Axial T2-weighted Magnetic Resonance Imaging Research Articles

Prospective Validation of the Spinal Cord Shape Classification System in the Prediction of Intraoperative Neuromonitoring Data Loss: Assessing the Risk of Spinal Cord Data Loss During Spinal Deformity Correction.

The Spinal Cord Shape Classification System (SCSCS) class has been associated with spinal cord monitoring data loss during spinal deformity surgery. The objective of the current study was to prospectively validate the SCSCS as a predictor of spinal cord monitoring data loss during spinal deformity surgery. A prospective cohort study of consecutive patients who were undergoing primary deformity surgery at a single institution from 2018 to 2023 and whose major curve was in the spinal cord region was undertaken. Spinal cord morphology at the apex of the major curve on preoperative axial T2-weighted magnetic resonance imaging was used to categorize patients into 3 spinal cord shape types based on the SCSCS. The primary outcome was intraoperative neuromonitoring (IONM) data loss related to spinal cord dysfunction. Demographics and surgical and radiographic variables were compared between patients with IONM data loss and those without loss. Predictors of IONM loss were determined using bivariate and multivariable logistic regression analyses. A total of 256 patients (168 adult, 88 pediatric) were included and were separated into 3 SCSCS types: 110 (43.0%) with Type I, 105 (41.0%) with Type II, and 41 (16.0%) with Type III. IONM loss was observed in 30 (11.7%) of the 256 patients, including 7 (6.4%) of 110 with SCSCS Type I, 7 (6.7%) of 105 with Type II, and 16 (39.0%) of 41 with Type III. IONM loss was associated with SCSCS Type III, the preoperative deformity angular ratio, performance of 3-column osteotomies, greater operative time, greater transfusion volume, and greater postoperative sagittal corrections. SCSCS type was the strongest independent predictor of IONM data loss. SCSCS Type III had the greatest odds of IONM loss (odds ratio [OR] = 6.68, 95% confidence interval [CI] = 2.45 to 18.23 compared with Types I and II combined). The overall predictive performance with respect to IONM loss (area under the receiver operating characteristic curve = 0.827) was considered excellent. This prospective cohort study of patients undergoing spinal deformity correction confirmed that patients with a Type-III spinal cord shape had greater odds of IONM loss. Inclusion of the SCSCS in preoperative risk stratification and intraoperative management of spinal deformity corrective surgery is recommended. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

Degeneration of Cervical Multifidus Muscles Negatively Affects Physical Activity-related Quality of Life After Laminoplasty for Degenerative Cervical Myelopathy.

A retrospective cohort study. The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles. The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous. Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis. In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age (R=-0.358, P=0.002), preoperative JOA score (R=0.286, P=0.021), preoperative PCS (R=0.603, P<0.001), C2-C7 lordotic angle (R=-0.284, P=0.017), stenosis severity (R=-0.271, P=0.019), and Goutallier classification at the C7 level (R=-0.268, P=0.021). In multiple linear regression analysis, sex (β=-0.334, P=0.002), age (β=-0.299, P=0.013), preoperative PCS (β=0.356, P=0.009), and Goutallier classification at the C7 level (β=-0.280, P=0.018) were significantly related to 2-year postoperative PCS. Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty. Level III.

