Skip to main content
Top
Published in: Neuroradiology 11/2012

01-11-2012 | Interventional Neuroradiology

Osteoporotic vertebral compression fracture augmentation by injectable partly resorbable ceramic bone substitute (Cerament™|SPINESUPPORT): a prospective nonrandomized study

Authors: Salvatore Masala, Giovanni Nano, Stefano Marcia, Mario Muto, Francesco P. M. Fucci, Giovanni Simonetti

Published in: Neuroradiology | Issue 11/2012

Login to get access

Abstract

Introduction

This study aimed to evaluate long-term stabilizing healing effectiveness and influence on adjacent intact vertebral bodies of a new injectable partly resorbable calcium sulfate (60 wt.%)/hydroxyapatite (40 wt.%) bone substitute employed in vertebral augmentation of osteoporotic collapses.

Methods

From April 2009 to April 2011, 80 patients underwent vertebral augmentation. Patient enrolment criteria are as follows: age more than 20 years; symptomatic osteoporotic vertebral compression fracture from low energy trauma encompassing level T5 to L1 and classified as A1.1 to A1.2 according to the AO classification system; vertebral height compression within 0–75% compared to the posterior (dorsal) wall; client history confirming the age of the compression fracture to be within at least 4 weeks; and patients who are able to understand the procedure and participate in the study. Preoperative and postoperative imaging studies consisted of computed tomography, plain X-ray, dual X-ray absorptiometry scanning, and magnetic resonance. Pain intensity has been evaluated by an 11-point visual analog scale (VAS), and physical and quality of life compromise assessments have been evaluated by Oswestry Disability Questionnaire (ODI). All procedures have been performed fluoroscopically guided by left unilateral approach under local anesthesia and mild sedation.

Results

VAS-based pain trend over 12-month follow-up has shown a statistical significant (p < 0.001) decrease, starting from 7.68 (SD 1.83) preoperatively with an immediate first day decrease at 3.51 (SD 2.16) and 0.96 (SD 0.93) at 12 months. The ODI score dropped significantly from 54.78% to 20.12% at 6 months. None device-related complication has been reported. In no case, a new incidental adjacent fracture has been reported.

