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Sam A, S J, Pandian V, Ramakrishnan KK, Natarajan P, Muralidharan Y. Evaluating the Efficacy of Volume Isotropic Turbo Spin Echo Acquisition Versus T2-Weighted Turbo Spin Echo Imaging in the Diagnosis of Nerve Root and Perineuronal Pathologies in Spinal Disorders. Cureus 2024; 16:e60988. [PMID: 38915957 PMCID: PMC11195522 DOI: 10.7759/cureus.60988] [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] [Received: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Background While two-dimensional (2D) turbo spin echo (TSE) sequences offer better through-plane resolution than three-dimensional (3D) isotropic TSE sequences images, with a narrower thickness of the slice, 3D isotropic TSE sequences are known to have a weaker in-plane resolution as well as blurring of the image. These elements may make it more difficult to distinguish between nearby structures that may affect nerve roots and small nerve roots during spinal imaging. This study aimed to analyze the accuracy of T2 TSE sequence and volumetric isotropic TSE acquisition in determining the indentation of nerve roots and perineural diseases such as nerve sheath tumors and Tarlov cysts. Methods Fifty patients who attended the Department of Radiodiagnosis for magnetic resonance (MR) spine participated in this prospective study. Routine MR lumbosacral (LS) spine sequences, such as survey, coronal T2 short-tau inversion recovery (STIR), sagittal T2 TSE, sagittal T1 TSE, and axial T2 TSE, were carried out after a localizer was acquired. More sequences from volume isotropic turbo spin echo acquisition (VISTA) were acquired. For both 2D and 3D sequences, the visibility ratings for perineural cysts, spinal canal stenosis, and nerve root indentation were evaluated. Visibility ratings ranged from zero to four. Results In the cases of perineural cyst, spinal canal stenosis, and nerve root impingement, the mean difference between the VISTA and T2 TSE visibility scores was 0.04, 0.54, and 0.56, respectively. The VISTA and T2 TS had standard deviation differences of 0.006, 0.026, and 0.06, respectively. The "t" values for nerve root impingement, spinal canal stenosis, and perineural cysts were, in order, 50, 180, and 70. Because the p-value was <0.01, a statistically significant variation has been observed. Conclusion In the diagnosis of neural and perineuronal disorders, the visibility scores for 3D T2 TSE (VISTA) were considerably better than those for 2D T2 TSE in identifying perineural cysts, spinal canal stenosis, and nerve root indentation.
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Affiliation(s)
- Ajina Sam
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, IND
| | - Jaypradha S
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, IND
| | - Vinoth Pandian
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, IND
| | - Karthik Krishna Ramakrishnan
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, IND
| | - Paarthipan Natarajan
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, IND
| | - Yuvaraj Muralidharan
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Chennai, IND
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Yilmaz TF, Sari L, Toprak H. Advanced cerebrospinal fluid flow MRI findings of aqueductal stenosis caused by web. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:201-207. [PMID: 38013602 DOI: 10.1002/jcu.23606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The aqueductal web (AW) is one of the causes of aqueductus stenosis (AS). Recent advances in Magnetic resonance (MR) imaging have enabled us to better reveal the cerebrospinal fluid (CSF) flow dynamics and aqueductal anatomy. PURPOSE The aim of this study is to evaluate the CSF flow dynamics of patients with AW with phase contrast Magnetic resonance imaging (MRI) and compare them with the imaging findings. MATERIALS AND METHODS We evaluated 23 patients under 65-year-old age. On constructive interference in steady-state (T2 CISS) images, the width of prepontine cistern (PPC) and the width of Sylvian aqueduct (SA) were measured. Localization and number of webs were evaluated. The existence of flow at the aqueduct and the presence of spontaneous third ventriculostomy (STV) were evaluated on sagittal Sampling Perfection with Application optimized Contrast (SPACE) sequences. RESULTS Of the 23 patients included in the study, 11 were male and 12 were female. The mean age was 34.02 (0.5-64). A total of 31 AWs were detected in 23 patients. Six of 23 patients (26.1%) had STV and 17 of those not. Four of 23 patients (17.4%) had aqueductal flow on SPACE sequences. The PPC distance was significantly wider in patients with STV (median: 6.7-4.5, interquartile range (IQR): 1.35, p = 0.004). In the cases where artifact secondary to flow is observed in SPACE sequences in aqueduct, the Evan index (EI) was significantly lower (median: 0.2955-0.3900, IQR: 0.03-0.14, p < 0.001). CONCLUSION In patients with a low EI, there may be flow in the SA even if there is a web. In patients with a wide PPC distance, it is necessary to consider the presence of STV and evaluate the presence of flow with the SPACE sequences.
