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Huflage H, Hendel R, Woznicki P, Conrads N, Feldle P, Patzer TS, Ergün S, Bley TA, Kunz AS, Grunz JP. The Small Pixel Effect in Ultra-High-Resolution Photon-Counting CT of the Lumbar Spine. Invest Radiol 2024; 59:629-634. [PMID: 38329822 DOI: 10.1097/rli.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Image acquisition in ultra-high-resolution (UHR) scan mode does not impose a dose penalty in photon-counting CT (PCCT). This study aims to investigate the dose saving potential of using UHR instead of standard-resolution PCCT for lumbar spine imaging. MATERIALS AND METHODS Eight cadaveric specimens were examined with 7 dose levels (5-35 mGy) each in UHR (120 × 0.2 mm) and standard-resolution acquisition mode (144 × 0.4 mm) on a first-generation PCCT scanner. The UHR images were reconstructed with 3 dedicated bone kernels (Br68 [spatial frequency at 10% of the modulation transfer function 14.5 line pairs/cm], Br76 [21.0], and Br84 [27.9]), standard-resolution images with Br68 and Br76. Using automatic segmentation, contrast-to-noise ratios (CNRs) were established for lumbar vertebrae and psoas muscle tissue. In addition, image quality was assessed subjectively by 19 independent readers (15 radiologists, 4 surgeons) using a browser-based forced choice comparison tool totaling 16,974 performed pairwise tests. Pearson's correlation coefficient ( r ) was used to analyze the relationship between CNR and subjective image quality rankings, and Kendall W was calculated to assess interrater agreement. RESULTS Irrespective of radiation exposure level, CNR was higher in UHR datasets than in standard-resolution images postprocessed with the same reconstruction parameters. The use of sharper convolution kernels entailed lower CNR but higher subjective image quality depending on radiation dose. Subjective assessment revealed high interrater agreement ( W = 0.86; P < 0.001) with UHR images being preferred by readers in the majority of comparisons on each dose level. Substantial correlation was ascertained between CNR and the subjective image quality ranking (all r 's ≥ 0.95; P < 0.001). CONCLUSIONS In PCCT of the lumbar spine, UHR mode's smaller pixel size facilitates a considerable CNR increase over standard-resolution imaging, which can either be used for dose reduction or higher spatial resolution depending on the selected convolution kernel.
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Affiliation(s)
- Henner Huflage
- From the Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany (H.H., R.H., P.W., N.C., P.F., T.S., T.A.B., A.S.K., J.-P.G.); and Institute of Anatomy and Cell Biology, University of Würzburg, Würzburg, Germany (S.E.)
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Hollabaugh WL, Foley Davelaar CM, McHorse KJ, Achar SA, MacDonald JP, Riederer MF. Clinical Practice Patterns of Isthmic Spondylolysis in Young Athletes: A Survey of Pediatric Research in Sports Medicine Members. Curr Sports Med Rep 2022; 21:405-412. [PMID: 36342395 DOI: 10.1249/jsr.0000000000001008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ABSTRACT Isthmic spondylolysis is a common cause of back pain in young athletes. The condition presents to numerous medical providers who employ a variety of different practices in diagnosis and management. The purpose of this study was twofold: to review the literature of diagnosis and management of the young athlete with isthmic spondylolysis and to survey Pediatric Research in Sports Medicine (PRiSM) members during the 2021 PRiSM Annual Meeting on practice patterns of diagnosis and management of the young athlete with isthmic spondylolysis. The response rate was 27%. Per respondents: 24% obtain oblique radiographs; 90% use magnetic resonance imaging as the advanced imaging modality; 60% treat with bracing; 57% recommend rest prior to physical therapy (PT); 53% prescribe return to sport activity restrictions. Although there are similarities in the diagnosis of isthmic spondylolysis in young athletes, this survey confirmed variability in management, especially bracing, timing of PT and return to sport activity restrictions.