The Success of Deep Learning Modalities in Evaluating Modic Changes

BackgroundModic changes are pathologies that are common in the population and cause low back pain. The aim of the study is to analyze the modic changes detected in magnetic resonance imaging (MRI) using deep learning modalities. MethodsThe sagittal T1, sagittal and axial T2-weighted lumbar MRI images of 307 patients, of which 125 were female and 182 were male, aged 19-86 years, who underwent MRI examination between 2016-2021 were analyzed. Modic changes (MC) were categorized and marked according to signal changes. Our study consists of two independent stages: classification and segmentation. The categorized data was first classified using convolutional neural network (CNN) architectures such as DenseNet-121, DenseNet-169, and VGG-19. In the next stage, masks were removed by segmentation using U-Net, which is the CNN architecture, with image processing programs on the marked images. ResultsDuring the classification stage, the success rates for modic type 1, type 2, and type 3 changes were 98%, 96%, 100% in DenseNet-121, 100%, 94%, 100% in DenseNet-169, and 98%, 92%, 97% in VGG-19, respectively. At the segmentation phase, the success rate was 71% with the U-Net architecture. ConclusionEvaluation of MRI findings of MC in the etiology of lower back pain with deep learning architectures can significantly reduce the workload of the radiologist by providing ease of diagnosis.

Normal diameter of the optic nerve using magnetic resonance imaging: A retrospective Nigerian study.

The variations in the diameter of the optic nerve (ON) are important clinically in the diagnosis of conditions associated with the ON such as raised intracranial pressure, meningioma, optic neuritis, and Grave's orbitopathy. This study determined the normal diameters of the ON in adult Nigerians seen in a Hospital in Delta State. Axial T1-weighted brain magnetic resonance imaging images of 150 patients (75 males and 75 females) aged ≥20 years were retrieved from the hospital's radiological database and retrospectively used to evaluate the diameter of the ON on axial and coronal sections. The data were analyzed and summarized using descriptive statistics. The mean diameters were compared based on gender, side, and age groups and correlated with age using inferential statistics. The significance level was considered at 5%. The diameter of the ON measured 0.45 ± 0.07 cm on the coronal section, besides 0.50 ± 0.07 cm, and 0.46 ± 0.06 cm at 0.3 cm and 0.8 cm from the posterior pole of the globe, respectively, on the axial slices. The diameters were significantly larger in males than in females (P < 0.05) and were symmetrical. However, they lacked significant association with age (P > 0.05). The three diameters measured had a significant positive correlation with each other (P < 0.05). The study provides a normal range of ON diameter in the study center to aid in the diagnosis of raised intracranial pressure and pathologies involving the nerve and its sheath.

An Expanded Surgical Corridor of Oblique Lateral Interbody Fusion at L4-5: A Magnetic Resonance Imaging Study.

We introduced a new preoperative method, the "expanded surgical corridor," to evaluate the actual safety corridor, which may expand the possibility of performing oblique lateral interbody fusion (OLIF). Axial T2-weighted magnetic resonance images at the L4-5 disc level of 511 lumbar degenerative disease patients was evaluated. The distance between the medial edge of the left-sided psoas muscle and the major artery was measured as the conventional surgical corridor (CSc). The distance between the major vein and lumbar plexus was measured as the expanded surgical corridor (ESc). The mean CSc and ESc were 13.9 ± 8.20 and 37.43 ± 10.1 mm, respectively. No surgical corridor was found in 7.05% of CSc and 1.76% of ESc, small corridor ( ≤ 1 cm) was found in 27.40% of CSc and 0.59% of ESc, moderate corridor (1-2 cm) was found in 42.07% of CSc and 1.96% of ESc, and large corridor ( > 2 cm) was found in 23.48% of CSc and 95.69% of ESc. A total of 33.83% (45 of 133) of whom were preoperatively categorized as having a limited surgical corridor by conventional measurement, underwent OLIF L4-5 successfully. By using the ESc, only 2.35% were categorized as having a limited surgical corridor. The other 97.65% of the patients had an approachable corridor that could be successfully operated by experienced spine surgeons who employ meticulous surgical dissection and thorough understanding of the anatomical structures. The ESc may represent true accessibility to the disc space for OLIF, particularly at the L4-5 level.

Unilateral transforaminal lumbar interbody fusion through a modified hemilateral spinous process-splitting approach.