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Affiliation(s)
- Temel Fatih Yilmaz
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Lutfullah Sari
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Huseyin Toprak
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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Wu Y, Cai Y, Rui W, Tang Y, Yang Z, He M, Ye H, Wang Y, Zhao Y, Ma Z, Yao Z. Contrast-enhanced 3D-T2-weighted SPACE sequence for MRI detection and localization of adrenocorticotropin (ACTH)-secreting pituitary microadenomas. Clin Endocrinol (Oxf) 2022; 96:578-588. [PMID: 34323314 DOI: 10.1111/cen.14574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cushing disease is a potentially fatal endocrine disorder caused by adrenocorticotropin (ACTH)-secreting microadenomas in the pituitary gland. Accurate detection and localization of the adenomas is the key to clinical treatment. This study analysed the value of contrast-enhanced Sampling Perfection with Application-optimized Contrasts using different flip angle Evolutions (SPACE) sequence in magnetic resonance imaging (MRI) assessment of ACTH-secreting pituitary microadenomas. DESIGN AND PATIENTS We carried out a retrospective study in which 45 patients with ACTH-secreting pituitary microadenomas were enrolled. Dynamic contrast-enhanced (DCE) coronal T1-SE sequence was performed. A contrast-enhanced coronal SPACE sequence was added immediately after DCE MRI finished. Two independent observers assessed the tumour existence and location, then the results were compared with surgical findings. RESULTS Twenty-four lesions (53.3%) were detected by the DCE T1-SE sequence alone, while 35 lesions (80.0%) were detected with the addition of contrast-enhanced SPACE sequence. The sensitivity (58.5% vs. 85.3%; p < .05) and best diagnostic accuracy (62.0% vs. 84.4%; p < .05) were significantly better for addition with SPACE sequence than DCE-SE images alone in detection of ACTH-secreting pituitary microadenomas. For lesions <5 mm, the detected numbers were 4 (16.6%) versus 10 (27.8%) by DCE T1-SE sequence and combined DCE T1-SE with SPACE sequence. CONCLUSIONS A combination of contrast-enhanced SPACE with DCE T1-SE sequence could improve the detection of ACTH-secreting pituitary microadenomas. Contrast-enhanced SPACE sequence could be a supplementary sequence for imaging of ACTH-secreting pituitary adenomas when T1-SE sequence provides negative or equivocal findings.
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Affiliation(s)
- Yue Wu
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yixin Cai
- Department of Neurosurgery, National Center for Neurological Disorders (NCND), Shanghai Pituitary Tumor Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenting Rui
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Tang
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhong Yang
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min He
- Department of Endocrinology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongying Ye
- Department of Endocrinology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yongfei Wang
- Department of Neurosurgery, National Center for Neurological Disorders (NCND), Shanghai Pituitary Tumor Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yao Zhao
- Department of Neurosurgery, National Center for Neurological Disorders (NCND), Shanghai Pituitary Tumor Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zengyi Ma
- Department of Neurosurgery, National Center for Neurological Disorders (NCND), Shanghai Pituitary Tumor Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Khaladkar S, Ajmera P, Rathi S. Utility of 3D-T2 space MRI sequence in diagnosing a rare cause of lower backache: horseshoe cord and meningocoele manqué in a case of composite split cord malformation. BMJ Case Rep 2022; 15:e248615. [PMID: 35351760 PMCID: PMC8966560 DOI: 10.1136/bcr-2021-248615] [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] [Accepted: 03/13/2022] [Indexed: 11/04/2022] Open
Abstract
Diastematomyelia is the asymmetric or symmetric lateral duplication of the spinal cord into two hemicords. Pang divided it into three types: type-1, type-2 and composite split cord malformation (SCM). Composite SCMs are uncommon and are defined by the coexistence of multiple types of split cord with normal cord in between. When partially bridged, they are called a horseshoe cord. We report a case of a young woman who presented with backache and was diagnosed with composite SCM with horseshoe cord and type-2 SCM with intervening normal cord. In our case, 3D-SPACE due to its superior topographical evaluation, allowed us to visualise and characterise the thin meningocoele manque bands and detect horseshoe cords, asymmetric cords and demarcate the precise extent of syrinx, which were suboptimally imaged on isolated T2 and T1WI sequences. If left untreated during surgery, bands can be the potential cause for persistent backache.
