Spinal vascular malformations: MR angiography after treatment

PURPOSE: To evaluate the role of magnetic resonance (MR) angiography in the assessment of spinal vascular malformation therapy. MATERIALS AND METHODS: Thirty-four patients with spinal vascular malformations (30 dural arteriovenous fistulas, two perimedullary arteriovenous fistulas, and two intramedullary arteriovenous malformations) underwent MR angiography and MR imaging before and after endovascular or surgical treatment. RESULTS: MR angiography showed residual flow in perimedullary vessels in seven patients with dural fistula after embolization with liquid adhesive. In all seven, treatment failure was confirmed with arteriography. Long-lasting disappearance of flow in perimedullary vessels was demonstrated at MR angiography in 22 patients with dural fistula. MR imaging demonstrated normalization of spinal cord volume in 16 of 22 patients and signal intensity on T2-weighted images in three patients. Disappearance of cord enhancement was observed in five of 21 patients and of perimedullary enhanced vessels in six of 13 patients. In one additional patient with dural fistula treated with embolization, early posttreatment MR angiography showed disappearance of flow in perimedullary vessels, which reappeared at follow-up and was consistent with reopening of a small residual fistula. Posttreatment MR angiography demonstrated transient reduction of flow in the nidus in two patients with intramedullary malformations treated with embolization. Permanent disappearance of flow in the perimedullary vessel was seen after endovascular treatment in two patients with perimedullary fistula. CONCLUSION: MR angiography is more sensitive than MR imaging in depicting residual or recurrent flow in peri- or intramedullary vessels, which indicates patency of the vascular malformation

Cognitive load in percentage change problems: unitary, pictorial, and equation approaches to instruction

Eighth grade students in Australia (N = 60) participated in an experiment on learning how to solve percentage change problems in a regular classroom in three conditions: unitary, pictorial, and equation approaches. The procedure involved a pre-test, an acquisition phase, and a post-test. The main goal was to test the relative merits of the three approaches from a cognitive load perspective. Experimental results indicated superior performance of the equation approach over the unitary or pictorial approach especially for the complex tasks. The unitary approach required students not only to process the interaction between numerous elements within and across solution steps, but also to search for critical information, thus imposing high cognitive load. The pictorial approach did not provide a consistent approach to tackling various percentage change problems. Coupled with the need to coordinate multiple elements within and across solution steps, and the need to search for relevant information in the diagram, this approach imposed high cognitive load. By treating the prior knowledge of percentage quantity as a single unit, the equation approach required students to process two elements only. Empirical evidence and theoretical support favor the equation approach as an instructional method for learning how to solve percentage change problems for eighth graders