To describe unilateral transforaminal lumbar interbody fusion (TLIF) via a modified hemilateral spinous process-splitting (MHSPS) approach and determine its effectiveness. Sixty-five consecutive patients with the lumbar degenerative disease who underwent MHSPS TLIF between August 2020 and July 2021 were retrospectively analyzed. Japanese Orthopedic Association (JOA) score and visual analog scale (VAS) scores for back and leg pain were evaluated before surgery and at the last follow-up. Postoperative paraspinal muscle atrophy was evaluated on axial T2-weighted magnetic resonance imaging. Mean JOA score increased from 13.6 ± 3.21 before surgery to 24.72 ± 3.34 at last follow-up (p < 0.001). The mean recovery rate was 68.2% ± 5.68%. Clinical outcome was excellent in 22, good in 35, and fair in 8 patients. The VAS score for low back pain was significantly lower at the last follow-up than before surgery (1.18 ± 0.99 vs. 3.09 ± 1.35; p < 0.001). The VAS score for leg pain was also significantly lower at the last follow-up than before surgery (1.13 ± 0.91 vs. 6.61 ± 1.23; p < 0.001). The mean paraspinal muscle atrophy rate did not significantly differ between the symptomatic side (6% ± 3.8%) and asymptomatic side (4.8% ± 3.3%) at last follow -up (p = 0.071). MHSPS TLIF is an effective minimally invasive surgical treatment for selected types of degenerative lumbar disease. This technique can achieve effective spinal decompression and interbody fusion. Its advantages include direct and adequate visualization, vast surgical working space, short operation time, and minimal muscle injury.

A correlation study of preoperative lumbar paraspinal muscle quality and L5-S1 lumbar foraminal stenosis degeneration after L4–5 TLIF

Study designThis was a retrospective study.ObjectivesAdjacent segment degeneration (ASD) is a major complication associated with spinal fusion. The lumbar paraspinal muscle is an essential factor influencing the occurrence of ASD. This study aimed to investigate the effect of preoperative lumbar paraspinal muscle quality on L5-S1 adjacent lumbar foraminal stenosis degeneration (ASLFSD) after L4–5 transforaminal lumbar interbody fusion (TLIF).MethodsA total of 113 patients diagnosed with lumbar spinal stenosis at L4–5 were treated with TLIF. Lumbar paraspinal muscle measurements were obtained preoperatively and bilaterally from axial T2-weighted MR images. The measurements included the total cross-sectional area of psoas (PS-tCSA), of erector spinae (ES-tCSA), and of multifidus (MF-tCSA); and fatty infiltration of psoas (PS-FI), of erector spinae (ES-FI), and of multifidus (MF-FI). Foraminal measurements, including posterior disc height (PDH), disc-to-facet distance (D–F), foraminal height (FH), and foraminal area (FA), were obtained bilaterally using a computed tomography system. The association between lumbar paraspinal muscle quality and changes in foraminal measurements was also studied.ResultsWe observed that the FH and FA significantly reduced at 1 year postoperatively at the mean follow-up period of 41.56 ± 8.38 months (range, 43–50 months), and PDH, D–F, FH, and FA all significantly reduced at final follow-up. These changes in foraminal measurements were significantly and negatively correlated with PS-FI, ES-FI, and MF-FI.ConclusionDuring the clinical follow-up, we found that patients with a higher degree of paraspinal muscle FI were more likely to develop L5-S1 ASLFSD after L4–5 TLIF.

P20.11.A TEMPORAL MUSCLE THICKNESS AS PROGNOSTIC MARKER IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA - A VALIDATION STUDY