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Affiliation(s)
- Sanjay Khaladkar
- Radiology, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Pranav Ajmera
- Radiology, Dr D Y Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Snehal Rathi
- Radiology, Mahatma Gandhi Mission's Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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Application of Contrast-Enhanced 3-Dimensional T2-Weighted Volume Isotropic Turbo Spin Echo Acquisition Sequence in the Diagnosis of Prolactin-Secreting Pituitary Microadenomas. J Comput Assist Tomogr 2021; 46:116-123. [PMID: 35099143 PMCID: PMC8763247 DOI: 10.1097/rct.0000000000001237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang Q, Li H, Kong J, Li X, Feng L, Wu Z. Diagnostic agreement between 3.0-T MRI sequences of nerve root and surgery in patients with cervical radiculopathy: A retrospective study. Medicine (Baltimore) 2021; 100:e24207. [PMID: 33530213 PMCID: PMC7850720 DOI: 10.1097/md.0000000000024207] [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: 05/08/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023] Open
Abstract
Currently, minute structures, such as cervical nerve roots, can be viewed using magnetic resonance imaging (MRI) sequences; however, studies comparing multiple sequences in the same set of patients are rare. The aim of the study is to compare the diagnostic values of three 3.0-T MRI sequences used in the imaging of cervical nerve roots.This study included 2 phases. In the first phase (n = 45 patients), the most optimal MRI sequence was determined. In the second phase, this MRI sequence was compared with surgical results (n = 31 patients). The three-dimensional double-echo steady-state (3D-DESS), multi-echo data image combination (MEDIC), and 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) sequences were performed to analyze the image quality. Furthermore, the most optimal MRI sequence was compared with surgical results to determine the agreement rate.The image quality scores of the 3 sequences were significantly different (P < .05). The score for 3D-DESS sequence was superior to that of MEDIC sequence, while the score for 3D-SPACE sequence was the worst. For visualization of compressed nerve roots, 3D-DESS sequence was superior to the other 2 sequences in terms of the total quality score and compressed nerve root score. Therefore, 3D-DESS sequence was used for MRI in 31 patients with cervical spondylosis in the second phase of this study. The diagnostic agreement rate was 93.5%.This study concluded that in patients with cervical radiculopathy, the 3D-DESS sequence is superior to the MEDIC and 3D-SPACE sequences and shows a high agreement rate with the surgical diagnosis.
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Affiliation(s)
| | | | - Jianjun Kong
- Department of Orthopedics, General Hospital of Jizhong Energy Xingtai Mining Group, Xingtai, Hebei, China
| | | | | | - Zhanyong Wu
- Department of Orthopedics, General Hospital of Jizhong Energy Xingtai Mining Group, Xingtai, Hebei, China
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Bratke G, Rau R, Weiss K, Kabbasch C, Sircar K, Morelli JN, Persigehl T, Maintz D, Giese D, Haneder S. Accelerated MRI of the Lumbar Spine Using Compressed Sensing: Quality and Efficiency. J Magn Reson Imaging 2018; 49:e164-e175. [PMID: 30267462 DOI: 10.1002/jmri.26526] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Decreasing MRI scan time is a key factor to increase patient comfort and compliance as well as the productivity of MRI scanners. PURPOSE/HYPOTHESIS Compressed sensing (CS) should significantly accelerate 3D scans. This study evaluated the clinical application and cost effectiveness of accelerated 3D T2 sequences of the lumbar spine. STUDY TYPE Prospective, cross-sectional, observational. POPULATION Twenty healthy volunteers and 10 patients. FIELD STRENGTH/SEQUENCE A 3D T2 TSE sequence, identical 3D sequences with three different parallel imaging and CS accelerating factors, and 2D TSE sequences as a clinical reference were obtained on a 3T scanner. ASSESSMENT Three readers evaluated the sequences for delineation of anatomical structures and image quality. A quantitative analysis consisting of root mean square error, structural similarity index, signal-to-noise ratio, and contrast-to-noise ratio were performed. The scan times were used to calculate cost differences for each sequence. STATISTICAL TESTS An analysis of variance with repeated measurements and the Friedman test were used to test for potential differences between the sequences. Post-hoc analysis was made with the chi-squared and Tukey-Kramer test. RESULTS CS with factor 4.5 results in unchanged image quality compared to the T2 TSE for volunteers and patients (overall image impression: 4.75 vs. 4.20 [P = 0.73] and 4.90 vs. 4.47 [P = 0.44]). The CS 4.5 scan is 167 seconds (-39%) faster than the 3D and 216.5 seconds (-45%) faster than the 2D sequences. No significant differences was found for the diagnostic certainty in the volunteers and patients between 2D TSE and 3D CS 4.5 (P = 0.89 and P = 0.43). A reduction of scan time to 148 seconds (CS 8) was still rated acceptable for most diagnosis. DATA CONCLUSION CS accelerates the 3D T2 without compromising image quality. The 3D sequences offer comparable diagnostic quality to the clinical 2D standard with less scan time (-45%), potentially increasing the productivity of MRI scanners. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e164-e175.