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Affiliation(s)
- William L Hollabaugh
- Department of Orthopaedic Surgery, Division of Sports Medicine, Vanderbilt University Medical Center, TN
| | - Cassidy M Foley Davelaar
- Nemours Children's Health, Department of Orthopedics and Sports Medicine, University of Central Florida College of Medicine, FL
| | | | - Suraj A Achar
- Department of Family Medicine, Division of Sports Medicine, University of California San Diego Health, CA
| | - James P MacDonald
- Department of Pediatrics, Division of Sports Medicine, Nationwide Children's Hospital, OH
| | - Mark F Riederer
- Department of Orthopaedic Surgery, Divisions of Pediatric Orthopaedics and Sports Medicine, University of Michigan, MI
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Linton AA, Hsu WK. A Review of Treatment for Acute and Chronic Pars Fractures in the Lumbar Spine. Curr Rev Musculoskelet Med 2022; 15:259-271. [DOI: 10.1007/s12178-022-09760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
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Goelz L, Arndt H, Hausmann J, Madeja C, Mutze S. Obstacles and Solutions Driving the Development of a National Teleradiology Network. Healthcare (Basel) 2021; 9:healthcare9121684. [PMID: 34946410 PMCID: PMC8701208 DOI: 10.3390/healthcare9121684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Teleradiology has the potential to link medical experts and specialties despite geographical separation. In a project report about hospital-based teleradiology, the significance of technical and human factors during the implementation and growth of a teleradiology network are explored. Evaluation: The article identifies major obstacles during the implementation and growth of the teleradiology network of the Berlin Trauma Hospital (BG Unfallkrankenhaus Berlin) between 2004 and 2020 in semi-structured interviews with senior staff members. Quantitative analysis of examination numbers, patient numbers, and profits relates the efforts of the staff members to the monetary benefits and success of the network. Identification of qualitative and quantitative factors for success: Soft and hard facilitators and solutions driving the development of the national teleradiology network are identified. Obstacles were often solved by technical innovations, but the time span between required personal efforts, endurance, and flexibility of local and external team members. The article describes innovations driven by teleradiology and hints at the impact of teleradiology on modern medical care by relating the expansion of the teleradiology network to patient transfers and profits. Conclusion: In addition to technical improvements, interpersonal collaborations were key to the success of the teleradiology network of the Berlin Trauma Hospital and remained a unique feature and selling point of this teleradiology network.
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Affiliation(s)
- Leonie Goelz
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
- Correspondence: ; Tel.: +49-30-56813829; Fax: +49-30-56813803
| | - Holger Arndt
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
| | - Jens Hausmann
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
| | - Christian Madeja
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
| | - Sven Mutze
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
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Abstract
Repetitive stress on the lumbosacral spine during sporting activity places the athletic patient at risk of developing symptomatic pars defect. Clinical history, physical examination, and diagnostic imaging are important to distinguish spondylolysis from other causes of lower back pain. Early pars stress reaction can be identified with advanced imaging, before the development of cortical fracture or vertebral slip progression to spondylolisthesis. Conservative management is first-line for low-grade injury with surgical intervention indicated for refractory symptoms, severe spondylolisthesis, or considerable neurologic deficit. Prompt diagnosis and management of spondylolysis leads to good outcomes and return to competition for most athletes.
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Affiliation(s)
- Christopher C Chung
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA
| | - Adam L Shimer
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA.
