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Lombardi AF, Aihara AY, Fernandes ADRC, Cardoso FN. Imaging of Paget's Disease of Bone. Radiol Clin North Am 2022; 60:561-573. [PMID: 35672089 DOI: 10.1016/j.rcl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Paget's disease is a metabolic bone disorder affecting the elderly and characterized by bone resorption followed by compensatory bone formation. Radiography is the imaging modality of choice for the diagnosis whereas bone scintigraphy helps stage the extent of the disease and assess response to treatment. MRI and CT are important imaging methods in the assessment of complications and surgical planning. Osteolytic lesions of Paget's first phase present with well-defined margins on radiographs, most commonly in the femur, pelvis, and skull. Cortical thickening, trabecular coarsening, bone marrow sclerosis, and deformities of long bones are present in the mixed- and late-sclerotic phases.
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Affiliation(s)
- Alecio F Lombardi
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; Department of Radiology, University of California San Diego, San Diego, CA 92037, USA.
| | - André Yui Aihara
- Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, SP 04024-000, Brazil; Diagnósticos da América (DASA), São Paulo, SP 05425-020, Brazil
| | | | - Fabiano Nassar Cardoso
- Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA
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Nwotchouang BST, Eppelheimer MS, Bishop P, Biswas D, Andronowski JM, Bapuraj JR, Frim D, Labuda R, Amini R, Loth F. Three-Dimensional CT Morphometric Image Analysis of the Clivus and Sphenoid Sinus in Chiari Malformation Type I. Ann Biomed Eng 2019; 47:2284-2295. [PMID: 31187348 DOI: 10.1007/s10439-019-02301-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023]
Abstract
This study evaluated three-dimensional (3D) volumetric image reconstructions to identify morphological differences of the clivus and sphenoid sinus on computed tomography (CT) scans of Chiari malformation type I (CMI) and control subjects. Axial CT images of adult females for 30 CMI subjects and 30 age and body mass index (BMI) matched controls were used for this retrospective study. 3D volumetric reconstructions were created from the bone windows of axial data following image registration for position and orientation correction of the head. The volume, surface area, linear dimensions and spatial position in the x, y, and z-axes were computed separately for the clivus and the sphenoid sinus for each subject. Eleven parameters were found to be significantly different between CMI subjects compared to controls. Most notably, clivus volume was reduced by 31% on average in CMI subjects. In contrast, we found that the sphenoid sinus volume was 38% greater on average in CMI subjects. Moreover, clivus length, height, width, and thickness were 3.7, 2.8, 3.0 and 9.4 mm reduced, respectively, in CMI subjects. This is the first study to demonstrate cephalometric differences in the 3D morphology of the clivus and sphenoid sinus between CMI subjects and controls.
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Affiliation(s)
| | - Maggie S Eppelheimer
- Department of Biomedical Engineering, University of Akron, Akron, OH, 44325-3903, USA
| | - Paul Bishop
- Department of Biomedical Engineering, University of Akron, Akron, OH, 44325-3903, USA
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Dipankar Biswas
- Department of Mechanical Engineering, University of Akron, Akron, OH, USA
| | | | - Jayapalli R Bapuraj
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - David Frim
- Department of Neurosurgery, University of Chicago, Chicago, IL, USA
| | | | - Rouzbeh Amini
- Department of Biomedical Engineering, University of Akron, Akron, OH, 44325-3903, USA
| | - Francis Loth
- Department of Biomedical Engineering, University of Akron, Akron, OH, 44325-3903, USA
- Department of Mechanical Engineering, University of Akron, Akron, OH, USA
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Urbizu A, Poca MA, Vidal X, Rovira A, Sahuquillo J, Macaya A. MRI-based morphometric analysis of posterior cranial fossa in the diagnosis of chiari malformation type I. J Neuroimaging 2013; 24:250-6. [PMID: 23324118 DOI: 10.1111/jon.12007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/12/2012] [Accepted: 10/28/2012] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The diagnosis of Chiari malformation type I (CMI) relies on MRI identification of a tonsillar descent (TD) through the foramen magnum, reflecting the overcrowding of an underdeveloped posterior cranial fossa (PCF). However, TD occurs in some patients with normal-sized PCF and, conversely, some patients with borderline or no TD have small PCF. We thus sought to identify a set of prototypic PCF measures for the diagnosis of CMI. METHODS We performed nineteen measurements of the PCF on sagittal MRI of 100 cases with cerebellar TD ≥5 mm and 50 control individuals, compared the average values in both cohorts and used logistic regression to devise a probability model to predict CMI status. RESULTS Significant decrements were detected for several PCF-related measures in the patients' cohort. We developed a probability model that combined seven of these parameters to predict diagnosis with 93% sensitivity and 92% specificity. CONCLUSIONS The addition of simple morphometric measurements in the diagnostic work-up of patients with suspected CMI may facilitate radiological diagnosis. Moreover, identification of the subset of CMI that arise from basichondrocranium underdevelopment is important for both, selection of the most appropriate therapeutic approach as well as proper CMI categorization in research studies.
