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Hannaford A, Paling E, Silsby M, Vincenten S, van Alfen N, Simon NG. Electrodiagnostic studies and new diagnostic modalities for evaluation of peripheral nerve disorders. Muscle Nerve 2024; 69:653-669. [PMID: 38433118 DOI: 10.1002/mus.28068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/05/2024]
Abstract
Electrodiagnostic studies (EDx) are frequently performed in the diagnostic evaluation of peripheral nerve disorders. There is increasing interest in the use of newer, alternative diagnostic modalities, in particular imaging, either to complement or replace established EDx protocols. However, the evidence to support this approach has not been expansively reviewed. In this paper, diagnostic performance data from studies of EDx and other diagnostic modalities in common peripheral nerve disorders have been analyzed and described, with a focus on radiculopathy, plexopathy, compressive neuropathies, and the important neuropathy subtypes of Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), vasculitic neuropathy and diabetic neuropathy. Overall EDx retains its place as a primary diagnostic modality in the evaluated peripheral nerve disorders. Magnetic resonance imaging and ultrasound have developed important complementary diagnostic roles in compressive and traumatic neuropathies and atypical CIDP, but their value is more limited in other neuropathy subtypes. Identification of hourglass constriction in nerves of patients with neuralgic amyotrophy may have therapeutic implications. Investigation of radiculopathy is confounded by poor correlation between clinical features and imaging findings and the lack of a diagnostic gold standard. There is a need to enhance the literature on the utility of these newer diagnostic modalities.
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Affiliation(s)
- Andrew Hannaford
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Elijah Paling
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Matthew Silsby
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
- Brain and Nerve Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sanne Vincenten
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Radboud University Medical Center, Donders Center for Neuroscience, Nijmegen, the Netherlands
| | - Neil G Simon
- Northern Beaches Clinical School, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Costello JE, Shah LM, Peckham ME, Stilwill SE, Safazadeh G, Hutchins TA. Time for change? Radiologists highly concordant assessing change in stenoses on follow-up cervical spine MRI. Neuroradiol J 2023; 36:588-592. [PMID: 37042077 PMCID: PMC10569186 DOI: 10.1177/19714009231163562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE There is considerable variability among radiologists when grading spinal canal and foraminal stenosis on MRI. However, to date, studies have not evaluated radiologists' agreement when assessing interval change in cervical spine stenoses. The purpose of this study was to evaluate radiologists' concordance for change in cervical spine stenoses on follow-up MRIs, a major indication for these exams. METHODS Initial and follow-up cervical MRIs were retrospectively reviewed by three blinded radiologists. Spinal canal and foramina from C1 through T1 were rated for interval change and concordance between the blinded raters was calculated. The original MRI reports were also reviewed for specific language assessing interval change on the follow-up exams. RESULTS 40 cervical MRI exams and 40 corresponding MRI follow-ups were assessed. Agreement for interval change in spinal canal and foraminal stenosis was near perfect amongst all readers (kappa values of 0.78-0.94). 97% of the original MRI reports used the standard severity scale. 68% of follow-up MRI reports specifically assessed for change. DISCUSSION Blinded radiologists had high agreement when assessing for change in spinal canal and foraminal stenosis on follow-up cervical spine MRIs. Because of inter-rater variability in stenosis grading, reports that do not emphasize change assessment, may imply change that is not truly present. For clarity and consistency in reporting of cervical spine stenoses, change assessment should be emphasized and added to structured reporting templates.