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Zakko Y, Thor D, Savitcheva I, Sundvall A, Wassberg C, Koskinen SK, Axelsson R. Is sub-mSv CT for evaluation of non-specific findings in bone scintigraphy of oncological patients feasible? Acta Radiol 2020; 61:662-667. [PMID: 31526014 DOI: 10.1177/0284185119874481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Hybrid SPECT/CT systems allow the shortening of lead time for investigation of cancer patients, since a complementary CT for radiological characterization of focally increased isotope uptake of unclear origin in bone scintigraphy can be performed simultaneously. The use of low-dose CT (sub-mSv CT) reduces radiation dose compared to standard-dose CT and facilitates the application of complementary CT. Purpose To test the feasibility of sub-mSv CT for the characterization of non-specific findings in the bone scintigraphy of oncological patients. Material and Methods Nineteen oncological patients with a total of 50 findings of unclear origin on bone scintigraphy which required further correlation with morphologic data were included in the study. Each patient underwent two CT scan series consecutively: one low-dose CT and one standard-dose CT. The CT studies were randomized and each finding was rated by four blinded experienced radiologists. A shift in ratings between standard-dose and low-dose images were assessed using the Stuart–Maxwell chi-squared test. Inter-observer agreement and intra-observer agreement was assessed using Light’s kappa and Cohen’s kappa, respectively. Results The mean effective dose of low-dose CT scans was 0.8 mSv compared to 4.2 mSv for the standard-dose CT scans. No statistically significant shift in ratings was observed ( P = 0.62). There was no statistically significant difference in the inter-observer agreements: the values for the standard-dose and low-dose groups were 0.68 (95% confidence interval [CI] 0.57–0.79) and 0.60 (95% CI 0.47–0.72), respectively. Conclusion These results indicate that sub-mSv CT for characterization of non-specific findings in bone scintigraphy of oncological patients is feasible.
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Affiliation(s)
- Yousuf Zakko
- Karolinska University Hospital, Imaging and Function, Radiology Department, Stockholm, Sweden
| | - Daniel Thor
- Karolinska University Hospital, Imaging and Function, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Radiology, Stockholm, Sweden
| | - Irina Savitcheva
- Karolinska University Hospital, Imaging and Function, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden
| | - Albert Sundvall
- Karolinska University Hospital, Imaging and Function, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden
| | - Cecilia Wassberg
- Karolinska University Hospital, Imaging and Function, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden
| | - Seppo K Koskinen
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Radiology, Stockholm, Sweden
- Karolinska University Hospital, Function Imaging and Physiology, Functional Area for Trauma and Musculoskeletal Radiology, Stockholm, Sweden
| | - Rimma Axelsson
- Karolinska University Hospital, Imaging and Function, Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Division of Radiology, Stockholm, Sweden
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Finkenstaedt T, Siriwanarangsun P, Achar S, Carl M, Finkenstaedt S, Abeydeera N, Chung CB, Bae WC. Ultrashort Time-to-Echo Magnetic Resonance Imaging at 3 T for the Detection of Spondylolysis in Cadaveric Spines: Comparison With CT. Invest Radiol 2019; 54:32-38. [PMID: 30157099 DOI: 10.1097/rli.0000000000000506] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to compare the diagnostic performance and confidence of conventional, optimized, and ultrashort time to echo (UTE) magnetic resonance (MR) protocols for detection of simulated lumbar spondylolysis in human cadavers. In addition, we sought to demonstrate the feasibility of the UTE technique in subjects with and without spondylolysis. MATERIALS AND METHODS Four human lumbar spine specimens with 46 individual pars interarticularis were randomly left intact (n = 26) or received experimental osteotomy (n = 20) using a microsurgical saw to simulate spondylolysis. The specimens were imaged using a computed tomography (CT) scan along with 3 "Tiers" of MR protocols at 3 T: Tier 1, conventional lumbar MR protocol; Tier 2, optimized conventional protocol consisting of a sagittal oblique spoiled gradient recall echo and axial oblique T1 and short tau inversion recovery sequences; and Tier 3, a sagittal UTE MR sequence. Two blinded readers evaluated the images using a 4-point scale (1 = spondylolysis certainly absent, 2 = probably absent, 3 = probably present, 4 = certainly present) at each individual pars. For each imaging protocol, diagnostic performance (sensitivity, specificity, and area under the receiver operating characteristic curve, using the surgical osteotomy as the reference) and confidence were assessed and compared using the McNemar test. Furthermore, 2 human subjects were imaged with the conventional and UTE MR protocols to demonstrate feasibility in vivo. RESULTS Diagnostic performance was moderate for Tiers 1 and 2, with a moderate sensitivity (0.70 to 0.75) and high (1.00) specificity. In contrast, CT and Tier 3 UTE MR imaging had both high sensitivity (1.00) and specificity (1.00). The sensitivities of CT or Tier 3 were statistically greater than Tier 1 sensitivity (P = 0.041) and neared statistical significance when compared with Tier 2 sensitivity (P = 0.074). Area under the receiver operating characteristic curve was also significantly greater for CT and Tier 3 (each area = 1.00), compared with the areas for Tier 1 (0.89, P = 0.037) or Tier 2 (0.873, P = 0.024). Diagnostic confidences of CT or Tier 3 were much greater than other Tiers: Both Tiers 1 and 2 had a large percentage of uncertain (>60%, P < 0.001) or wrong interpretations (>10%, P < 0.001), unlike CT or Tier 3 (0% uncertain or wrong interpretations). Preliminary in vivo UTE images clearly depicted intact and fractured pars. CONCLUSIONS Our study demonstrated that the detection of pars fractures using a single sagittal UTE MR sequence is superior in performance and confidence to conventional and optimized MR protocols at 3 T, whereas matching those from CT evaluation. Furthermore, we demonstrated the feasibility of in vivo application of the UTE sequence in subjects with and without spondylolysis.