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Affiliation(s)
- Grischa Bratke
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Robert Rau
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | | | | | - Krishnan Sircar
- Department of Orthopedics, University Hospital Cologne, Cologne, Germany
| | | | | | - David Maintz
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Giese
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Stefan Haneder
- Department of Radiology, University Hospital Cologne, Cologne, Germany
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Lian J, Levine N, Cho W. A review of lumbosacral transitional vertebrae and associated vertebral numeration. 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 2018; 27:995-1004. [PMID: 29564611 DOI: 10.1007/s00586-018-5554-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/01/2018] [Accepted: 03/16/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE To review the current literature on methods of accurate numeration of vertebral segments in patients with Lumbosacral transitional vertebrae (LSTVs). LSTVs are a common congenital anomaly of the L5-S1 junction. While their clinical significance has been debated, unquestionable is the need for their identification prior to spinal surgery. We hypothesize that there are no reliable landmarks by which we can accurately number transitional vertebrae, and thus a full spinal radiograph is required. METHODS A Pubmed and EMBASE search using various combinations of specific key words including "LSTV", "lumbosacral transitional vertebrae", "count", "vertebral numbering", and "number" was performed. RESULTS The gold standard for spinal segment numeration in patients with LSTV remains whole spine imaging and counting caudally, starting from C2. If whole spine imaging is not available, the use of the iliac crest tangent sign on coronal magnetic resonance imaging (MRI) has fairly reliable sensitivity and specificity (81 and 64-88%, respectively) for accurate numeration of LSTV. The role of paraspinal anatomic markers such as the right renal artery, superior mesenteric artery, aortic bifurcation, and conus medullaris, for identification of vertebral levels is unreliable and should not be used. CONCLUSIONS A sagittal whole spine view should be added as a scout view when patients obtain lumbar MRI to standardize the vertebral numbering technique. To date, there has been no other method for accurate numeration of a transitional vertebral segment, other than counting caudally from C2. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Jayson Lian
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Nicole Levine
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Woojin Cho
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA. .,Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Ave, 6th Fl., Bronx, NY, 10467, USA.
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9
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Chandra SS, Engstrom C, Fripp J, Neubert A, Jin J, Walker D, Salvado O, Ho C, Crozier S. Local contrast-enhanced MR images via high dynamic range processing. Magn Reson Med 2018; 80:1206-1218. [PMID: 29399889 DOI: 10.1002/mrm.27109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/08/2017] [Accepted: 01/06/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Shekhar S Chandra
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Craig Engstrom
- School of Human Movement Studies, University of Queensland, St Lucia, Australia
| | - Jurgen Fripp
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, Australia
| | - Ales Neubert
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, Australia
| | - Jin Jin
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | | | - Olivier Salvado
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, Australia
| | - Charles Ho
- Steadman Philippon Research Institute (SPRI), Vail, Colorado
| | - Stuart Crozier
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
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Koontz NA, Wiggins RH, Mills MK, McLaughlin MS, Pigman EC, Anzai Y, Shah LM. Less Is More: Efficacy of Rapid 3D-T2 SPACE in ED Patients with Acute Atypical Low Back Pain. Acad Radiol 2017; 24:988-994. [PMID: 28385420 DOI: 10.1016/j.acra.2017.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/01/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES Emergency department (ED) patients with acute low back pain (LBP) may present with ambiguous clinical findings that pose diagnostic challenges to exclude cauda equina syndrome (CES). As a proof of concept, we aimed to determine the efficacy of a rapid lumbar spine (LS) magnetic resonance imaging (MRI) screening protocol consisting of a single 3D-T2 SPACE FS (3D-T2 Sampling Perfection with Application optimized Contrasts using different flip angle Evolution fat saturated) sequence relative to conventional LS MRI to exclude emergently treatable pathologies in this complex patient population. MATERIALS AND METHODS LS MRI protocol including a sagittal 3D-T2 SPACE FS pulse sequence was added to the routine for ED patients presenting with acute atypical LBP over a 12-month period. Imaging findings were categorically scored on the 3D-T2 SPACE FS sequence and separately on the reference standard conventional LS MRI sequences. Patients' symptoms were obtained from review of the electronic medical record. Descriptive test statistics were performed. RESULTS Of the 206 ED patients who obtained MRI for acute atypical LBP, 118 (43.3 ± 13.5 years of age; 61 female) were included. Specific pathologies detected on reference standard conventional MRI included disc herniation (n = 30), acute fracture (n = 3), synovial cyst (n = 3), epidural hematoma (n = 2), cerebrospinal fluid leak (n = 1), and leptomeningeal metastases (n = 1), and on multiple occasions these pathologies resulted in nerve root impingement (n = 36), severe spinal canal stenosis (n = 13), cord/conus compression (n = 2), and cord signal abnormality (n = 2). The 3D-T2 SPACE FS sequence was an effective screen for fracture (sensitivity [sens] = 100%, specificity [spec] = 100%), cord signal abnormality (sens = 100%, spec = 99%), and severe spinal canal stenosis (sens = 100%, spec = 96%), and identified cord compression not seen on reference standard. Motion artifact was not seen on the 3D-T2 SPACE FS but noted on 8.5% of conventional LS MRI. CONCLUSIONS The 3D-T2 SPACE FS sequence MRI is a rapid, effective screen for emergently actionable pathologies that might be a cause of CES in ED patients presenting with acute atypical LBP. As this abbreviated, highly sensitive sequence requires a fraction of the acquisition time of conventional LS MRI, it has the potential of contributing to increased efficiencies in the radiology department and improved ED throughput.
