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Sarblah SR, Rachman P, Antwi WK, Anudjo MNK, Botwe BO, Akudjedu TN. Value of MRI in the cervical spine imaging series of trauma patients: A state-of-the-art review. Radiography (Lond) 2024; 30:1001-1013. [PMID: 38692168 DOI: 10.1016/j.radi.2024.04.017] [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: 12/19/2023] [Revised: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Clinical decision protocols for evaluation and assessment of traumatic cervical spine injuries (TCSI) lean more towards the use of CT imaging. Investigation with MRI is therefore considered unnecessary following negative CT findings according to some local protocols. This review aims to explore what benefits MRI may offer in the clinical management of TCSI patients. METHODS A systematic search of the literature was conducted in the following databases: AMED, CINAHL, EMBASE and MEDLINE using defined key terms and synonyms optimised for each database. The eligible articles were subjected to data extraction and thematic synthesis. RESULTS The initial electronic search yielded 2527 articles. Of these, 15 articles remained following the application of a pre-defined inclusion criteria and full-text assessment. Four themes (mechanism of injury, type of patient, injuries detected on MRI, significance of injuries detected on MRI) were developed relating to the usage and value of MRI in the management of CSI. DISCUSSION Our findings indicate that MRI may be very valuable in some situations for the evaluation of TCSI, however, its usage must be cautiously considered on a case-by-case basis in light of additional clinical benefit, patient safety and resource availability following a normal CT scan or in conjunction with CT or projection radiography where appropriate. IMPLICATIONS FOR PRACTICE MRI may serve as a confirmatory test in the management pathway of TCSI based on individual clinical needs. Consideration for key limitations (e.g., patients' cooperation) and accessibility challenges (e.g., cost) against the clinical benefit to the patient must be noted. Development of centre-specific policies from standard trauma imaging protocols may be essential for the timely management of TCSI.
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Affiliation(s)
- S R Sarblah
- Radiology Department, Hereford County Hospital, Wye Valley NHS Foundation Trust, Hereford, UK; Department of Health Sciences, Faculty of Environmental & Life Sciences, Southampton University, UK
| | - P Rachman
- Department of Health Sciences, Faculty of Environmental & Life Sciences, Southampton University, UK
| | - W K Antwi
- Department of Radiography, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Box KB143, Korle Bu, Accra, Ghana
| | - M N K Anudjo
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK; School of Radiology, AECC University College, Bournemouth, UK
| | - B O Botwe
- Department of Radiography, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Box KB143, Korle Bu, Accra, Ghana; Department of Midwifery and Radiography Division School of Health & Psychological Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.
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ESTRO ACROP guidelines for external beam radiotherapy of patients with complicated bone metastases. Radiother Oncol 2022; 173:240-253. [DOI: 10.1016/j.radonc.2022.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/19/2022]
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Yokota K, Kawano O, Kaneyama H, Maeda T, Nakashima Y. Acute spinal subdural hematoma: A case report of spontaneous recovery from paraplegia. Medicine (Baltimore) 2020; 99:e20032. [PMID: 32384463 PMCID: PMC7220760 DOI: 10.1097/md.0000000000020032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH. PATIENT CONCERNS A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. DIAGNOSIS Based on MRI findings, the diagnosis was SSDH. INTERVENTIONS We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24 hours after the onset. OUTCOMES Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization. LESSONS Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.
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MESH Headings
- Conservative Treatment/methods
- Hematoma, Subdural, Spinal/complications
- Hematoma, Subdural, Spinal/diagnosis
- Hematoma, Subdural, Spinal/physiopathology
- Hematoma, Subdural, Spinal/rehabilitation
- Humans
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Monitoring, Physiologic/methods
- Neurologic Examination/methods
- Paraplegia/etiology
- Paraplegia/physiopathology
- Paraplegia/rehabilitation
- Recovery of Function
- Remission, Spontaneous
- Spinal Canal/diagnostic imaging
- Treatment Outcome
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Affiliation(s)
- Kazuya Yokota
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
- Departments of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Osamu Kawano
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
| | - Hironari Kaneyama
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization Spinal Injuries Center
| | - Yasuharu Nakashima
- Departments of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
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Ahmad FU, Bisson EF, Burks SS, Chang JJ, Chugh AJ, Côté I, Frerich JM, Gersey ZC, Hendricks BK, Karsy M, Kasliwal M, Krause KL, Manzano GR, Morgan CD, Snyder LA, Swinney CC, Than KD, Theodotou CB, Veeravagu A, Ventura J. Spine. Oper Neurosurg (Hagerstown) 2019; 17:S153-S181. [PMID: 31099842 DOI: 10.1093/ons/opz073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Faiz U Ahmad
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Erica F Bisson
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Stephen Shelby Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jason J Chang
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - A Jessey Chugh
- Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio
| | - Ian Côté
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jason M Frerich
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Benjamin K Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael Karsy
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Manish Kasliwal
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Katie L Krause
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Glen R Manzano
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Laura A Snyder
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Christian C Swinney
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Khoi D Than
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon
| | - Christian B Theodotou
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Anand Veeravagu
- Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Jacqueline Ventura
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Abstract
How to cite this article: Patra A, Janu A, Sahu A. MR Imaging in Neurocritical Care. Indian J Crit Care Med 2019;23(Suppl 2):S104–S114.