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Affiliation(s)
- Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Suraj Achar
- Department of Family Medicine, University of California, San Diego, La Jolla
| | | | - Sina Finkenstaedt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Nirusha Abeydeera
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA
| | - Christine B Chung
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA
| | - Won C Bae
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA
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8
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West AM, d'Hemecourt PA, Bono OJ, Micheli LJ, Sugimoto D. Diagnostic Accuracy of Magnetic Resonance Imaging and Computed Tomography Scan in Young Athletes With Spondylolysis. Clin Pediatr (Phila) 2019; 58:671-676. [PMID: 30813766 DOI: 10.1177/0009922819832643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to determine diagnostic accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) scans in young athletes diagnosed with spondylolysis. A cross-sectional study was used. Twenty-two young athletes (14.7 ± 1.5 years) were diagnosed as spondylolysis based on a single-photon emission CT. Following the diagnosis, participants underwent MRI and CT scan imaging tests on the same day. The sensitivity and false-negative rate of the MRI and CT scans were analyzed. MRI test confirmed 13 (+) and 9 (-) results while CT test showed 17 (+) and 5 (-) results. The sensitivity and false-negative rate of MRI were, respectively, 59.1% (95% confidence interval [CI] = 36.7% to 78.5%) and 40.9% (95% CI = 21.5% to 63.3%). Furthermore, the sensitivity and false-negative rate of CT scan were 77.3% (95% CI = 54.2% to 91.3%) and 22.7% (95% CI = 0.09% to 45.8%). Our results indicated that CT scan is a more accurate imaging modality to diagnose spondylolysis compared with MRI in young athletes.
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Affiliation(s)
- Amy M West
- 1 Spaulding Rehabilitation Hospital, Boston, MA, USA.,2 Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Pierre A d'Hemecourt
- 2 Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.,3 Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston MA, USA.,4 The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | | | - Lyle J Micheli
- 2 Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.,3 Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston MA, USA.,4 The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Dai Sugimoto
- 2 Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA.,3 Division of Sports Medicine, Department of Orthopaedics, Boston Children's Hospital, Boston MA, USA.,4 The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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Larson AN, Schueler BA, Dubousset J. Radiation in Spine Deformity: State-of-the-Art Reviews. Spine Deform 2019; 7:386-394. [PMID: 31053308 DOI: 10.1016/j.jspd.2019.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/05/2019] [Accepted: 01/06/2019] [Indexed: 01/10/2023]
Abstract
STUDY DESIGN/METHODS Review article. OBJECTIVES This article will provide an overview regarding measurement of radiation exposure and effects on patients with spinal deformity. SUMMARY OF BACKGROUND DATA/RESULTS Pediatric and adult spinal deformity patients are frequently exposed to diagnostic studies exposing them to ionizing radiation. There is a concern that medical radiation can result in increased cancer risk, particularly in children who will live for a long period of time in which cancer may develop and who have rapidly dividing cells that may be more susceptible to DNA damage. CT imaging imparts 10-100 times higher radiation dosing than standard radiographs. Usage of CT imaging studies is growing in the United States and represents 50% of medical imaging exposure. In addition to the 3 millisieverts (mSv) mean natural background exposure, in the United States, the average American experiences an additional 3 mSv of exposure primarily due to medical diagnostic imaging. Early-onset scoliosis patients are at risk of high cumulative radiation exposure given the young age at diagnosis and frequency of multiorgan system involvement in the case of neuromuscular, congenital, and syndromic patients. Biplanar slot scanning reduces patient radiation exposure, and overall levels of exposure from radiographic imaging is quite low compared with CT imaging or historic radiographs. Specialized pediatric CT dosing protocols result in lower patient absorbed dose. Surgeon and team intraoperative exposure to radiation should always be a concern. Appropriate shielding with a lead apron and minimizing radiation exposure are appropriate strategies. CONCLUSIONS This article will help guide surgeons to make appropriate decisions regarding the need for imaging studies and advocate for low-dose imaging protocols within their facilities. LEVEL OF EVIDENCE V.