Abstract BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare, aggressive diffuse large B-cell lymphoma, confined to the central nervous system. Age and performance status are validated prognostic variables in PCNSL. Frailty may also be a factor but is not easily quantified. Temporal muscle thickness (TMT), as parameter of sarcopenia, is believed to reflect frailty, is easily measurable and may be a valuable additional prognostic factor: mean TMT has been described as an independent prognostic factor in PCNSL patients. This study aims to validate these results in a prospective cohort. MATERIAL AND METHODS All patients from a large phase III trial (HOVON 105/ALLG NHL 24; EudraCT 2009-014722-42) of whom baseline axial T1 weighted magnetic resonance images (MRI) were available were included. Sarcopenia is defined as a mean TMT &amp;lt;6.3mm for men and &amp;lt;5.2mm for women, measured on axial T1-weighted MRI. The TMT was measured by a radiologist (RG) with and a neurologist (MvdM) without correction for angulation of images. Sarcopenia, together with known other prognostic factors were analyzed in a Cox-regression analysis for progression-free (PFS) and overall survival (OS) for both investigators. RESULTS TMT measurements were possible in 164/199 trial patients. The median mean TMT was 7.62mm (IQR: 6.58-9.00; measured by RG) and 5.94mm (IQR: 5.09-7.01; measured by MvdM). The mean TMT was not significantly different between those who used dexamethasone, and those who did not. Sarcopenia was present in 75 patients (46%), measured by MvdM without correction for angulation of the images and in 21 patients (13%), measured by RG with correction for angulation of the images. In univariate analyses, age (&amp;gt;60 years-old) and baseline Mini-Mental State Examination-score &amp;lt;27 were significantly associated with adverse PFS and OS. In multivariate analyses, only age remained as independent prognostic factor for adverse PFS and OS. Sarcopenia, as measured by either of the investigators, was not associated with survival. For measurements by RG, presumed to be most accurate, the Hazard Ratio (95% confidence interval) was 0.68 (0.33-1.40), p=0.30 for PFS, and HR (95% CI): 0.97 (0.42-2.20), p=0.93 for OS in the multivariate analysis. CONCLUSION There was a low interobserver agreement between a neurologist and a radiologist regarding TMT measurements, which questions the use of this parameter in daily practice by non-radiologists. Sarcopenia, based on the mean TMT, was not a prognostic factor in PCNSL patients for PFS and OS. The small number of patients with sarcopenia in this series may have influenced results.

Temporal muscle thickness has no prognostic relevance in patients with high-grade glioma compared to functional scales.

GBM research is constantly assessing potential valuable prognostic biomarkers to better understand the disease and prognosticate future outcomes. Measuring temporal muscle thickness (TMT) has appeared to be a promising new surrogate marker for skeletal muscle mass and sarcopenia, which further indicates frailty and predicts overall survival (OS). The aim of this study was to determine its usefulness as a prognostic marker in patients with high-grade glioma compared to functional status scales. TMT was measured in preoperative axial T1-weighted contrast-enhanced magnetic resonance images in 277 patients who received surgical treatment of newly diagnosed WHO III and IV gliomas in our institution between 2015 and 2020. Clinical Frailty Scale (CFS) and Karnofsky Performance Scale (KPS) were assessed preoperatively and during a follow-up visit. Female gender has shown significant correlation with TMT, while TMT did not correlate with preoperative and follow-up functional scores, age, WHO classification, IDH mutation, MGMT promoter methylation, EGFR and ATRX expression, or 1p/19q co-deletion. No significant prognostic value of TMT could be shown in 6, 12, and 24 months OS, while changes in CFS and KPS proved to have a significant impact. Only female gender, but no other clinical, histological, or molecular marker showed any interrelation with TMT. Functional scores outclass measuring TMT as a reliable prognostic factor for predicting OS in patients with high-grade glioma.

Deep learning-based detection and classification of lumbar disc herniation on magnetic resonance images.