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Affiliation(s)
- Anurima Patra
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arpita Sahu
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Li T, Li W, Du Y, Gao M, Liu X, Wang G, Cui H, Jiang Z, Cui X, Sun J. Discrimination of pyogenic spondylitis from brucellar spondylitis on MRI. Medicine (Baltimore) 2018; 97:e11195. [PMID: 29952971 PMCID: PMC6039692 DOI: 10.1097/md.0000000000011195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Retrospective Cross-Sectional Study.The purpose of this study was to investigate the accuracy of magnetic resonance imaging (MRI) for distinguishing between pyogenic spondylitis and brucellar spondylitis.Although pyogenic spondylodiscitis (PS) and brucellar spondylitis (BS) are common causes of spinal infections, the variety of their clinical manifestations complicates differential diagnosis. MRI may be helpful in differential diagnosis and treatment.MRI images of 64 patients who underwent MRI of the spine and with confirmed spondylitis were retrospectively reviewed. After referring to the related medical literature, we compared 32 patients with pyogenic spondylitis and 32 patients with brucellar spondylitis regarding MRI findings. Statistical analysis was performed with the chi-square test. Statistical significance was defined as P < .05.The significant differences between PS and BS on MRI findings are listed as follows (P < .05): diffuse, partial and fan-shaped hyperintense signals on middle sagittal fat-suppressed weighted images (PS: 51, 11, 3/65 vs BS:35, 18, 19/72); focal endplate destruction (PS: 9/43 vs BS:27/35); extensive end plate destruction (PS: 29/43 vs BS:8/35); ballooning change of the intravertebral space (PS: 7/32 vs BS:0/32); an inflammatory reaction line from the end plate (PS: 30/65 vs BS: 1/72); a disc invasion sign (PS: 1/28 vs BS:12/33); an inflammatory reaction line in the disc (PS: 5/28 vs BS:25/33); and 8) severe intravertebral space destruction (PS: 17/28 vs BS:12/33);MRI imaging provides useful information for the differentiation between pyogenic spondylitis and brucellar spondylitis.
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Affiliation(s)
- Tao Li
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Wei Li
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Yong Du
- Department of Orthopedics, Qingyun County People's Hospital, Jinan City, PR China
| | - Meng Gao
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Xiaoyang Liu
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Guodong Wang
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Haomin Cui
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Zhensong Jiang
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Xingang Cui
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
| | - Jianmin Sun
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University
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Quarrington RD, Jones CF, Tcherveniakov P, Clark JM, Sandler SJI, Lee YC, Torabiardakani S, Costi JJ, Freeman BJC. Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses, and risk factors for spinal cord injury. Spine J 2018; 18:387-398. [PMID: 28739474 DOI: 10.1016/j.spinee.2017.07.175] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/23/2017] [Accepted: 07/17/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Distractive flexion injuries (DFIs) of the subaxial cervical spine are major contributors to spinal cord injury (SCI). Prompt assessment and early intervention of DFIs associated with SCI are crucial to optimize patient outcome; however, neurologic examination of patients with subaxial cervical injury is often difficult, as patients commonly present with reduced levels of consciousness. Therefore, it is important to establish potential associations between injury epidemiology and radiographic features, and neurologic involvement. PURPOSE The aims of this study were to describe the epidemiology and radiographic features of DFIs presenting to a major Australian tertiary hospital and to identify those factors predictive of SCI. The agreement and repeatability of radiographic measures of DFI severity were also investigated. STUDY DESIGN/SETTING This is a combined retrospective case-control and reliability-agreement study. PATIENT SAMPLE Two hundred twenty-six patients (median age 40 years [interquartile range = 34]; 72.1% male) who presented with a DFI of the subaxial cervical spine between 2003 and 2013 were reviewed. OUTCOME MEASURES The epidemiology and radiographic features of DFI, and risk factors for SCI were identified. Inter- and intraobserver agreement of radiographic measurements was evaluated. METHODS Medical records, radiographs, and computed tomography and magnetic resonance imaging scans were examined, and the presence of SCI was evaluated. Radiographic images were analyzed by two consultant spinal surgeons, and the degree of vertebral translation, facet apposition, spinal canal occlusion, and spinal cord compression were documented. Multivariable logistic regression models identified epidemiology and radiographic features predictive of SCI. Intraclass correlation coefficients (ICCs) examined inter- and intraobserver agreement of radiographic measurements. RESULTS The majority of patients (56.2%) sustained a unilateral (51.2%) or a bilateral facet (48.8%) dislocation. The C6-C7 vertebral level was most commonly involved (38.5%). Younger adults were over-represented among motor-vehicle accidents, whereas falls contributed to a majority of DFIs sustained by older adults. Greater vertebral translation, together with lower facet apposition, distinguished facet dislocation from subluxation. Dislocation, bilateral facet injury, reduced Glasgow Coma Scale, spinal canal occlusion, and spinal cord compression were predictive of neurologic deficit. Radiographic measurements demonstrated at least a "moderate" agreement (ICC>0.4), with most demonstrating an "almost perfect" reproducibility. CONCLUSIONS This large-scale cohort investigation of DFIs in the cervical spine describes radiographic features that distinguish facet dislocation from subluxation, and associates highly reproducible anatomical and clinical indices to the occurrence of concomitant SCI.