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Affiliation(s)
- Justin E Costello
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
- Walter Reed National Military Medical Center, Department of Neuroradiology, Bethesda, MD, United States
| | - Lubdha M Shah
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Miriam E Peckham
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Sarah E Stilwill
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Ghazaleh Safazadeh
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Troy A Hutchins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
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Oshina M, Kawamura N, Hara N, Higashikawa A, Ono T, Takeshita Y, Azuma S, Fukushima M, Iwai H, Kaneko T, Inanami H, Oshima Y. A Propensity Score-matched Analysis of Clinical Outcomes Between Single-level and Multilevel Intervertebral Decompression for Cervical Radiculopathy. Spine (Phila Pa 1976) 2023; 48:247-252. [PMID: 36255352 PMCID: PMC9855740 DOI: 10.1097/brs.0000000000004508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN Retrospective multicenter study with propensity score matching. OBJECTIVE To compare the clinical outcomes of single-level and multilevel intervertebral decompression for cervical degenerative radiculopathy. SUMMARY OF BACKGROUND DATA In patients with cervical radiculopathy, physical examination findings are sometimes inconsistent with imaging data. Multilevel decompression may be necessary for multiple foraminal stenosis. Additional decompression is more invasive yet expected to comprehensively decompress all suspected nerve root compression areas. However, the surgical outcomes of this approach compared with that of single-level decompression remain unknown. MATERIALS AND METHODS The data of patients with spinal surgery for pure cervical radiculopathy were collected. Patients were categorized into the single-level (SLDG) or multilevel (MLDG) intervertebral decompression group at C3/C4/C5/C6/C7/T1. Demographic data and patient-reported outcome scores, including the Neck Disability Index (NDI) and Numerical Rating Scale (NRS) scores for pain and numbness in the neck, upper back, and arms, were collected. The NDI improvement rates and changes in NRS scores were analyzed one year postoperatively at patient-reported outcome evaluation. Propensity score matching was performed to compare both groups after adjusting for baseline characteristics, including the preoperative NDI and NRS scores. RESULTS Among the 357 patients in this study, SLDG and MLDG comprised 231 and 126 patients, respectively. Two groups (n=112, each) were created by propensity score matching. Compared with the MLDG, the SLDG had a higher postoperative NDI improvement rate ( P =0.029) and lower postoperative arm numbness NRS score ( P =0.037). Other outcomes tended to be more favorable in the SLDG than in the MLDG, yet no statistical significance was detected. CONCLUSIONS In patients with cervical radiculopathy, the surgical outcomes of the SLDG showed better improvement in clinical outcomes than those of the MLDG. Numbness remained on the distal (arms) rather than the central (neck and upper back) areas in patients receiving multilevel decompression.
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Affiliation(s)
- Masahito Oshina
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kanagawa, Japan
| | - Takashi Ono
- Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Yujiro Takeshita
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Kanagawa, Japan
| | - Seiichi Azuma
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | | | - Hiroki Iwai
- Iwai Orthopedic Medical Hospital, Tokyo, Japan
| | | | | | - Yasushi Oshima
- Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan
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Novel MRI signs of ruptured disc in the cervical spine with intraoperative comparisons. Eur Radiol 2023; 33:1475-1485. [PMID: 36066732 DOI: 10.1007/s00330-022-09124-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/04/2022] [Accepted: 08/19/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of two novel MRI signs for extruded disc (ED) and uncontained ED (ruptured disc, RD) in the cervical spine using intraoperative findings as reference. METHODS This retrospective study included patients who underwent cervical spine MRI and surgery for disc pathology with intraoperative confirmation of RD from September 1, 2016, to January 31, 2021. Two radiologists determined whether the disc was extruded or ruptured with and without the aid of two novel MRI signs suggesting RD (sign 1: blurred margin of the disc; sign 2: mushroom-shaped disc). The diagnostic performance was analyzed using surgical findings as reference. Intra- and interobserver agreements were measured for each MRI sign. RESULTS A total of 91 patients totaling 131 discs were enrolled (mean age: 56.02 ± 12.93; range: 26-88; 62 men and 29 women), of whom 62 were surgically confirmed with RD. When the diagnosis was based exclusively on existing ED definitions, ED was diagnosed with 62.9-79.0% sensitivity and 80.2% accuracy, whereas RD was diagnosed with 35.5-45.2% sensitivity and 67.9-71.0% accuracy. However, when the two novel MRI signs were used as an aid in the diagnosis, ED was diagnosed with 95.2-96.8% sensitivity and 84.0-88.5% accuracy, while RD was diagnosed with 95.2-96.8% sensitivity and 84.0-89.3% accuracy. Intra- and interobserver agreement was substantial (k = 00.77-0.86, 0.69-0.79, respectively, p < 0.001). CONCLUSIONS The detection of two novel MRI signs on preoperative MRI can lead to a more accurate RD diagnosis. KEY POINTS • The diagnostic sensitivity of MRI for cervical ruptured disc is very low (about 35-45 %) using the standardized definition of lumbar disc nomenclature. • Two novel MRI signs can lead to a more accurate diagnosis of the surgically confirmed ruptured disc in the cervical spine. • These two novel MRI signs showed substantial intra-and interobserver reliabilities.