The severity assessment of lumbar disc herniation (LDH) on MR images is crucial for selecting suitable surgical candidates. However, the interpretation of MR images is time-consuming and requires repetitive work. This study aims to develop and evaluate a deep learning-based diagnostic model for automated LDH detection and classification on lumbar axial T2-weighted MR images. A total of 1115 patients were analyzed in this retrospective study; both a development dataset (1015 patients, 15 249 images) and an external test dataset (100 patients, 1273 images) were utilized. According to the Michigan State University (MSU) classification criterion, experts labeled all images with consensus, and the final labeled results were regarded as the reference standard. The automated diagnostic model comprised Faster R-CNN and ResNeXt101 as the detection and classification network, respectively. The deep learning-based diagnostic performance was evaluated by calculating mean intersection over union (IoU), accuracy, precision, sensitivity, specificity, F1 score, the area under the receiver operating characteristics curve (AUC), and intraclass correlation coefficient (ICC) with 95% confidence intervals (CIs). High detection consistency was obtained in the internal test dataset (mean IoU = 0.82, precision = 98.4%, sensitivity = 99.4%) and external test dataset (mean IoU = 0.70, precision = 96.3%, sensitivity = 97.8%). Overall accuracy for LDH classification was 87.70% (95% CI: 86.59%-88.86%) and 74.23% (95% CI: 71.83%-76.75%) in the internal and external test datasets, respectively. For internal testing, the proposed model achieved a high agreement in classification (ICC = 0.87, 95% CI: 0.86-0.88, P < 0.001), which was higher than that of external testing (ICC = 0.79, 95% CI: 0.76-0.81, P < 0.001). The AUC for model classification was 0.965 (95% CI: 0.962-0.968) and 0.916 (95% CI: 0.908-0.925) in the internal and external test datasets, respectively. The automated diagnostic model achieved high performance in detecting and classifying LDH and exhibited considerable consistency with experts' classification.

Association between history of lumbar spine surgery and paralumbar muscle health: a propensity score-matched analysis

Prior studies have suggested that muscle strength and quality may be associated with low back pain. Recently, a novel magnetic resonance imaging (MRI)-based lumbar muscle health grade was shown to correlate with health-related quality of life scores after spine surgery. However, the potential association between history of lumbar spine surgery and paralumbar muscle health requires further investigation. To compare MRI-based paralumbar muscle health parameters between patients with versus without a history of surgery for degenerative lumbar spinal disease. Retrospective cohort study. Consecutive series of patients who presented to the spine surgery clinic of a single surgeon. MRI-based measurements of paralumbar cross-sectional area (PL-CSA), Goutallier grade, lumbar indentation value (LIV). A retrospective analysis was performed on a consecutive series of patients of a single surgeon, and patients were included based on availability of lumbar MRI. Axial T2-weighted lumbar MRIs were analyzed for PL-CSA, Goutallier classification, and LIV. Measurements were performed at the center of disc spaces from L1 to L5. Patients with and without history of spine surgery were matched based on age, sex, race, ethnicity, and body mass index (BMI) via propensity score matching. Normality of each muscle health variable was assessed using Kolmogorov-Smirnov test. Mann-Whitney U test or independent t-test performed to compare the matched cohorts, as appropriate. A total of 615 patients were assessed. For final analysis, 89 patients with a history of previous spine surgery were matched with 89 patients without a history of spine surgery. There were no statistically significant differences in age, sex, race, ethnicity, or BMI between the matched cohorts. History of spine surgery was generally associated with worse lumbar muscle health. At all 4 intervertebral levels between L1-L5, PL-CSA was significantly smaller among patients with history of spine surgery. At L4-L5, patients with prior spine surgery had significantly smaller PL-CSA/BMI. Patients with prior spine surgery were found to have greater fatty infiltration of the muscles, with higher average Goutallier grades at levels L1-L2, L2-L3, and L4-L5. In addition, history of spine surgery was associated with smaller LIV at L1-L2, L3-L4, and L4-L5. The current study demonstrates that history of lumbar spine surgery is associated with worse paralumbar muscle health based on quantitative and qualitative measurements on MRI. On average, patients with history of spine surgery were found to have smaller cross-sectional areas of the paralumbar muscles, greater amounts of fatty infiltration based on Goutallier classification, and smaller lumbar indentation values.