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Affiliation(s)
- Nicholas A Koontz
- Department of Radiology, University of Utah Health Sciences Center, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140; Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Richard H Wiggins
- Department of Radiology, University of Utah Health Sciences Center, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Megan K Mills
- Department of Radiology, University of Utah Health Sciences Center, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Michael S McLaughlin
- Department of Radiology, University of Utah Health Sciences Center, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Elaine C Pigman
- Department of Radiology, University of Utah Health Sciences Center, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Yoshimi Anzai
- Department of Radiology, University of Utah Health Sciences Center, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Lubdha M Shah
- Department of Radiology, University of Utah Health Sciences Center, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
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Kralik SF, O'Neill DP, Kamer AP, Rodriguez E, Ho CY. Radiological diagnosis of drop metastases from paediatric brain tumours using combination of 2D and 3D MRI sequences. Clin Radiol 2017; 72:902.e13-902.e19. [PMID: 28545686 DOI: 10.1016/j.crad.2017.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 11/15/2022]
Abstract
AIM To evaluate spinal magnetic resonance imaging (MRI) examinations using a combination of two-dimensional (2D) and three-dimensional (3D) MRI sequences for diagnosis of drop metastases. MATERIALS AND METHODS Fifty-five paediatric patients with primary brain tumours were evaluated for drop metastases at initial presentation using spinal MRI including sagittal 2D T1-weighted (W) contrast-enhanced (+C), axial 3D T1W+C volumetric interpolated breath-hold (VIBE), and sagittal 3D T2W SPACE (Sampling Perfection with Application optimised Contrasts using different flip angle Evolutions). RESULTS The MRI false-negative rate was 4%, and cerebrospinal fluid (CSF) false-negative rate was 16% (p=0.07). The 3D T1W+C VIBE increased the number of drop metastases detected in 42% of patients. Drop metastases were more conspicuous in 25% of patients on 3D T2W SPACE. CONCLUSION Spinal MRI examinations including 2D and 3D sequences demonstrate characteristics that may improve radiological diagnosis of drop metastases.
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Affiliation(s)
- S F Kralik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - D P O'Neill
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - A P Kamer
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - E Rodriguez
- Department of Radiology, Henry Ford Hospital-Wayne State University, Detroit, MI, USA
| | - C Y Ho
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
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12
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Sung J, Jee WH, Jung JY, Jang J, Kim JS, Kim YH, Ha KY. Diagnosis of Nerve Root Compromise of the Lumbar Spine: Evaluation of the Performance of Three-dimensional Isotropic T2-weighted Turbo Spin-Echo SPACE Sequence at 3T. Korean J Radiol 2017; 18:249-259. [PMID: 28096733 PMCID: PMC5240479 DOI: 10.3348/kjr.2017.18.1.249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/12/2016] [Indexed: 11/29/2022] Open
Abstract
Objective To explore the performance of three-dimensional (3D) isotropic T2-weighted turbo spin-echo (TSE) sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) sequence on a 3T system, for the evaluation of nerve root compromise by disc herniation or stenosis from central to extraforaminal location of the lumbar spine, when used alone or in combination with conventional two-dimensional (2D) TSE sequence. Materials and Methods Thirty-seven patients who had undergone 3T spine MRI including 2D and 3D sequences, and had subsequent spine surgery for nerve root compromise at a total of 39 nerve levels, were analyzed. A total of 78 nerve roots (48 symptomatic and 30 asymptomatic sites) were graded (0 to 3) using different MRI sets of 2D, 3D (axial plus sagittal), 3D (all planes), and combination of 2D and 3D sequences, with respect to the nerve root compromise caused by posterior disc herniations, lateral recess stenoses, neural foraminal stenoses, or extraforaminal disc herniations; grading was done independently by two readers. Diagnostic performance was compared between different imaging sets using the receiver operating characteristics (ROC) curve analysis. Results There were no statistically significant differences (p = 0.203 to > 0.999) in the ROC curve area between the imaging sets for both readers 1 and 2, except for combined 2D and 3D (0.843) vs. 2D (0.802) for reader 1 (p = 0.035), and combined 2D and 3D (0.820) vs. 3D including all planes (0.765) for reader 2 (p = 0.049). Conclusion The performance of 3D isotropic T2-weighted TSE sequence of the lumbar spine, whether axial plus sagittal images, or all planes of images, was not significantly different from that of 2D TSE sequences, for the evaluation of nerve root compromise of the lumbar spine. Combining 2D and 3D might possibly improve the diagnostic accuracy compared with either one.