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Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
| | - Beth A Schueler
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA
| | - Jean Dubousset
- Académie National de Médicine, 16 Rue Bonaparte, Paris 75006, France
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10
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Cheung KK, Dhawan RT, Wilson LF, Peirce NS, Rajeswaran G. Pars interarticularis injury in elite athletes – The role of imaging in diagnosis and management. Eur J Radiol 2018; 108:28-42. [DOI: 10.1016/j.ejrad.2018.08.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 08/31/2018] [Indexed: 02/01/2023]
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Lemoine T, Fournier J, Odent T, Sembély-Taveau C, Merenda P, Sirinelli D, Morel B. The prevalence of lumbar spondylolysis in young children: a retrospective analysis using CT. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1067-1072. [PMID: 29030702 DOI: 10.1007/s00586-017-5339-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/11/2017] [Accepted: 10/07/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Although lumbar spondylolysis is encountered in general population with an incidence estimated to be 3-10%, limited information is available for children. The aim of the study is to determine the prevalence of spondylolysis according to associated vertebral bony malformation and spinopelvic parameters in children under eight requiring CT evaluation for unrelated lumbar conditions. METHODS Seven hundred and seventeen abdominal and pelvic multi-detector CT scans were obtained in patients under 8 years of age were reviewed. Two board certificated radiologists and two resident radiologists retrospectively evaluated CT scans for lumbar spondylolysis and associated malformations. Pelvic incidence and spondylolisthesis were reported. RESULTS Our analysis included 717 CT scans in 532 children (259 girls and 273 boys). Twenty-five cases of spondylolysis were diagnosed (16 bilateral and 9 unilateral, 64 and 36%, respectively) in 14 boys (56%) and 11 girls (44%), associating with 12 grade I spondylolisthesis. The mean normal pelvic incidence was 45° (median 44°, SD 7°). The prevalence of spondylolysis was 1% in children under age 3 (n = 3 among 292 patients), 3.7% in children under age 6 (n = 17 among 454 patients) and 4.7% among the 532 patients. Unilateral spondylolysis was significantly associated with a spinal malformation (p = 0.04, Fisher's exact test), with normal pelvic incidence. Half of the patients with bilateral spondylolysis had high pelvic incidence. CONCLUSIONS We observed a prevalence peak of unilateral spondylolysis in the context of a specific malformation in young infants under age 4 with normal pelvic incidence, and, then, a progressive increase in the prevalence of bilateral isolated spondylolysis.
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Affiliation(s)
- Thibaut Lemoine
- Department of Pediatric Radiology, Clocheville Hospital, CHRU Tours, 49 Boulevard Beranger, 37000, Tours, France
| | - Joseph Fournier
- Department of Spinal Surgery, The Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, England, UK
| | - Thierry Odent
- Department of Pediatric Orthopedic Surgery, CHRU Tours, 49 Boulevard Beranger, Tours, France.,Faculty of Medicine, Francois Rabelais University, Tours, France
| | - Catherine Sembély-Taveau
- Department of Pediatric Radiology, Clocheville Hospital, CHRU Tours, 49 Boulevard Beranger, 37000, Tours, France
| | - Pauline Merenda
- Department of Pediatric Radiology, Clocheville Hospital, CHRU Tours, 49 Boulevard Beranger, 37000, Tours, France
| | - Dominique Sirinelli
- Department of Pediatric Radiology, Clocheville Hospital, CHRU Tours, 49 Boulevard Beranger, 37000, Tours, France.,Faculty of Medicine, Francois Rabelais University, Tours, France
| | - Baptiste Morel
- Department of Pediatric Radiology, Clocheville Hospital, CHRU Tours, 49 Boulevard Beranger, 37000, Tours, France. .,Faculty of Medicine, Francois Rabelais University, Tours, France.
