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

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.

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.

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).

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.