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Affiliation(s)
- Jinkyeong Sung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Won-Hee Jee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jinhee Jang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Young-Hoon Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Kee-Yong Ha
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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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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Tins BJ, Balain B. Incidence of numerical variants and transitional lumbosacral vertebrae on whole-spine MRI. Insights Imaging 2016; 7:199-203. [PMID: 26873359 PMCID: PMC4805617 DOI: 10.1007/s13244-016-0468-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives This study sets out to prospectively investigate the incidence of transitional vertebrae and numerical variants of the spine. Materials and methods Over a period of 28 months, MRIs of the whole spine were prospectively evaluated for the presence of transitional lumbosacral vertebrae and numerical variants of the spine. Results MRI of the whole spine was evaluated in 420 patients, comprising 211 female and 209 male subjects. Two patients had more complex anomalies. Lumbosacral transitional vertebrae were seen in 12 patients: eight sacralised L5 (3 male, 5 female) and four lumbarised S1 (3 male, 1 female). The incidence of transitional vertebrae was approximately 3.3. % (14/418). Thirty-two (7.7 %) of 418 patients had numerical variants of mobile vertebrae of the spine without transitional vertebrae. The number of mobile vertebrae was increased by one in 18 patients (12 male, 6 female), and the number was decreased by one in 14 patients (4 male, 10 female). Conclusions Numerical variants of the spine are common, and were found to be almost 2.5 times as frequent as transitional lumbosacral vertebrae in the study population. Only whole-spine imaging can identify numerical variants and the anatomical nature of transitional vertebrae. The tendency is toward an increased number of mobile vertebrae in men and a decreased number in women. Main messages • Numerical variants of the spine are more common than transitional vertebrae. • Spinal numerical variants can be reliably identified only with whole-spine imaging. • Increased numbers of vertebrae are more common in men than women. • Transitional lumbosacral vertebrae occurred in about 3.3 % of the study population. • The incidence of numerical variants of the spine was about 7.7 %.
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Affiliation(s)
- Bernhard J Tins
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Twmpath Lane, Oswestry, Shropshire, SY10 7AG, UK.
| | - Birender Balain
- Department of Spinal Surgery, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, Shropshire, UK
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Wu Y, Wang J, Yao Z, Yang Z, Ma Z, Wang Y. Effective performance of contrast enhanced SPACE imaging in clearly depicting the margin of pituitary adenoma. Pituitary 2015; 18:480-6. [PMID: 25236436 DOI: 10.1007/s11102-014-0599-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study is to determine if contrast enhanced (CE) sampling perfection with application-optimized contrasts using different flip-angle evolutions (SPACE) images can provide clearer pituitary adenoma margin than conventional CE T1-weighted spin echo (T1-SE) sequence for cavernous sinus (CS) invasion evaluation. METHODS 21 healthy volunteers were preformed with SPACE scans before and after administration of gadopentetate dimeglumine at different time points (1, 7 and 13 min). Signal intensity (SI) of regions of interest was plotted in SI/time curves for bilateral CS, pituitary and temporal lobe. 35 patients with pituitary adenoma (≥1 cm) were performed CE T1-SE and CE SPACE scans. Two observers made the visual assessment of the tumor margin delineation and CS invasion evaluation on both SPACE and T1-SE images. Surgical findings were compared with the invasion assessment results. RESULTS At 1, 7 and 13 min after enhancement, SI of left CS increased 6.7, 9.5 and 11.2% respectively compared with unenhanced images (all p < 0.05). Right CS increased 7.2, 9.3 and 11.3% (all p < 0.05%). Within pituitary, a decline (6.3%, p < 0.05) of SI was measured at 1 min after enhancement. CE SPACE performed superior to those of CE T1-SE sequence in visual assessment of tumor edge (assessment score, 1.66 ± 0.42 vs. 1.23 ± 0.65, p < 0.05), as well as the specificity (86.8 vs. 66.0%, p < 0.05) and accuracy (85.7 vs. 68.6%, p < 0.05) for CS invasion evaluation. CONCLUSION CE SPACE could provide better contrast of pituitary adenoma with surrounding CS and clear demonstration of tumor edge for CS invasion evaluation than conventional CE T1-SE sequence.