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Mizouchi T, Katsumi K, Izumi T, Yamazaki A, Shoji H, Tashi H, Ohashi M, Hirano T, Endo N, Watanabe K. Three-dimensional morphological analysis of cervical foraminal stenosis using dynamic flexion-extension computed tomography images. J Orthop Sci 2020; 25:805-811. [PMID: 31831318 DOI: 10.1016/j.jos.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/18/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Morphological features of foraminal stenosis in cervical spondylotic radiculopathy and the adequate extent of facet resection in posterior cervical foraminotomy remain uncertain. Herein, we evaluated quantitatively foraminal widths in cervical spondylotic radiculopathy on dynamic flexion-extension computed tomography using a novel three-dimensional analysis method and determined the extent of facet resection in posterior cervical foraminotomy. METHODS Seventeen patients undergoing posterior cervical foraminotomy for cervical spondylotic radiculopathy were evaluated. A neuroforamen three-dimensional model was built from preoperative images of flexion-extension computed tomography myelography, and an ordinary cervical spine coordinate system and an original neuroforaminal coordinate system, were established. In the neuroforaminal coordinate system, minimum areas perpendicular to the long axis by the slices from inlet to outlet of neuroforamen and narrowest foraminal width in a slice of minimum area were measured. The location of the narrowest region from inlet of the foramen was calculated. Ratios of minimum and sufficient facet resection were obtained from the location of the narrowest region in the neuroforaminal coordinate system. RESULTS The narrowest foraminal widths (flexion/extension) in the cervical spine coordinate system and the neuroforaminal coordinate system were 2.9/2.3 and 2.6/1.9 mm, respectively. The mean values of the location of the narrowest region (flexion/extension) were 0.27/0.22 and 0.50/0.45 mm, respectively, and the narrowest region in the neuroforaminal coordinate system was located on the outer side than in the cervical spine coordinate system (p < 0.001). The ratios of minimum and sufficient facet resection were 23 ± 8% and 32 ± 9%, respectively. CONCLUSIONS The narrowest regions both in flexion and extension are located at the middle of the foramen based on the neuroforaminal coordinate system. Ordinary evaluation of axial computed tomography images likely underestimates the extent of facet resection, whereas certain extent of facet resection does not exceed 50% in cases with single-level cervical spondylotic radiculopathy. STUDY DESIGN A retrospective case control study.
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Affiliation(s)
- Tatsuki Mizouchi
- Department of Orthopedic Surgery, Niigata University, Medical and Dental General Hospital, 1-757 Asahimachidori, Chuoku, Niigata City, Niigata, 951-8510, Japan.
| | - Keiichi Katsumi
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinko-cho, Chuoku, Niigata City, Niigata, 950-8556, Japan
| | - Tomohiro Izumi
- Department of Orthopedic Surgery, Niigata Minami Hospital, 2007-6 Toyano, Chuoku, Niigata City, Niigata, 950-8601, Japan
| | - Akiyoshi Yamazaki
- Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, 1-18 Shinko-cho, Chuoku, Niigata City, Niigata, 950-8556, Japan
| | - Hirokazu Shoji
- Department of Orthopedic Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuoku, Niigata City, Niigata, 950-1197, Japan
| | - Hideki Tashi
- Department of Orthopedic Surgery, Niigata University, Medical and Dental General Hospital, 1-757 Asahimachidori, Chuoku, Niigata City, Niigata, 951-8510, Japan
| | - Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University, Medical and Dental General Hospital, 1-757 Asahimachidori, Chuoku, Niigata City, Niigata, 951-8510, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-uonuma City, Niigata, 949-7302, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University, Medical and Dental General Hospital, 1-757 Asahimachidori, Chuoku, Niigata City, Niigata, 951-8510, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University, Medical and Dental General Hospital, 1-757 Asahimachidori, Chuoku, Niigata City, Niigata, 951-8510, Japan
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Piper K, Pittock L, Woznitza N. Radiographer reporting of neurological magnetic resonance imaging examinations of the head and cervical spine: Findings of an accredited postgraduate programme. Radiography (Lond) 2018; 24:366-369. [DOI: 10.1016/j.radi.2018.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/25/2018] [Accepted: 05/19/2018] [Indexed: 11/25/2022]