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Booth TN, Iyer RS, Falcone RA, Hayes LL, Jones JY, Kadom N, Kulkarni AV, Myseros JS, Partap S, Reitman C, Robertson RL, Ryan ME, Saigal G, Soares BP, Tekes A, Trout AT, Zumberge NA, Coley BD, Palasis S. ACR Appropriateness Criteria ® Back Pain—Child. J Am Coll Radiol 2017; 14:S13-S24. [DOI: 10.1016/j.jacr.2017.01.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 01/12/2017] [Accepted: 01/20/2017] [Indexed: 10/19/2022]
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13
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Delavan JA, Stence NV, Mirsky DM, Gralla J, Fadell MF. Confidence in Assessment of Lumbar Spondylolysis Using Three-Dimensional Volumetric T2-Weighted MRI Compared With Limited Field of View, Decreased-Dose CT. Sports Health 2016; 8:364-71. [PMID: 27282808 PMCID: PMC4922525 DOI: 10.1177/1941738116653587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Limited z-axis–coverage computed tomography (CT) to evaluate for pediatric lumbar spondylolysis, altering the technique such that the dose to the patient is comparable or lower than radiographs, is currently used at our institution. The objective of the study was to determine whether volumetric 3-dimensional fast spin echo magnetic resonance imaging (3D MRI) can provide equal or greater diagnostic accuracy compared with limited CT in the diagnosis of pediatric lumbar spondylolysis without ionizing radiation. Hypothesis: Volumetric 3D MRI can provide equal or greater diagnostic accuracy compared with low-dose CT for pediatric lumbar spondylolysis without ionizing radiation. Study Design: Clinical review. Level of Evidence: Level 2. Methods: Three pediatric neuroradiologists evaluated 2-dimensional (2D) MRI, 2D + 3D MRI, and limited CT examinations in 42 pediatric patients who obtained imaging for low back pain and suspected spondylolysis. As there is no gold standard for the diagnosis of spondylolysis besides surgery, interobserver agreement and degree of confidence were compared to determine which modality is preferable. Results: Decreased-dose CT provided a greater level of agreement than 2D MRI and 2D + 3D MRI. The kappa for rater agreement with 2D MRI, 2D + 3D MRI, and CT was 0.19, 0.32, and 1.0, respectively. All raters agreed in 31%, 40%, and 100% of cases with 2D MRI, 2D + 3D MRI, and CT. Lack of confidence was significantly lower with CT (0%) than with 2D MRI (30%) and 2D + 3D MRI (25%). Conclusion: For diagnosing spondylolysis, radiologist agreement and confidence trended toward improvement with the addition of a volumetric 3D MRI sequence to standard 2D MRI sequences compared with 2D MRI alone; however, agreement and confidence remain significantly greater using decreased-dose CT when compared with either MRI acquisition. Clinical Relevance: Decreased-dose CT of the lumbar spine remains the optimal examination to confirm a high suspicion of spondylolysis, with dose essentially equivalent to radiographs. If clinical symptoms are not classic for spondylolysis, 2D MRI is still very good at detecting spondylolysis while remaining sensitive for detection of alternative diagnoses such as disc abnormalities and pars stress reaction. The data suggest that standard 2D MRI sequences should not be entirely replaced by a volumetric T2-weighted 3D sequence (despite promising features of rapid acquisition time, increased spatial resolution, and reconstruction capability).
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Affiliation(s)
| | - Nicholas V Stence
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado
| | - Jane Gralla
- Department of Pediatrics, School of Medicine, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
| | - Michael F Fadell
- Department of Radiology, Children's Hospital Colorado, Aurora, Colorado
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