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Affiliation(s)
- Yue Wu
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumiqi Road, Shanghai, 200040, China
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Feasibility of 3-dimensional sampling perfection with application optimized contrast sequence in the evaluation of patients with hydrocephalus. J Comput Assist Tomogr 2015; 39:321-8. [PMID: 25978590 DOI: 10.1097/rct.0000000000000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to investigate the effectiveness and additive value of T2W 3-dimensional sampling perfection with application optimized contrast (3D-SPACE) with variant flip-angle mode in imaging of all types of hydrocephalus. Our secondary objective was to assess the reliability of 3D-SPACE sequence and correspondence of the results with phase-contrast magnetic resonance imaging (PC-MRI)-based data. MATERIALS AND METHODS Forty-one patients with hydrocephalus have undergone 3-T MRI. T2W 3D-SPACE sequence has been obtained in addition to routine hydrocephalus protocol. Cerebrospinal fluid circulation, presence/type/etiology of hydrocephalus, obstruction level scores, and diagnostic levels of confidence were evaluated separately by 2 radiologists. In the first session, routine sequences with PC-MRI were evaluated, and in another session, only 3D-SPACE and 3-dimensional magnetization prepared rapid acquisition gradient echo sequences were evaluated. Results obtained in these sessions were compared with each other and those obtained in consensus session. RESULTS Agreement values were very good for both 3D-SPACE and PC-MRI sequences (P < 0.001 for all). Also, the correlation of more experienced reader's 3D-SPACE-based scores and consensus-based scores was perfect (κ = 1, P < 0.001).The mean value of PC-MRI-based confidence scores were lower than those obtained in 3D-SPACE and consensus sessions. CONCLUSIONS T2W 3D-SPACE sequence provides morphologic cerebrospinal fluid flow data. It is a noninvasive technique providing extensive multiplanar reformatted images with a lower specific absorption rate. These advantages over PC-MRI make 3D-SPACE sequence a promising tool in management of patients with hydrocephalus.
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El Mendili MM, Chen R, Tiret B, Villard N, Trunet S, Pélégrini-Issac M, Lehéricy S, Pradat PF, Benali H. Fast and accurate semi-automated segmentation method of spinal cord MR images at 3T applied to the construction of a cervical spinal cord template. PLoS One 2015; 10:e0122224. [PMID: 25816143 PMCID: PMC4376938 DOI: 10.1371/journal.pone.0122224] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 02/19/2015] [Indexed: 12/11/2022] Open
Abstract
Objective To design a fast and accurate semi-automated segmentation method for spinal cord 3T MR images and to construct a template of the cervical spinal cord. Materials and Methods A semi-automated double threshold-based method (DTbM) was proposed enabling both cross-sectional and volumetric measures from 3D T2-weighted turbo spin echo MR scans of the spinal cord at 3T. Eighty-two healthy subjects, 10 patients with amyotrophic lateral sclerosis, 10 with spinal muscular atrophy and 10 with spinal cord injuries were studied. DTbM was compared with active surface method (ASM), threshold-based method (TbM) and manual outlining (ground truth). Accuracy of segmentations was scored visually by a radiologist in cervical and thoracic cord regions. Accuracy was also quantified at the cervical and thoracic levels as well as at C2 vertebral level. To construct a cervical template from healthy subjects’ images (n=59), a standardization pipeline was designed leading to well-centered straight spinal cord images and accurate probability tissue map. Results Visual scoring showed better performance for DTbM than for ASM. Mean Dice similarity coefficient (DSC) was 95.71% for DTbM and 90.78% for ASM at the cervical level and 94.27% for DTbM and 89.93% for ASM at the thoracic level. Finally, at C2 vertebral level, mean DSC was 97.98% for DTbM compared with 98.02% for TbM and 96.76% for ASM. DTbM showed similar accuracy compared with TbM, but with the advantage of limited manual interaction. Conclusion A semi-automated segmentation method with limited manual intervention was introduced and validated on 3T images, enabling the construction of a cervical spinal cord template.