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Moll LT, Kindt MW, Stapelfeldt CM, Jensen TS. Degenerative findings on MRI of the cervical spine: an inter- and intra-rater reliability study. Chiropr Man Therap 2018; 26:43. [PMID: 30356854 PMCID: PMC6190655 DOI: 10.1186/s12998-018-0210-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge about the assessment reliability of common cervical spine changes is a prerequisite for precise and consistent communication about Magnetic Resonance Imaging (MRI) findings. The purpose of this study was to determine the inter- and intra-rater reliability of degenerative findings when assessing cervical spine MRI. Methods Fifty cervical spine MRIs from subjects with neck pain were used. A radiologist, a chiropractor and a second-year resident of rheumatology independently assessed kyphosis, disc height, disc contour, vertebral endplate signal changes, spinal canal stenosis, neural foraminal stenosis, and osteoarthritis of the uncovertebral and zygapophyseal joints. An evaluation manual was composed containing classifications and illustrative examples, and ten of the MRIs were evaluated twice followed by consensus meetings to refine the classifications. Next, the three readers independently assessed the full sample. Reliability measures were reported using prevalence estimates and unweighted kappa (Κ) statistics. Results The overall inter-rater reliability was substantial (Κ ≥ 0.61) for the majority of variables and moderate only for zygapophyseal osteoarthritis (Κ = 0.56). Intra-rater reliability estimates were higher for all findings. Conclusions The present classifications for some of the most common cervical degenerative findings yielded mainly substantial inter-rater reliability estimates and substantial to almost perfect intra-rater reliability estimates. . Trial registration Regional Data Protection Agency (J.no. 1-16-02-86-16). The letter of exemption from the Regional Ethical Committee is available from the author on request (case no. 86 / 2017).
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Affiliation(s)
- Line Thorndal Moll
- 1DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, DK-8000 Aarhus C, Denmark.,2Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, DK-8000 Aarhus C, Denmark.,Spine Centre, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, DK-8600 Silkeborg, Denmark
| | - Morten Wasmod Kindt
- Department for Diagnostic Imaging, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, DK-8600 Silkeborg, Denmark
| | - Christina Malmose Stapelfeldt
- 1DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, DK-8000 Aarhus C, Denmark.,2Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, DK-8000 Aarhus C, Denmark
| | - Tue Secher Jensen
- Department for Diagnostic Imaging, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Falkevej 1-3, DK-8600 Silkeborg, Denmark.,5Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
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Engel G, Bender YY, Adams LC, Boker SM, Fahlenkamp UL, Wagner M, Diederichs G, Hamm B, Makowski MR. Evaluation of osseous cervical foraminal stenosis in spinal radiculopathy using susceptibility-weighted magnetic resonance imaging. Eur Radiol 2018; 29:1855-1862. [DOI: 10.1007/s00330-018-5769-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/23/2018] [Accepted: 09/14/2018] [Indexed: 02/04/2023]
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Diagnostic Accuracy of Zero-Echo Time MRI for the Evaluation of Cervical Neural Foraminal Stenosis. Spine (Phila Pa 1976) 2018; 43:928-933. [PMID: 29095415 DOI: 10.1097/brs.0000000000002462] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cohort study. OBJECTIVE The aim of this study was to evaluate the clinical utility of Zero-Echo-Time (ZTE) magnetic resonance imaging (MRI) for the assessment of cervical neural foraminal stenosis (CNFS) through the comparison of inter-modality [computed tomography (CT) and ZTE-MRI] CNFS grade severity agreements. SUMMARY OF BACKGROUND DATA Conventional MRI limited in its ability to provide direct visualization of cortical bone. The highly organized tissue structure of cortical bone results in very short T2 values that preclude acquisition of sufficient signal intensity and positive image contrast. ZTE imaging permits visualization of tissues with very short transverse relaxation times, and is capable of displaying images with CT-like contrast. METHODS Thirty-four subjects were recruited from a clinical cohort of patients undergoing standard of care MRI and CT imaging for evaluation of CNFS. Standard of care CT imaging studies were obtained on all subjects within 6 months of their ZTE-MRI acquisition (mean time interval: 25.3 ± 54.1 days; median: 0 days). ZTE-MRI and CT imaging studies were evaluated and severity of CNFS was graded on a scale from 0 to 5 (0 = none; 5 = severe). Weighted-kappa statistics were used to assess agreement between ZTE and CT grades of CNFS on both sides (right and left) of each motion segment. Ordinal logistic mixed-effects regression analyses evaluated the effects of inter-modality position differences (flexion-extension curvature) on inter-modality differences in CNFS grade. RESULTS Substantial agreement (κ = 0.72) was found between ZTE- and CT-based grades of CNFS. Significant inter-modality differences in cervical spine curvature were found for all motion segments, except C2-3 and C3-4 (P < 0.05). However, no significant relationship was found between inter-modality differences in curvature, and inter-modality differences in CNFS grade for any motion segment (P = 0.28). CONCLUSION Results of the current study suggest that ZTE-MRI is well-suited for the evaluation of CNFS and may have the potential to obviate the need for concurrent CT scans in some cases. LEVEL OF EVIDENCE 2.
