维骨盆获得。对长度和角度参数进行评估和比较。结果 S1AI置钉较S2AI置钉尾向倾角大,男性平均增加约26°,女性平均增加约24°[男性S1(57.25±4.37)°vs S2(31.02±7.43)°,女性S1(58.61±5.11)°vs S2(34.16±6.02)°;P<0.05];外倾稍小,男性、女性皆平均减少2°[男性S1(38.14±3.10)°vs S2(40.25±2.84)°,女性S1(37.24±2.96°)vs S2(39.25±2.64°);P<0.05];最长钉道长度:男性S1(119.46±3.77)mm vs S2(120.04±6.52)mm(P=0.551),女性S1(108.21±5.24)mm vs S2(109.47±4.63)mm(P=0.434);骶骨内钉道长度:男性S1(43.12±4.63)mm vs S2(35.75±5.03)mm(P<0.05),女性S1(39.73±5.85)mm vs S2(32.16±5.28)mm(P<0.05);髂骨内宽度:男性S1(22.05±4.91)mm vs S2(21.49±3.22)mm(P=0.672),女性S1(16.93±2.12)mm vs S2(15.35±2.71)mm(P=0.366);骨皮质距离:男性S1(9.42±2.41)mm vs S2(9.01±2.33)mm(P=0.352),女性S1(5.92±1.48)mm vs S2(6.34±1.26)mm(P=0.837)。S1AI与S2AI的入钉点比较,距皮肤距离、距中线距离、距髂后上棘距离均有统计学差异。结论国人成人骨盆存在最佳骶髂骨螺钉置钉钉道时,S1AI及S2AI螺钉均具有可行性。S1AI螺钉较S2AI螺钉置钉角度尾向倾角男性平均增加约26°,女性平均增加约24°,外倾稍小,男性女性皆平均减少2°,最长置钉长度基本相同,S1AI的入钉点距皮肤和髂后上棘更深,距中线稍远。临床操作中应注意S1和S2骶髂骨螺钉置钉角度、钉道长度及入钉点的差异。