Conclusion

Data show how this injectable partly resorbable ceramic cement could be a nontoxic and lower stiffness alternative to polymethylmethacrylate for immediate and long-term stabilization of osteoporotic collapsed vertebral bodies.
Literature
1.
go back to reference Riggs BL, Melton LJ 3rd (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17(5 Suppl):505S–511SPubMedCrossRef Riggs BL, Melton LJ 3rd (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17(5 Suppl):505S–511SPubMedCrossRef
2.
go back to reference Phillips FM (2003) Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 28(15 Suppl):S45–S53 Phillips FM (2003) Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 28(15 Suppl):S45–S53
3.
go back to reference Kumar K, Verma AK, Wilson J, LaFontaine A (2005) Vertebroplasty in osteoporotic spine fractures: a quality of life assessment. Can J Neurol Sci 32(4):487–495PubMed Kumar K, Verma AK, Wilson J, LaFontaine A (2005) Vertebroplasty in osteoporotic spine fractures: a quality of life assessment. Can J Neurol Sci 32(4):487–495PubMed
4.
go back to reference McKiernan F, Faciszewski T, Jensen R (2004) Quality of life following vertebroplasty. J Bone Joint Surg Am 86-A(12):2600–2606PubMed McKiernan F, Faciszewski T, Jensen R (2004) Quality of life following vertebroplasty. J Bone Joint Surg Am 86-A(12):2600–2606PubMed
5.
go back to reference McGirt MJ, Parker SL, Wolinsky JP et al (2009) Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J 9(6):501–508, Epub 2009 Feb 28PubMedCrossRef McGirt MJ, Parker SL, Wolinsky JP et al (2009) Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J 9(6):501–508, Epub 2009 Feb 28PubMedCrossRef
6.
go back to reference Garfin SR, Reilley MA (2002) Minimally invasive treatment of osteoporotic vertebral body compression fractures. Spine J 2(1):76–80PubMedCrossRef Garfin SR, Reilley MA (2002) Minimally invasive treatment of osteoporotic vertebral body compression fractures. Spine J 2(1):76–80PubMedCrossRef
7.
go back to reference Jang JS, Kim DY, Lee SH (2003) Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with non-infected avascular necrosis of the vertebral body. Spine (Phila Pa 1976) 28(14):1588–1592 Jang JS, Kim DY, Lee SH (2003) Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with non-infected avascular necrosis of the vertebral body. Spine (Phila Pa 1976) 28(14):1588–1592
8.
go back to reference Jensen ME, Evans AJ, Mathis JM et al (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 18(10):1897–1904PubMed Jensen ME, Evans AJ, Mathis JM et al (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 18(10):1897–1904PubMed
9.
go back to reference Gangi A, Clark WA (2010) Have recent vertebroplasty trials changed the indications for vertebroplasty? Cardiovasc Interv Radiol 33(4):677–680CrossRef Gangi A, Clark WA (2010) Have recent vertebroplasty trials changed the indications for vertebroplasty? Cardiovasc Interv Radiol 33(4):677–680CrossRef
10.
go back to reference Galibert P et al (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33:166–168 [in French]PubMed Galibert P et al (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33:166–168 [in French]PubMed
11.
go back to reference Lieberman IH, Togawa D, Kayanja MM (2005) Vertebroplasty and kyphoplasty: filler materials. Spine J 5(6 suppl):305S–316SPubMedCrossRef Lieberman IH, Togawa D, Kayanja MM (2005) Vertebroplasty and kyphoplasty: filler materials. Spine J 5(6 suppl):305S–316SPubMedCrossRef
12.
go back to reference Anselmetti GC, Manca A, Kanika K, Murphy K, Eminefendic H, Masala S, Regge D (2009) Temperature measurement during polymerization of bone cement in percutaneous vertebroplasty: an in vivo study in humans. Cardiovasc Interv Radiol 32(3):491–498, Epub 2009 Mar 12CrossRef Anselmetti GC, Manca A, Kanika K, Murphy K, Eminefendic H, Masala S, Regge D (2009) Temperature measurement during polymerization of bone cement in percutaneous vertebroplasty: an in vivo study in humans. Cardiovasc Interv Radiol 32(3):491–498, Epub 2009 Mar 12CrossRef
13.
go back to reference Aebli N, Goss BG, Thorpe P, Williams R, Krebs J (2006) In vivo temperature profile of intervertebral discs and vertebral endplates during vertebroplasty: an experimental study in sheep. Spine (Phila Pa 1976) 31(15):1674–1679CrossRef Aebli N, Goss BG, Thorpe P, Williams R, Krebs J (2006) In vivo temperature profile of intervertebral discs and vertebral endplates during vertebroplasty: an experimental study in sheep. Spine (Phila Pa 1976) 31(15):1674–1679CrossRef