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Lee HJ, Ahn JS, Shin B, Lee H. C4/5 foraminal stenosis predicts C5 palsy after expansive open-door laminoplasty. 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; 26:2340-2347. [DOI: 10.1007/s00586-017-5077-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 03/04/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
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Chokshi FH, Sadigh G, Carpenter W, Allen JW. Diagnostic Quality of 3D T2-SPACE Compared with T2-FSE in the Evaluation of Cervical Spine MRI Anatomy. AJNR Am J Neuroradiol 2017; 38:846-850. [PMID: 28154126 DOI: 10.3174/ajnr.a5080] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/23/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spinal anatomy has been variably investigated using 3D MRI. We aimed to compare the diagnostic quality of T2 sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) with T2-FSE sequences for visualization of cervical spine anatomy. We predicted that T2-SPACE will be equivalent or superior to T2-FSE for visibility of anatomic structures. MATERIALS AND METHODS Adult patients undergoing cervical spine MR imaging with both T2-SPACE and T2-FSE sequences for radiculopathy or myelopathy between September 2014 and February 2015 were included. Two blinded subspecialty-trained radiologists independently assessed the visibility of 12 anatomic structures by using a 5-point scale and assessed CSF pulsation artifact by using a 4-point scale. Sagittal images and 6 axial levels from C2-T1 on T2-FSE were reviewed; 2 weeks later and after randomization, T2-SPACE was evaluated. Diagnostic quality for each structure and CSF pulsation artifact visibility on both sequences were compared by using a paired t test. Interobserver agreement was calculated (κ). RESULTS Forty-five patients were included (mean age, 57 years; 40% male). The average visibility scores for intervertebral disc signal, neural foramina, ligamentum flavum, ventral rootlets, and dorsal rootlets were higher for T2-SPACE compared with T2-FSE for both reviewers (P < .001). Average scores for remaining structures were either not statistically different or the superiority of one sequence was discordant between reviewers. T2-SPACE showed less degree of CSF flow artifact (P < .001). Interobserver variability ranged between -0.02-0.20 for T2-SPACE and -0.02-0.30 for T2-FSE (slight to fair agreement). CONCLUSIONS T2-SPACE may be equivalent or superior to T2-FSE for the evaluation of cervical spine anatomic structures, and T2-SPACE shows a lower degree of CSF pulsation artifact.
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Affiliation(s)
- F H Chokshi
- From the Department of Radiology and Imaging Sciences, Division of Neuroradiology (F.H.C., G.S., J.W.A.) .,Department of Biomedical Informatics (F.H.C.)
| | - G Sadigh
- From the Department of Radiology and Imaging Sciences, Division of Neuroradiology (F.H.C., G.S., J.W.A.)
| | - W Carpenter
- Department of Radiology and Imaging Sciences, Division of Musculoskeletal Radiology (W.C.)
| | - J W Allen
- From the Department of Radiology and Imaging Sciences, Division of Neuroradiology (F.H.C., G.S., J.W.A.).,Department of Neurology (J.W.A.), Emory University School of Medicine, Atlanta, Georgia
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Interreader Reliability and Clinical Validity of a Magnetic Resonance Imaging Grading System for Cervical Foraminal Stenosis. J Comput Assist Tomogr 2017; 41:926-930. [DOI: 10.1097/rct.0000000000000628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chhabra A, Farahani SJ, Thawait GK, Wadhwa V, Belzberg AJ, Carrino JA. Incremental value of magnetic resonance neurography of Lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: A prospective study. World J Radiol 2016; 8:109-116. [PMID: 26834949 PMCID: PMC4731346 DOI: 10.4329/wjr.v8.i1.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 11/12/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To test the incremental value of 3T magnetic resonance neurography (MRN) in a series of unilateral radiculopathy patients with non-contributory magnetic resonance imaging (MRI).