Basilar artery diameter as neuroimaging biomarker in Chinese Fabry disease patients

BackgroundFabry disease (FD) is an X-linked lysosomal storage disease resulting from mutations of α-galactosidase A gene, and has been emphasized as one of the etiologies of young stroke and leukoencephalopathy. Vertebrobasilar dolichoectasia (VBD) is a highlighted finding in FD. We aim to examine the utility of VBD in Chinese FD by comparing the differences in basilar artery (BA) diameter of Chinese FD patients against age-matched controls with and without stroke.MethodsThis was a matched case-control study involving 37 Chinese FD patients. The BA diameters were evaluated on axial T2-weighted magnetic resonance imaging and compared to two age-and-gender matched control groups, one with stroke and one without. The association between BA diameter and stroke occurrences and white matter hyperintensities (WMH) were analyzed among all FD patients.ResultsPatients with FD had significantly increased BA diameter compared to controls with and without stroke (p < 0.001). A BA diameter of 4.16 mm could distinguish FD from controls in the stroke subgroup (ROC AUC 0.870, p = 0.001, sensitivity 80% specificity 100%), and with a cut-off of 3.21 mm in the non-stroke subgroup (ROC AUC 0.846, p < 0.001, sensitivity 77.8% specificity 88.9%). Larger BA diameter had more stroke occurrences and was moderately associated with heavier WMH load in terms of higher total FAZEKAS scores. (Spearman’s rho = 0.423, p = 0.011).ConclusionVBD was also present in Chinese FD patients. BA diameter has high diagnostic utility in identifying FD from a mixed cohort of stroke and normal controls, and carried predictive value in evaluating neurological complications of FD.

Case series: Noninfectious myositis of temporal muscle: a report of 2 cases.

Noninfectious myositis (NIM) of the masticatory muscles is uncommon local myalgia disorder persisted by a centrally-mediated neurogenic mechanism. Due to the rarity of this condition and the lack of appropriate data regarding it, diagnosing this pathology when it affects the temporal muscle (TM) is challenging. Clinical signs and symptoms, diagnostic process, and treatment outcome of 2 rare cases of NIM of the TM were presented. The signs and symptoms of the patients were not pathognomonic. There were restrictions on the mouth opening and lateral excursion of the mandible. The duration of the symptoms may not be chronic. The findings of clinical evaluation may indicate the diagnosis of anterior disc displacement (DD) without reduction of the temporomandibular joint (TMJ) and/or local myalgia. Swelling of the involved muscle could be evident and identified on palpation depending on the involved site of myositis. The axial T2-weighted magnetic resonance (MR) imaging was important for the accurate diagnosis of this rare condition. Application of non-surgical conservative treatment modalities such as administration of non-steroidal anti-inflammatory analgesics for a sufficient period of time, control of oral parafunctional habits, and jaw exercises were effective for the management of NIM of the TM. A thorough clinical examination and MR imaging including the axial T2-weighted view are required for accurate diagnosis and effective management of NIM of the TM.

Deep learning for image classification between primary central nervous system lymphoma and glioblastoma in corpus callosal tumors.

It can be challenging in some situations to distinguish primary central nervous system lymphoma (PCNSL) from glioblastoma (GBM) based on magnetic resonance imaging (MRI) scans, especially those involving the corpus callosum. The objective of this study was to assess the diagnostic performance of deep learning (DL) models between PCNSLs and GBMs in corpus callosal tumors. The axial T1-weighted gadolinium-enhanced MRI scans of 274 individuals with pathologically confirmed PCNSL (n = 94) and GBM (n = 180) were examined. After image pooling, pre-operative MRI scans were randomly split with an 80/20 procedure into a training dataset (n = 709) and a testing dataset (n = 177) for DL model development. Therefore, the DL model was deployed as a web application and validated with the unseen images (n = 114) and area under the receiver operating characteristic curve (AUC); other outcomes were calculated to assess the discrimination performance. The first baseline DL model had an AUC of 0.77 for PCNSL when evaluated with unseen images. The 2nd model with ridge regression regularization and the 3rd model with drop-out regularization increased an AUC of 0.83 and 0.84. In addition, the last model with data augmentation yielded an AUC of 0.57. DL with regularization may provide useful diagnostic information to help doctors distinguish PCNSL from GBM.