14.
go back to reference Kriek JJ, Govender S (2006) AO-classification of thoracic and lumbar fractures: reproducibility utilizing radiographs and clinical information. Eur Spine J 15(8):1239–1246, Epub 2005 Dec 21PubMedCrossRef Kriek JJ, Govender S (2006) AO-classification of thoracic and lumbar fractures: reproducibility utilizing radiographs and clinical information. Eur Spine J 15(8):1239–1246, Epub 2005 Dec 21PubMedCrossRef
15.
go back to reference Dasher LG, Newton CD, Lenchik L (2010) Dual X-ray absorptiometry in today’s clinical practice. Radiol Clin N Am 48(3):541–560PubMedCrossRef Dasher LG, Newton CD, Lenchik L (2010) Dual X-ray absorptiometry in today’s clinical practice. Radiol Clin N Am 48(3):541–560PubMedCrossRef
16.
go back to reference Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23(18):2003–2013CrossRef Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23(18):2003–2013CrossRef
17.
go back to reference Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, De Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 33(1):90–94CrossRef Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, De Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 33(1):90–94CrossRef
18.
go back to reference Mathis JM (2003) Percutaneous vertebroplasty: complication avoidance and technique optimization. AJNR Am J Neuroradiol 24(8):1697–1706PubMed Mathis JM (2003) Percutaneous vertebroplasty: complication avoidance and technique optimization. AJNR Am J Neuroradiol 24(8):1697–1706PubMed
19.
go back to reference Stubbs D, Deakin M, Chapman-Sheath P, Bruce W, Debes J, Gillies RM, Walsh WR (2004) In vivo evaluation of resorbable bone graft substitutes in a rabbit tibial defect model. Biomaterials 25(20):5037–5044PubMedCrossRef Stubbs D, Deakin M, Chapman-Sheath P, Bruce W, Debes J, Gillies RM, Walsh WR (2004) In vivo evaluation of resorbable bone graft substitutes in a rabbit tibial defect model. Biomaterials 25(20):5037–5044PubMedCrossRef
20.
go back to reference Nilsson M, Wang JS, Wielanek L, Tanner KE, Lidgren L (2004) Biodegradation and biocompatibility of a calcium sulphate-hydroxyapatite bone substitute. J Bone Joint Surg Br 86(1):120–125PubMed Nilsson M, Wang JS, Wielanek L, Tanner KE, Lidgren L (2004) Biodegradation and biocompatibility of a calcium sulphate-hydroxyapatite bone substitute. J Bone Joint Surg Br 86(1):120–125PubMed
21.
go back to reference Spivak JM, Hasharoni A (2001) Use of hydroxyapatite in spine surgery. Eur Spine J 10(Suppl 2):S197–S204PubMedCrossRef Spivak JM, Hasharoni A (2001) Use of hydroxyapatite in spine surgery. Eur Spine J 10(Suppl 2):S197–S204PubMedCrossRef
22.
go back to reference Abramo A, Geijer M, Kopylov P, Tägil M (2010) Osteotomy of distal radius fracture malunion using a fast remodeling bone substitute consisting of calcium sulphate and calcium phosphate. J Biomed Mater Res B Appl Biomater 92(1):281–286PubMed Abramo A, Geijer M, Kopylov P, Tägil M (2010) Osteotomy of distal radius fracture malunion using a fast remodeling bone substitute consisting of calcium sulphate and calcium phosphate. J Biomed Mater Res B Appl Biomater 92(1):281–286PubMed
23.
go back to reference De Laet CE, Van der Klift M, Hofman A, Pols HA (2002) Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res 17(12):2231–2236PubMedCrossRef De Laet CE, Van der Klift M, Hofman A, Pols HA (2002) Osteoporosis in men and women: a story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res 17(12):2231–2236PubMedCrossRef
24.
go back to reference Theodorou DJ, Theodorou SJ (2002) Dual-energy X-ray absorptiometry in clinical practice: application and interpretation of scans beyond the numbers. Clin Imaging 26(1):43–49PubMedCrossRef Theodorou DJ, Theodorou SJ (2002) Dual-energy X-ray absorptiometry in clinical practice: application and interpretation of scans beyond the numbers. Clin Imaging 26(1):43–49PubMedCrossRef
25.
go back to reference El Maghraoui A, Roux C (2008) DXA scanning in clinical practice. QJM 101(8):605–617, Epub 2008 Mar 10PubMedCrossRef El Maghraoui A, Roux C (2008) DXA scanning in clinical practice. QJM 101(8):605–617, Epub 2008 Mar 10PubMedCrossRef