METHODS: Ten subjects (3 men, 7 women; mean age 54 year and range 22-74 year) with unilateral lumbar radiculopathy and with previous non-contributory lumbar spine MRI underwent lumbosacral (LS) plexus MRN over a period of one year. Lumbar spine MRI performed as part of the MRN LS protocol as well as bilateral L4-S1 nerves, sciatic, femoral and lateral femoral cutaneous nerves were evaluated in each subject for neuropathy findings on both anatomic (nerve signal, course and caliber alterations) and diffusion tensor imaging (DTI) tensor maps (nerve signal and caliber alterations). Minimum fractional anisotropy (FA) and mean apparent diffusion coeffcient (ADC) of L4-S2 nerve roots, sciatic and femoral nerves were recorded.
RESULTS: All anatomic studies and 80% of DTI imaging received a good-excellent imaging quality grading. In a blinded evaluation, all 10 examinations demonstrated neural and/or neuromuscular abnormality corresponding to the site of radiculopathy. A number of contributory neuropathy findings including double crush syndrome were observed. On DTI tensor maps, nerve signal and caliber alterations were more conspicuous. Although individual differences were observed among neuropathic appearing nerve (lower FA and increased ADC) as compared to its contralateral counterpart, there were no significant mean differences on statistical comparison of LS plexus nerves, femoral and sciatic nerves (P > 0.05).
CONCLUSION: MRN of LS plexus is useful modality for the evaluation of patients with non-contributory MRI of lumbar spine as it can incrementally delineate the etiology and provide direct objective and non-invasive evidence of neuromuscular pathology.
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Fu MC, Webb ML, Buerba RA, Neway WE, Brown JE, Trivedi M, Lischuk AW, Haims AH, Grauer JN. Comparison of agreement of cervical spine degenerative pathology findings in magnetic resonance imaging studies. Spine J 2016; 16:42-8. [PMID: 26291398 DOI: 10.1016/j.spinee.2015.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/14/2015] [Accepted: 08/11/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Magnetic resonance imaging (MRI) is often used in the evaluation of degenerative conditions of the cervical spine. However, the agreement of interpreting and reporting varying degenerative findings on cervical MRI has not been well assessed. PURPOSE This study aimed to compare the inter-rater and intra-rater agreement of MRI findings between common degenerative findings of the cervical spine. STUDY DESIGN A retrospective diagnostic study was used as study design. PATIENT SAMPLE The sample consisted of 48 patients who underwent routine cervical spine MRI at our institution between January 2011 and June 2012. OUTCOME MEASURES Reviewers evaluated each MRI study at each vertebral level for disc hydration, disc space height, central stenosis, foraminal stenosis, end plate changes, spondylolisthesis, and cord signal change. METHODS A panel of two orthopedic spine surgeons and four musculoskeletal radiologists independently reviewed 48 sets of T2-weighted axial and sagittal MRI sequences for a series of preselected criteria, and their findings were compared with those of the other panelists to determine inter-rater agreement. Each panelist also re-reviewed the first 10 studies to determine intra-rater agreement. Absolute inter-rater and intra-rater agreements were then calculated and compared for different findings. A modified analysis ignored disagreements between the least severe grades of findings to determine the inter-rater and intra-rater agreements of the most clinically important severity grades. RESULTS Absolute inter-rater agreement ranged from 54.6% to 95.0%. Disc hydration (54.6%), central stenosis (72.7%), and foraminal stenosis (73.1%) demonstrated the lowest inter-rater agreement, whereas spondylolisthesis (95.0%) and cord signal change (92.9%) demonstrated the highest agreement. The modified analysis found better inter-rater agreement, ranging from 80.9% to 95.0%. Absolute intra-rater agreement ranged from 74.2% to 94.7%. The modified analysis again found better agreement, ranging from 85.0% to 94.7%. As would be expected, overall intra-rater agreement (81.6%, 95% CI 78.9%-84.3%) was higher than inter-rater agreement (75.7%, 95% CI 74.4%-77.0%). The clinical specialty of the reviewer had no significant impact on inter- or intra-rater agreement. CONCLUSIONS MRI findings play an important role in the management of patients with cervical spine conditions. For this reason, consistent descriptions of these findings are essential and physicians should be aware of the relative reliability of these findings. This systematic study developed standardized grading criteria and nomenclature for common clinically significant MRI findings in the cervical spine. Even in this optimized research setting, we found significant ranges in agreement across these MRI findings. In the clinical setting, inter- and intra-rater agreements may be lower, and the range of agreements between findings may be greater. Physicians should be aware of inconsistencies inherent in the interpretation of cervical MRI findings and should be aware that some findings demonstrate lower agreement than others.
