Detecting asymptomatic cement pulmonary embolisms following vertebral augmentation using dual-energy computed tomography pulmonary angiography

Jo-Yu Chen; Fon-Yih Tsuang; Yen-Heng Lin; Chung-Wei Lee

doi:10.1016/j.jfma.2025.01.015

Detecting asymptomatic cement pulmonary embolisms following vertebral augmentation using dual-energy computed tomography pulmonary angiography

J Formos Med Assoc. 2025 Jan 24:S0929-6646(25)00031-2. doi: 10.1016/j.jfma.2025.01.015. Online ahead of print.

Authors

Jo-Yu Chen¹, Fon-Yih Tsuang², Yen-Heng Lin³, Chung-Wei Lee⁴

Affiliations

¹ Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan.
² Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: linyh@ntuh.gov.tw.
⁴ Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University Cancer Center, Taipei, Taiwan.

PMID: 39863426
DOI: 10.1016/j.jfma.2025.01.015

Abstract

Background and purpose: Dual-energy computed tomography (DECT) pulmonary angiography can reliably detect cement pulmonary embolisms (CPEs) and parenchymal perfusion defects. This prospective observational study investigated CPEs in asymptomatic patients using DECT.

Methods: We enrolled 42 patients who underwent vertebroplasty or received cement screws for vertebral augmentation, examining them using spinal computed tomography and DECT pulmonary angiography. An iodine map was employed to identify perfusion defects. We recorded the number, location, and perfusion defects of each CPE, and the vertebral cement distribution and perivertebral venous leakage patterns of prevertebral, paravertebral, epidural, and inferior vena cava leaks at each treated level. The presence of CPEs and perfusion defects was correlated with clinical factors and perivertebral venous leakage patterns in patient- and level-based analyses.

Results: Seven patients had 19 CPEs among them: fourteen in subsegmental arteries, two in segmental arteries, two in lobar arteries, and one in the main pulmonary artery. Twelve CPEs identified in four patients had corresponding perfusion defects on an iodine map. Patient-based univariable and multivariable logistic regression revealed that prevertebral leakage was significantly associated with the presence of CPEs (P < 0.05). Prevertebral leakage was significantly associated in the univariable analysis with the presence of perfusion defects (P = 0.025). In mixed-model univariable level-based logistic regression, prevertebral leakage was significantly associated with the presence of CPEs (P = 0.04).

Conclusions: CPEs frequently occur following vertebral augmentation, are associated with substantial prevertebral venous leakage, and predominantly occur in the subsegmental pulmonary artery. They do not always cause perfusion defects.

Keywords: Dual energy computed tomography; Pulmonary embolism; Vertebral augmentation.