26.
go back to reference Kamel HK (2005) Male osteoporosis: new trends in diagnosis and therapy. Drugs Aging 22(9):741–748PubMedCrossRef Kamel HK (2005) Male osteoporosis: new trends in diagnosis and therapy. Drugs Aging 22(9):741–748PubMedCrossRef
27.
go back to reference Nevitt MC, Ross PD, Palermo L, Musliner T, Genant HK, Thompson DE (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. Bone 25(5):613–619PubMedCrossRef Nevitt MC, Ross PD, Palermo L, Musliner T, Genant HK, Thompson DE (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. Bone 25(5):613–619PubMedCrossRef
28.
go back to reference Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13(suppl 2):S27–S31PubMedCrossRef Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13(suppl 2):S27–S31PubMedCrossRef
29.
go back to reference Melton LJ, Kan SH, Frye MA et al (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129(5):1000–1011PubMed Melton LJ, Kan SH, Frye MA et al (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129(5):1000–1011PubMed
30.
go back to reference Cooper C, Atkinson EJ, O’Fallon WM et al (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7(2):221–227PubMedCrossRef Cooper C, Atkinson EJ, O’Fallon WM et al (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7(2):221–227PubMedCrossRef
31.
go back to reference Jensen ME, Dion JE (1997) Vertebroplasty relieves osteoporosis pain. Diagn Imaging (San Franc) 19(9):68–72 Jensen ME, Dion JE (1997) Vertebroplasty relieves osteoporosis pain. Diagn Imaging (San Franc) 19(9):68–72
32.
go back to reference Belkoff SM, Molloy S (2003) Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty. Spine 28(14):1555–1559PubMed Belkoff SM, Molloy S (2003) Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty. Spine 28(14):1555–1559PubMed
33.
go back to reference Yetkinler DN, Litsky AS (1998) Viscoelastic behaviour of acrylic bone cements. Biomaterials 19(17):1551–1559PubMedCrossRef Yetkinler DN, Litsky AS (1998) Viscoelastic behaviour of acrylic bone cements. Biomaterials 19(17):1551–1559PubMedCrossRef
34.
go back to reference Ahn DK, Lee S, Choi DJ, Park SY, Woo DG, Kim CH, Kim HS (2009) Mechanical properties of blood-mixed polymethylmetacrylate in percutaneous vertebroplasty. Asian Spine J 3(2):45–52, Epub 2009 Dec 31PubMedCrossRef Ahn DK, Lee S, Choi DJ, Park SY, Woo DG, Kim CH, Kim HS (2009) Mechanical properties of blood-mixed polymethylmetacrylate in percutaneous vertebroplasty. Asian Spine J 3(2):45–52, Epub 2009 Dec 31PubMedCrossRef
35.
go back to reference Lin EP, Ekholm S, Hiwatashi A, Westesson PL (2004) Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 25:175–180PubMed Lin EP, Ekholm S, Hiwatashi A, Westesson PL (2004) Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol 25:175–180PubMed
36.
go back to reference Williams JL, Johnson WJ (1989) Elastic constants of composites formed from PMMA bone cement and anisotropic bovine tibial cancellous bone. J Biomech 22(6–7):673–682PubMedCrossRef Williams JL, Johnson WJ (1989) Elastic constants of composites formed from PMMA bone cement and anisotropic bovine tibial cancellous bone. J Biomech 22(6–7):673–682PubMedCrossRef
37.
go back to reference Frankel BM, Monroe T, Wang C (2007) Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. Spine J 7:575–582PubMedCrossRef Frankel BM, Monroe T, Wang C (2007) Percutaneous vertebral augmentation: an elevation in adjacent-level fracture risk in kyphoplasty as compared with vertebroplasty. Spine J 7:575–582PubMedCrossRef
38.
go back to reference Chevalier Y, Pahr D, Charlebois M, Heini P, Schneider E, Zysset P (2008) Cement distribution, volume, and compliance in vertebroplasty: some answers from an anatomy-based nonlinear finite element study. Spine (Phila Pa 1976) 33(16):1722–1730CrossRef Chevalier Y, Pahr D, Charlebois M, Heini P, Schneider E, Zysset P (2008) Cement distribution, volume, and compliance in vertebroplasty: some answers from an anatomy-based nonlinear finite element study. Spine (Phila Pa 1976) 33(16):1722–1730CrossRef
39.
go back to reference Polikeit A, Nolte LP, Ferguson SJ (2003) The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976) 28(10):991–996 Polikeit A, Nolte LP, Ferguson SJ (2003) The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine (Phila Pa 1976) 28(10):991–996