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Affiliation(s)
- Michael C Fu
- Department of Orthopaedics & Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Matthew L Webb
- Department of Orthopaedics & Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Rafael A Buerba
- Department of Orthopaedics & Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Department of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles, CA, USA
| | - William E Neway
- Department of Orthopaedics & Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Department of Surgery, Division of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Elliott Brown
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Mitesh Trivedi
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew W Lischuk
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew H Haims
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- Department of Orthopaedics & Rehabilitation, Yale University School of Medicine, New Haven, CT, USA.
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Diagnostic Accuracy of Lumbosacral Spine Magnetic Resonance Image Reading by Chiropractors, Chiropractic Radiologists, and Medical Radiologists. Spine (Phila Pa 1976) 2015; 40:E653-60. [PMID: 25803219 DOI: 10.1097/brs.0000000000000896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional diagnostic accuracy study was conducted in 2 sessions. OBJECTIVE It is important to know whether it is possible to accurately detect "specific findings" on lumbosacral magnetic resonance (MR) images and whether the results of different observers are comparable. SUMMARY OF BACKGROUND DATA Health care providers frequently use magnetic resonance imaging in the diagnostic process of patients with low back pain. The use of MR scans is increasing. This leads to an increase in costs and to an increase in risk of inaccurately labeling patients with an anatomical diagnosis that might not be the actual cause of symptoms. METHODS A set of 300 blinded MR images was read by medical radiologists, chiropractors, and chiropractic radiologists in 2 sessions. Each assessor read 100 scans in round 1 and 50 scans in round 2. The reference test was an expert panel.For all analyses, the magnetic resonance imaging findings were dichotomized into "specific findings" or "no specific findings." For the agreement, percentage agreement and κ values were calculated and for validity, sensitivity, and specificity. Sensitivity analysis was done for classifications A and B (prevalence of 31% and 57%, respectively). RESULTS The intraobserver κ values for chiropractors, chiropractic radiologists, and medical radiologists were 0.46, 0.49, and 0.69 for A and 0.55, 0.75, and 0.64 for B, respectively.The interobserver κ values were lowest for chiropractors (0.28 for A, 0.37 for B) and highest for chiropractic radiologists (0.50 for A, 0.49 for B).The sensitivities of the medical radiologists, chiropractors, and chiropractic radiologists were 0.62, 0.71, and 0.75 for A and 0.70, 0.74, 0.84 for B, respectively.The specificities of medical radiologists, chiropractic radiologists, and chiropractors were 0.82, 0.77, and 0.70 for A and 0.74, 0.52, and 0.61 for B, respectively. CONCLUSION Agreement and validity of MR image readings of chiropractors and chiropractic and medical radiologists is modest at best. This study supports recommendations in clinical guidelines against routine use of magnetic resonance imaging in patients with low back pain. LEVEL OF EVIDENCE 3.
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Abstract
Cervical radiculopathy is the result of irritation and/or compression of nerve root as it exits the cervical spine. Pain is a common presenting symptom and may be accompanied by motor or sensory deficits in areas innervated by the affected nerve root. Diagnosis is suggested by history and corresponding physical examination findings. Confirmation is achieved with MRI. A multimodal approach to treatment helps patients improve. Medications may be used to alleviate symptoms and manage pain. Physical therapy and manipulation may improve neck discomfort. Guided corticosteroid injections and selected nerve blocks may help control nerve root pain. Most patients improve with a conservative, nonoperative treatment course.
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Affiliation(s)
- Deanna Lynn Corey
- Department of Family Medicine, Boston Medical Center, Boston University, 1 BMC Place, Boston, MA 02118, USA.
