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Hunsaker P, Gupta K, Otto N, Epelman MJ, Chandra T. Developmental Abnormalities of the Pediatric Spine: A Review of the Correlation Between Ultrasound and MRI Findings. Cureus 2023; 15:e44580. [PMID: 37790066 PMCID: PMC10545393 DOI: 10.7759/cureus.44580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 10/05/2023] Open
Abstract
A broad spectrum of spinal pathologies can affect the pediatric population. Ultrasound (US) is the primary modality for pediatric spine assessment due to its widespread availability, non-requirement of sedation, and absence of ionizing radiation. Supplementing this, MRI offers an in-depth exploration of these conditions, aiding in preoperative strategizing. In this review, we examine the clinical indications, methodologies, and protocols for US and MRI scans of the pediatric spine. Additionally, we illustrate normal pediatric spinal anatomy, highlighting several examples of normal variants that are often misinterpreted. Through a series of case-based illustrations, we offer a comprehensive overview of various pathological conditions such as tethered cord, spinal dysraphism, spinal lipoma, diastematomyelia, and dermal sinus tract, among others. Furthermore, we explore the correlation between US and MRI findings for these lesions, employing real-world cases to enhance our understanding of this topic.
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Affiliation(s)
- Parker Hunsaker
- Diagnostic Radiology, University of Central Florida College of Medicine, Orlando, USA
| | - Kanika Gupta
- Diagnostic Radiology, University of Arizona, Tucson, USA
| | - Nolan Otto
- Diagnostic Radiology, University of South Florida Health, Orlando, USA
| | | | - Tushar Chandra
- Pediatric Radiology, Nemours Children's Hospital, Orlando, USA
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Trò R, Roascio M, Tortora D, Severino M, Rossi A, Cohen-Adad J, Fato MM, Arnulfo G. Diffusion Kurtosis Imaging of Neonatal Spinal Cord in Clinical Routine. FRONTIERS IN RADIOLOGY 2022; 2:794981. [PMID: 37492682 PMCID: PMC10365122 DOI: 10.3389/fradi.2022.794981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 07/27/2023]
Abstract
Diffusion kurtosis imaging (DKI) has undisputed advantages over the more classical diffusion magnetic resonance imaging (dMRI) as witnessed by the fast-increasing number of clinical applications and software packages widely adopted in brain imaging. However, in the neonatal setting, DKI is still largely underutilized, in particular in spinal cord (SC) imaging, because of its inherently demanding technological requirements. Due to its extreme sensitivity to non-Gaussian diffusion, DKI proves particularly suitable for detecting complex, subtle, fast microstructural changes occurring in this area at this early and critical stage of development, which are not identifiable with only DTI. Given the multiplicity of congenital anomalies of the spinal canal, their crucial effect on later developmental outcome, and the close interconnection between the SC region and the brain above, managing to apply such a method to the neonatal cohort becomes of utmost importance. This study will (i) mention current methodological challenges associated with the application of advanced dMRI methods, like DKI, in early infancy, (ii) illustrate the first semi-automated pipeline built on Spinal Cord Toolbox for handling the DKI data of neonatal SC, from acquisition setting to estimation of diffusion measures, through accurate adjustment of processing algorithms customized for adult SC, and (iii) present results of its application in a pilot clinical case study. With the proposed pipeline, we preliminarily show that DKI is more sensitive than DTI-related measures to alterations caused by brain white matter injuries in the underlying cervical SC.
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Affiliation(s)
- Rosella Trò
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Monica Roascio
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | | | | | - Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
- Mila—Quebec AI Institute, Montreal, QC, Canada
| | - Marco Massimo Fato
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Gabriele Arnulfo
- Departments of Informatics, Bioengineering, Robotics, and System Engineering, University of Genoa, Genoa, Italy
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
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Rossi A, Martinetti C, Morana G, Severino M, Tortora D. Diagnostic Approach to Pediatric Spine Disorders. Magn Reson Imaging Clin N Am 2017; 24:621-44. [PMID: 27417404 DOI: 10.1016/j.mric.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Understanding the developmental features of the pediatric spine and spinal cord, including embryologic steps and subsequent growth of the osteocartilaginous spine and contents is necessary for interpretation of the pathologic events that may affect the pediatric spine. MR imaging plays a crucial role in the diagnostic evaluation of patients suspected of harboring spinal abnormalities, whereas computed tomography and ultrasonography play a more limited, complementary role. This article discusses the embryologic and developmental anatomy features of the spine and spinal cord, together with some technical points and pitfalls, and the most common indications for pediatric spinal MR imaging.
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Affiliation(s)
- Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy.
| | - Carola Martinetti
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Mariasavina Severino
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Domenico Tortora
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
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Henderson P, Desai IP, Pettit K, Benke S, Brouha SS, Romine LE, Beeker K, Chuang NA, Yaszay B, Van Houten L, Pretorius DH. Evaluation of Fetal First and Second Cervical Vertebrae: Normal or Abnormal? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:527-536. [PMID: 26887450 DOI: 10.7863/ultra.14.12044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To use 3-dimensional sonographic volumes to evaluate the variable appearance of the normal fetal cervical spine and craniocervical junction, which if unrecognized may lead to misdiagnosis of malalignment at the first and second cervical vertebrae (C1 and C2). METHODS Three-dimensional sonographic volumes of the fetal cervical spine were obtained from 24 fetuses at gestational ages between 12 weeks 6 days and 35 weeks 1 day. The volumes were reviewed on 4-dimensional software, and the vertebral level was determined by labeling the first rib-bearing vertebra as the first thoracic vertebra. The ossification centers of the cervical spine and occipital condyles were then labeled accordingly and evaluated for alignment and structure by rotating the volumes in oblique planes. The appearance on multiplanar images was assessed for possible perceived anomalies, including malalignment, particularly at the C1 and C2 levels. Evidence of head rotation was correlated with the presence of possible malalignment at C1-C2. Head rotation was identified in the axial plane by measuring the angle of the anteroposterior axis of C1 to the anteroposterior axis of C2. RESULTS Of the 24 fetuses, 16 had adequate quality to assess the entire cervical spine and craniocervical junction. All 16 cases showed an osseous component of C1 that did not align directly with C2 on some of the multiplanar images when the volumes were rotated, which could lead to suspected diagnosis of spinal malalignment or a segmental abnormality, as occurred in 2 clinical cases in our practice. All 16 cases showed at least some degree of head rotation, ranging from 2° to 36°, which may possibly explain the apparent malalignment. The lateral offset from C1 to C2 ranged from 0.0 to 3.3 mm. CONCLUSIONS The normal C1 and C2 ossification centers may appear to be malaligned due to normal offsetting (lateral displacement) of C1 on C2. An understanding of the normal development of the cervical spine is important in assessing spinal anatomy.
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Affiliation(s)
- Patrick Henderson
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Ishita P Desai
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Kate Pettit
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Sarah Benke
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Sharon S Brouha
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Lorene E Romine
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Krissa Beeker
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Nathaniel A Chuang
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Burt Yaszay
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Laurie Van Houten
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Dolores H Pretorius
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.).
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