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Affiliation(s)
- Ryan D Quarrington
- School of Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA 5000, Australia; Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, 30 Frome Rd, Adelaide, SA 5000, Australia; Adelaide Centre for Spinal Research, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA 5000, Australia.
| | - Claire F Jones
- School of Mechanical Engineering, The University of Adelaide, North Terrace, Adelaide, SA 5000, Australia; Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, 30 Frome Rd, Adelaide, SA 5000, Australia; Adelaide Centre for Spinal Research, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA 5000, Australia
| | | | - Jillian M Clark
- Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, 30 Frome Rd, Adelaide, SA 5000, Australia; Adelaide Centre for Spinal Research, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA 5000, Australia; South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, SA, Australia
| | - Simon J I Sandler
- The Spinal Injuries Unit, Department of Neurosurgery, Royal Adelaide Hospital, SA, Australia
| | - Yu Chao Lee
- The Spinal Injuries Unit, Department of Neurosurgery, Royal Adelaide Hospital, SA, Australia
| | | | - John J Costi
- Biomechanics and Implants Research Group, The Medical Device Research Institute, Flinders University, SA, Australia
| | - Brian J C Freeman
- Centre for Orthopaedic & Trauma Research, Adelaide Medical School, The University of Adelaide, 30 Frome Rd, Adelaide, SA 5000, Australia; Adelaide Centre for Spinal Research, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide, SA 5000, Australia; The Spinal Injuries Unit, Department of Neurosurgery, Royal Adelaide Hospital, SA, Australia
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Clinical utility for diffusion MRI sequence in emergency and inpatient spine protocols. Clin Imaging 2017; 45:37-50. [PMID: 28601735 DOI: 10.1016/j.clinimag.2017.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/10/2017] [Accepted: 05/30/2017] [Indexed: 11/20/2022]
Abstract
Diffusion imaging of the spine has the potential to change clinical management, but is challenging due to the small size of the cord and susceptibility artifacts from adjacent structures. Reduced field-of-view (rFOV) diffusion can improve image quality by decreasing the echo train length. Over the past 2 years, we have acquired a rFOV diffusion sequence for MRI spine protocols on most inpatients and emergency room patients. We provide selected imaging diagnoses to illustrate the utility of including diffusion spine MRI in clinical practice. Our experiences support using diffusion MRI to improve diagnostic certainty and facilitate prompt treatment or clinical management.
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Usefulness of laser-evoked potentials and quantitative sensory testing in the diagnosis of neuropathic spinal cord injury pain: a multiple case study. Spinal Cord 2017; 55:575-582. [PMID: 28117333 DOI: 10.1038/sc.2016.191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/12/2016] [Accepted: 12/18/2016] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The aim of this study was to investigate the contribution of laser-evoked potentials (LEPs) and quantitative sensory testing (QST) to the diagnosis of neuropathic pain in patients with spinal cord injury (SCI) and inconclusive magnetic resonance imaging (MRI) findings. SETTING A multidisciplinary pain center. METHODS QST (DFNS protocol) and Tm-YAG-laser stimulation of the skin were applied within the pain site corresponding with dermatomes of altered sensation. Available MRI scans were reviewed. RESULTS Thirteen individuals (50±16 years) with SCI were examined. In four cases with no detectable neural lesion on MRI, all QST but three LEP were abnormal. In four patients with poorly defined spinal lesion on MRI, all QST but three LEP only were abnormal. In four cases where pain was not matching adequately with MRI lesions, all patients had abnormal LEP and QST. In one patient showing a spinal cord atrophy, LEP was normal but QST was abnormal. Findings supported the diagnoses at-level (n=5) and below-level (n=8) SCI pain. Spinothalamic tract function assessed by LEP was normal in three cases, but QST was abnormal in all cases. CONCLUSIONS As QST is a psychophysical examination depending on patient cooperation, we suggest that the combination of QST and LEP might be a valuable diagnostic tool to detect lesions of the somatosensory system in a subgroup of patients with neuropathic spinal cord injury pain and inconclusive MRI findings.
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