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Affiliation(s)
- Aintzane Urbizu
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona
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Loukas M, Shayota BJ, Oelhafen K, Miller JH, Chern JJ, Tubbs RS, Oakes WJ. Associated disorders of Chiari Type I malformations: a review. Neurosurg Focus 2012; 31:E3. [PMID: 21882908 DOI: 10.3171/2011.6.focus11112] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A single pathophysiological mechanism of Chiari Type I malformations (CM-I) has been a topic of debate. To help better understand CM-I, the authors review disorders known to be associated with CM-I. The primary methodology found among most of them is deformation of the posterior cranial fossa, usually with subsequent decrease in volume. Other mechanisms exist as well, which can be categorized as either congenital or acquired. In understanding the relationship of such disorders with CM-I, we may gain further insight into the process by which cerebellar tonsillar herniation occurs. Some of these pathologies appear to be true associations, but many appear to be spurious.
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Affiliation(s)
- Marios Loukas
- Department of Anatomical Sciences, St. George's University, Grenada
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Chiari type 1 anomaly in pseudohypoparathyroidism type Ia: pathogenetic hypothesis. Childs Nerv Syst 2011; 27:2035-9. [PMID: 21994050 DOI: 10.1007/s00381-011-1606-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 09/28/2011] [Indexed: 10/16/2022]
Abstract
AIM This study aims to report a patient with Chiari type 1 malformation (CM1) occurring in the context of pseudohypoparathyroidism type 1a (PHP-Ia) that we believe represents the first instance of this association in the current literature. CASE REPORT The authors describe the case of a 6-year-old girl diagnosed with PHP-Ia who presented an associated tonsillar descent. During the follow-up, the skull vault and the occipital squama became extremely thickened at the same time as the tonsillar herniation showed a marked regression. DISCUSSION Chronic tonsillar descent has been reported in diverse genetic and metabolic diseases of bone. A constant finding in PH-Ia consists of changes that mainly involve the bones of the patients' hands and feet. Cerebral anomalies have also been documented in PHP-Ia, especially cerebral calcifications, but in contrast involvement of the skull bones has seldom been described in this condition. The authors briefly discuss the probable role played by the observed skull changes in the origin and subsequent regression of the tonsillar descent in this child. CONCLUSIONS We suggest that CM1 may develop in patients with PHP-Ia and that it should be actively sought, especially in individuals diagnosed with PHP-Ia presenting with neurological manifestations. Probably, the seeming rarity of chronic tonsillar descent in PHP-Ia is due to the fact that many patients with this condition are rarely investigated with magnetic resonance.
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Tubbs RS, Webb D, Abdullatif H, Conklin M, Doyle S, Oakes WJ. Posterior Cranial Fossa Volume in Patients with Rickets: Insights into the Increased Occurrence of Chiari I Malformation in Metabolic Bone Disease. Neurosurgery 2004; 55:380-3; discussion 383-4. [PMID: 15271244 DOI: 10.1227/01.neu.0000129547.30778.b7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2003] [Accepted: 03/24/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Some have proposed that the calvarial thickening seen in patients with rickets results in an increased rate of Chiari I malformation (CIM) in these patients. The present study measures the posterior fossa volume in children with rickets to verify previous case reports indicting a small posterior fossa as the cause for an increased rate of CIM in children with rickets. METHODS Patients were chosen by use of a computer database to search for individuals diagnosed with rickets. Nineteen patients were identified with this diagnosis. Seven patients were found from this cohort to have imaging of the head. Axial computed tomographic and magnetic resonance images were analyzed by use of the Cavalieri method to define posterior fossa volumes. These data were then compared with those from age-matched control subjects. RESULTS Mean volumes of the posterior fossa were significantly reduced in all patients compared with age-matched control subjects (P < 0.0001). CONCLUSION We have found that the volume of the posterior fossa is significantly smaller in children with rickets versus age-matched control subjects. Furthermore, 29% of our study group had an associated CIM. We may hope that these data will aid in the further understanding of the pathophysiology of CIM in cases of metabolic bone disease.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, Children's Hospital, Birmingham, Alabama 35233, USA.
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