40.
go back to reference Masala S, Nano G, Mammucari M, Simonetti G (2010) Kummel disease treatment by unipedicular vertebral augmentation using curved injection cannula. Cardiovasc Interv Radiol 34(5):1014–1020CrossRef Masala S, Nano G, Mammucari M, Simonetti G (2010) Kummel disease treatment by unipedicular vertebral augmentation using curved injection cannula. Cardiovasc Interv Radiol 34(5):1014–1020CrossRef
41.
go back to reference Liebschner MA, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976) 26(14):1547–1554CrossRef Liebschner MA, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976) 26(14):1547–1554CrossRef
42.
go back to reference JS Wang et al. (2006) Biomechanics and bone integration on injectable calcium sulphate and hydroxyapatite in large bone defect in rat, Abstract, American Orthopedic Research Society, Chicago, 18–22 March JS Wang et al. (2006) Biomechanics and bone integration on injectable calcium sulphate and hydroxyapatite in large bone defect in rat, Abstract, American Orthopedic Research Society, Chicago, 18–22 March
43.
go back to reference Wang JS, Goodman S, Aspenberg P (1994) Bone formation in the presence of phagocytosable hydroxyapatite particles. Clin Orthop 304:272–279PubMed Wang JS, Goodman S, Aspenberg P (1994) Bone formation in the presence of phagocytosable hydroxyapatite particles. Clin Orthop 304:272–279PubMed
44.
go back to reference Sato S, Koshino T, Saito T (1998) Osteogenic response of rabbit tibia to hydroxyapatite particle—Plaster of Paris mixture. Biomaterials 19:1895–1900PubMedCrossRef Sato S, Koshino T, Saito T (1998) Osteogenic response of rabbit tibia to hydroxyapatite particle—Plaster of Paris mixture. Biomaterials 19:1895–1900PubMedCrossRef
45.
go back to reference Watson JT (2004) The use of an injectable bone graft substitute in tibial metaphyseal fractures. Orthopedics 27(1 Suppl):S103–S107PubMed Watson JT (2004) The use of an injectable bone graft substitute in tibial metaphyseal fractures. Orthopedics 27(1 Suppl):S103–S107PubMed
46.
go back to reference Hierholzer J, Fuchs H, Westphalen K, Baumann C, Slotosch C, Schulz R (2008) Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty. Cardiovasc Interv Radiol 31(6):1178–1183, Epub 2008 Jul 1CrossRef Hierholzer J, Fuchs H, Westphalen K, Baumann C, Slotosch C, Schulz R (2008) Incidence of symptomatic vertebral fractures in patients after percutaneous vertebroplasty. Cardiovasc Interv Radiol 31(6):1178–1183, Epub 2008 Jul 1CrossRef
47.
go back to reference Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 27:217–223PubMed Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 27:217–223PubMed
48.
go back to reference Pitton MB, Herber S, Bletz C, Drees P, Morgen N, Koch U, Böhm B, Eckardt A, Düber C (2008) CT-guided vertebroplasty in osteoporotic vertebral fractures: incidence of secondary fractures and impact of intradiscal cement leakages during follow-up. Eur Radiol 18(1):43–50, Epub 2007 Jul 19PubMedCrossRef Pitton MB, Herber S, Bletz C, Drees P, Morgen N, Koch U, Böhm B, Eckardt A, Düber C (2008) CT-guided vertebroplasty in osteoporotic vertebral fractures: incidence of secondary fractures and impact of intradiscal cement leakages during follow-up. Eur Radiol 18(1):43–50, Epub 2007 Jul 19PubMedCrossRef
50.
go back to reference Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S, Sawada S (2006) Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Interv Radiol 29:580–585CrossRef Komemushi A, Tanigawa N, Kariya S, Kojima H, Shomura Y, Komemushi S, Sawada S (2006) Percutaneous vertebroplasty for osteoporotic compression fracture: multivariate study of predictors of new vertebral body fracture. Cardiovasc Interv Radiol 29:580–585CrossRef
Metadata
Title
Osteoporotic vertebral compression fracture augmentation by injectable partly resorbable ceramic bone substitute (Cerament™|SPINESUPPORT): a prospective nonrandomized study
Authors
Salvatore Masala
Giovanni Nano
Stefano Marcia
Mario Muto
Francesco P. M. Fucci
Giovanni Simonetti
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 11/2012
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-012-1016-x

Other articles of this Issue 11/2012

Neuroradiology 11/2012 Go to the issue