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Affiliation(s)
- Mohamed-Mounir El Mendili
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
- * E-mail:
| | - Raphaël Chen
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Brice Tiret
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Noémie Villard
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Stéphanie Trunet
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neuroradiologie, F-75013, Paris, Île de France, France
| | - Mélanie Pélégrini-Issac
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
| | - Stéphane Lehéricy
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neuroradiologie, F-75013, Paris, Île de France, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S975, Inserm U975, CNRS UMR7225, Centre de recherche de l’Institut du Cerveau et de la Moelle épinière—CRICM, Centre de Neuroimagerie de Recherche—CENIR, F-75013, Paris, Île de France, France
| | - Pierre-François Pradat
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Département des Maladies du Système Nerveux, F-75013, Paris, Île de France, France
| | - Habib Benali
- Sorbonne Universités, UPMC Univ Paris 06, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, F-75013, Paris, Île de France, France
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Comparison of Contrast-Enhanced SPACE and CISS in Evaluating Cavernous Sinus Invasion by Pituitary Macroadenomas on 3-T Magnetic Resonance. J Comput Assist Tomogr 2015; 39:222-7. [DOI: 10.1097/rct.0000000000000191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Assessment of pituitary micro-lesions using 3D sampling perfection with application-optimized contrasts using different flip-angle evolutions. Neuroradiology 2014; 56:1047-53. [DOI: 10.1007/s00234-014-1432-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
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Schistad EI, Espeland A, Rygh LJ, Røe C, Gjerstad J. The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicular pain. Skeletal Radiol 2014; 43:1271-9. [PMID: 24965739 DOI: 10.1007/s00256-014-1928-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 05/26/2014] [Accepted: 05/26/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine whether Modic changes influence pain during a 1-year follow-up in patients with lumbar radicular pain. MATERIALS AND METHODS A total of 243 patients with lumbar radicular pain due to disc herniation were recruited from two hospitals in Norway and followed up at 6 weeks, 6 months, and 12 months. On baseline lumbar magnetic resonance images, two observers independently evaluated Modic changes (types I-III; craniocaudal size 0-3). Outcomes were sensory pain (McGill Pain Questionnaire), back and leg pain (visual analogue scale, VAS). Association between Modic type and outcomes was explored with a mixed model and then by two-way analysis of variance (ANOVA) at each time point with Modic and treatment groups (surgical, n = 126; nonsurgical, n = 117) as fixed factors, adjusted for disc degeneration, age, sex, smoking, and duration of radicular pain. Modic size was also analyzed using ANOVA. RESULTS Pain scores had decreased significantly at 1-year follow-up. Modic type was significantly related to McGill sensory scores (mixed model: p = 0.014-0.026; ANOVA: p = 0.007 at 6 weeks), but not to VAS back pain or VAS leg pain scores. At 6 weeks, the mean McGill sensory score was higher in Modic I than in Modic II-III patients (p = 0.003) and in patients without Modic changes (p = 0.018). Modic size L1-S1 was not associated with pain outcomes. CONCLUSION Patients with lumbar radicular pain have a substantial pain reduction during 1-year follow-up, but Modic type I changes may imply a slower initial decrease in sensory pain.
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Affiliation(s)
- Elina Iordanova Schistad
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål, Nydalen, Postbox 4956, 0424, Oslo, Norway,
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Tins BJ, Butler R. Imaging in rheumatology: reconciling radiology and rheumatology. Insights Imaging 2013; 4:799-810. [PMID: 24127271 PMCID: PMC3846932 DOI: 10.1007/s13244-013-0293-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 09/17/2013] [Accepted: 09/19/2013] [Indexed: 02/07/2023] Open
Abstract
Imaging in rheumatology was in the past largely confined to radiographs of the hands and sacroiliac joints (SIJs) helping to establish the diagnosis and then monitoring disease progression. Radiographs are not very sensitive for early inflammation in inflammatory rheumatic disorders and the demand on imaging services was therefore limited. However, over the last 10-15 years new drugs and new technologies have brought new challenges and opportunities to rheumatology and radiology as specialties. New drug treatments allow more effective treatment, preventing many complications. Early diagnosis and disease monitoring has become the challenge for the rheumatologist and radiologist alike. The best possible patient outcome is only achieved if the two specialties understand each other's viewpoint. This article reviews the role of imaging-in particular radiography, magnet resonance imaging, computer tomography, ultrasound and nuclear medicine-for the diagnosis and monitoring of rheumatological disorders, concentrating on rheumatoid arthritis, inflammatory spondylarthropathies and gout. Teaching Points • New drugs for the treatment of inflammatory disorders has led to greatly improved outcomes. • Imaging often allows for earlier diagnosis of inflammatory disorders. • Early diagnosis and treatment can often prevent the development of crippling disease manifestations. • Tailored imaging examinations are best achieved by consultation of rheumatologist and radiologist.
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Affiliation(s)
- Bernhard J Tins
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Twmpath Lane, Oswestry, SY10 7AG, UK,
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