| | - Douglas Comeau
- Sports Medicine, Ryan Center for Sports Medicine, Boston Medical Center, Boston University, 915 Commonwealth Avenue Rear, Boston, MA 02215, USA; Family Medicine, Boston University School of Medicine, Boston University, 1 BMC Place, Boston, MA 02118, USA; Department of Sports Medicine, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
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Bartlett RJV, Rigby AS, Joseph J, Raman A, Kunnacherry A, Hill CAR. Extension MRI is clinically useful in cervical myelopathy. Neuroradiology 2013; 55:1081-8. [PMID: 23740097 DOI: 10.1007/s00234-013-1208-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cervical spine MRI with the neck in extension has been well described over the last 10 years, but its clinical value remains unknown. METHODS We performed extension imaging in 60 patients in whom the initial neutral study showed borderline cord compression. Images were assessed using a previously validated grading system for cord compression. Multiple linear and area measurements were also obtained. Images were scored blindly and randomly. Inter- and intra-rater variability were determined in a subset of 20 cases. Independent clinical assessment utilised the Ranwat criteria. RESULTS For most parameters inter/intra-observer variance of kappa/ICC > 0.6 was highly satisfactory. Standard MR was poor at discriminating between patients with and without myelopathy (ROC analysis, area under the curve (AUC), 0.52). This was considerably improved with extension imaging (AUC, 0.60), or by using the change in compression score between neutral and extension studies. Most measurements were not helpful; however, the ratio of cord area/CSF area at the level of maximum compression on extended images was the best discriminator (AUC, 0.71), as well as the presence of T2 change in cord substance (AUC, 0.68). CONCLUSION This is the first study to demonstrate added clinical value utilising extension MRI. In this cohort of difficult patients, when there was no T2 signal change in the cord, the presence of clinical myelopathy could only be predicted by utilising the data from extension imaging.
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Bastovansky A, Ziegler K, Stöllberger C, Finsterer J. Lift the quilt in case of atrial fibrillation and disc prolapse. Vasc Health Risk Manag 2012; 8:389-92. [PMID: 22787404 PMCID: PMC3390994 DOI: 10.2147/vhrm.s31156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Peripheral embolism to the lower extremities may mimic disc prolapse with severe consequences. CASE REPORT A 71-year-old male with a history of chronic alcoholism developed low back pain radiating to both lower extremities in a nonradicular distribution and bilateral dysesthesias of the distal lower legs after lifting a heavy weight. Given that magnetic resonance imaging (MRI) of the lumbar spine showed disc herniation in L3/4 and L4/5, he was scheduled for laminectomy but was unable to undergo surgery due to thrombocytopenia. After transfer to another hospital, persistence of symptoms and signs, absent pulses on the distal lower legs, and rhabdomyolysis with temporary renal insufficiency, peripheral embolism with compartment syndrome was suspected. Magnetic resonance angiography revealed occlusion of the right superficial femoral artery and long high-grade stenosis of the left superficial and profound femoral arteries and distal arteries. He successfully underwent embolectomy and fasciotomy. CONCLUSIONS If lumbar pain is not radicular, peripheral pulses are minimally palpable, and distal limbs are cold and show livid decolorization, peripheral embolism is much more likely than disc herniation, particularly if the patient's history is positive for atrial fibrillation. MRI of the lumbar spine must be interpreted in conjunction with clinical presentation.
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Affiliation(s)
- Adam Bastovansky
- Department of Radiology, Krankenanstalt Rudolfstiftung, Vienna, Austria
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Lack of uniform diagnostic criteria for cervical radiculopathy in conservative intervention studies: a systematic review. 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 2012; 21:1459-70. [PMID: 22531897 PMCID: PMC3535232 DOI: 10.1007/s00586-012-2297-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/03/2012] [Accepted: 03/29/2012] [Indexed: 11/03/2022]
Abstract
PURPOSE Cervical radiculopathy (CR) is a common diagnosis. It is unclear if intervention studies use uniform definitions and criteria for patient selection. Our objective was to assess the uniformity of diagnostic criteria and definitions used in intervention studies to select patients with CR. METHODS We electronically searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE and CINAHL. Studies were included when evaluating conservative interventions in randomised clinical trials (RCTs) in patients with CR. Selection criteria and definitions for patients with CR were extracted and evaluated on their uniformity. RESULTS Thirteen RCTs were included. Pain was used as an inclusion criterion in 11 studies. Inclusion based on the duration and location of pain varied between studies. Five studies used sensory symptoms in the arm as inclusion criterion. Four studies used cervical range of motion and motor disturbances as inclusion criteria, while reflex changes were used in two studies. Three studies included patients with a positive Spurling's test and two studies used it within a cluster of provocation tests. CONCLUSIONS Criteria used to select patients with CR vary widely between different intervention studies. Selection criteria and test methods used are poorly described. There is consensus on the presence of pain, but not on the exact location of pain.
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Radiation dose of non-enhanced chest CT can be reduced 40% by using iterative reconstruction in image space. Clin Radiol 2011; 66:1023-9. [DOI: 10.1016/j.crad.2011.04.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 03/31/2011] [Accepted: 04/08/2011] [Indexed: 12/22/2022]
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