Uterine Inversion.

HomeRadioGraphicsVol. 43, No. 6 PreviousNext Cases from the Cooky JarFree AccessUterine InversionKaitlin M. Zaki-Metias , Melina Hosseiny, Fardad Behzadi, Patricia BalthazarKaitlin M. Zaki-Metias , Melina Hosseiny, Fardad Behzadi, Patricia BalthazarAuthor AffiliationsFrom the Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, 44405 Woodward Ave, Medical Education, Pontiac, MI 48341 (K.M.Z.M.); Department of Radiology, University of California San Diego, San Diego, Calif (M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (F.B.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.).Address correspondence to K.M.Z.M. (email: [email protected]).Kaitlin M. Zaki-Metias Melina HosseinyFardad BehzadiPatricia BalthazarPublished Online:May 18 2023https://doi.org/10.1148/rg.230004MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Uterine inversion, or uterine intussusception, is a rare, potentially life-threatening entity characterized by inversion of the fundus into the uterine cavity, which often manifests as an acute complication of childbirth (1,2). Less commonly, uterine inversion is nonpuerperal, occurring as a result of an endometrial or myometrial mass (2,3). Patients typically present with symptoms that include vaginal bleeding and pelvic pain.At MRI, uterine inversion appears as a U-shaped uterus with loss of the normal convex fundal contour on sagittal images (Fig 1A, 1B) (2). A target configuration may be visualized on axial images, representing the concentric serosa, myometrium, and endometrium (Fig 1C, 1D) (2). MRI is also useful in assessing the cause in patients with nonpuerperal uterine inversion, including submucosal leiomyomas, uterine leiomyosarcomas, and endometrial malignancies. There are four grades of uterine inversion, which are characterized by the degree of inferior bowing of the fundus relative to the cervix and/or vaginal introitus (Fig 2).Figure 1. Uterine inversion in a previously healthy premenopausal female patient with acute onset of pelvic pain and vaginal bleeding. A bleeding vaginal or cervical mass was suspected on physical examination, and pelvic MRI was performed for further evaluation. Sagittal T2-weighted (A) and contrast-enhanced fat-suppressed T1-weighted (B) MR images of the pelvis demonstrate a U-shaped uterus (U) with loss of the normal fundal contour, with protrusion of the fundus into the distended vaginal canal (V), consistent with grade III uterine inversion. The cervix (C) is located superior to the inverted fundus. At the fundus, there is an ill-defined rounded lesion (arrow in A and B) with heterogeneous T1 signal intensity and enhancement with irregular margins, with adjacent heterogeneous T2 signal intensity and increased T1 signal intensity. The findings are most consistent with a hemorrhagic submucosal uterine leiomyoma. Axial T2-weighted (C) and contrast-enhanced fat-suppressed T1-weighted (D) MR images of the pelvis show concentric rings of signal intensity indicating the serosa, myometrium, endometrium, and vagina.Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. Illustration depicts the normal anatomic position of the uterus (A) and the various grades of inversion. Grade I uterine inversion (B) is characterized by inferior bowing of the fundus up to but not beyond the cervix. In grade II uterine inversion (C), the inverted fundus protrudes through the cervix and into the vagina. The uterus is fully inverted and protrudes out of the vagina in grade III uterine inversion (D).Figure 2.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest.—K.M.Z.M. Meeting attendance and travel reimbursement from Trinity Health Oakland Hospital. P.B. Editorial board member of RadioGraphics, Association of University Radiologists GE Radiology Research Academic Fellowship, meeting travel reimbursement from the American College of Radiology.K.M.Z.M and P.B. have provided disclosures (see end of article); all other authors have disclosed no relevant relationships.

Symptoms: Sudden Sensorineural Hearing Loss and Aural Fullness

Symptoms: Sudden Sensorineural Hearing Loss and Aural Fullness

Menière's Syndrome Associated With Fibrous Dysplasia of the Temporal Bone.

Menière's Syndrome Associated With Fibrous Dysplasia of the Temporal Bone.

Transuterine Ultrasound-Guided Fetal Embolization of Vein of Galen Malformation, Eliminating Postnatal Pathophysiology.

Transuterine Ultrasound-Guided Fetal Embolization of Vein of Galen Malformation, Eliminating Postnatal Pathophysiology.

Gadolinium enhancement in cervical dorsal roots in a patient with acute autonomic and sensory neuropathy: a case report

BackgroundWe report an enhancement of the dorsal roots on gadolinium-enhanced cervical magnetic resonance imaging (MRI) in a patient with acute autonomic and sensory neuropathy (AASN).Case presentationA 38-year-old woman visited our university hospital for dizziness and fainting while rising from sitting or lying down and a tingling sensation in the whole body, including her limbs, torso, and abdomen, which was sustained for 15 days. The patient had hyperalgesia in nearly her entire body and slight motor weakness in her bilateral upper and lower limbs. Autonomic dysfunction was confirmed using autonomic testing. Furthermore, the nerve conduction study showed an absence of sensory nerve action potentials in all evaluated peripheral nerves. Cervical MRI was performed 18 days after dysautonomia onset. In the axial T1-gadolinum-enhanced MRIs, enhancement in cervical ventral and dorsal nerve roots and the posterior column of the spinal cord were observed, and the axial T2-weighted MRI showed high signal intensity in the posterior column of the cervical spinal cord. Considering the clinical, electrophysiological and imaging findings, the patient was diagnosed with AASN. A total dose of 90 g (2 g/kg) of intravenous immunoglobulin was administered over 5 days. At the follow-up at 4 years after AASN symptom onset, the hyperalgesia and orthostatic hypotension symptoms improved. However, her systolic blood pressure intermittently decreased to < 80 mmHg.ConclusionGadolinium-enhanced MRI may facilitate the accurate and prompt diagnosis of AASN.

Duration of Back Pain Symptoms and Its Relationship to Paralumbar Muscle Volume.

Paralumbar muscle volume has been indicated as an important factor for patients reporting back pain. Our goal was to determine if there is a statistically significant relationship between the duration of patients' back pain symptoms (>12 weeks or ≤12 weeks) and paralumbar muscle volume. In this retrospective cohort study, paralumbar muscles on axial T2-weighted lumbar magnetic resonance images were outlined using ImageJ to determine the paralumbar cross-sectional area (PL-CSA) and lumbar indentation value (LIV) at the center of disc spaces from L1 to L5. The Goutallier classification was determined by the primary author. Quantile regression was performed to compare the PL-CSA, PL-CSA normalized by body mass index, and LIV between the 2 cohorts. Cohort A consisted of patients reporting symptoms ≤12 weeks, and cohort B included patients with symptoms >12 weeks. Negative binomial regression was used to compare Goutallier class. A total of 551 patients operated on by a single surgeon with lumbar magnetic resonance imaging within the past 12 months and recorded duration of symptoms were included. Cohort A consisted of 229 patients (41.6%), and cohort B included 322 patients (58.4%). Statistical significance was not found at any lumbar level for PL-CSA, PL-CSA normalized by body mass index, Goutallier class, and LIV. Our results suggest that duration of symptoms may not be an accurate indicator for lumbar muscle volume. These novel findings are clinically valuable because lumbar muscle volume has been shown to be a marker for recovery. With this information, patients previously believed to be inoperable because of long-standing symptoms can be reevaluated.