Cervical Magnetic Resonance Imaging Research Articles

Case Report: Vertebro-vertebral arteriovenous fistula showing symptoms mimicking ALS: Diagnostic imaging supports accurate differentiation between ALS and mimicking conditions

We report a rare case of a vertebro-vertebral arteriovenous fistula (VVAVF) manifesting as amyotrophic lateral sclerosis (ALS). A 76-year-old female patient presented with progressive weakness, muscle atrophy, fasciculation, and preserved deep tendon reflexes in the right upper limb. Electrophysiological testing showed lower motor neuron dysfunction. The patient was suspected to have ALS, but cervical magnetic resonance imaging (MRI) revealed enlarged blood vessels in the spinal canal, which compressed the cervical spinal cord and nerve roots. Angiography showed a shunt from the right vertebral artery to the right intervertebral vein and the vertebral venous plexus; therefore, the patient was diagnosed with VVAVF. Transarterial embolization was performed to obliterate the shunt, and weakness in the patient’s right upper limb subsequently improved. It is worth considering VVAVF as a differential diagnosis of ALS-like diseases.

Symptomatic Cervical Spinal Cord Injury Without Accompanying Intracranial Injury Because of Child Abuse.

Although spinal ligamentous injuries and extra-axial hemorrhages are known to commonly accompany abusive head trauma (AHT), symptomatic and radiological apparent cervical spinal cord injuries are rare. Of the 16 previously reported cases, 3 such cord injuries lacked the accompanying intracranial injuries of AHT. We report an additional child who developed symptomatic central cervical cord syndrome, with accompanying cervical imaging findings, but no intracranial AHT injuries. The mechanism of trauma for this child and the other children without intracranial injury remains unclear. However, 1 additional reported child sustained similar injuries when she was held by her head and shaken. It is likely that as cervical magnetic resonance imaging becomes more common in AHT, more cases will be recognized.

Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain-A pragmatic study.

ObjectivesCervical nerve root compression can lead to radiculopathy in the arm. Some studies have reported low accuracy in determining the responsible nerve root in both cervical and lumbar regions. This prospective, observational, pragmatic study aimed to determine the accuracy of the clinical evaluation relative to magnetic resonance imaging (MRI) findings in patients with arm radiculopathy.MethodsPatients with neck pain and neck‐related arm pain referred to a spine unit underwent a standard clinical neurological examination and cervical spine MRI. The clinical examination required a judgment of the most likely cervical root involved, including the side. The Interobserver reproducibility was tested. Using MRI, the most likely nerve root involved according to radiology was assessed.ResultsEighty‐three patients met the inclusion criteria. The Interobserver reproducibility between clinical evaluators was 58%, with a modest κ coefficient (0.33, 95% confidence interval [CI]: 0.18–0.47) classified only as "fair agreement.” Only 31% (95% CI: 22–42) of the 83 patients exhibited full agreement regarding the suspected cervical root as assessed via the clinical evaluation and MRI. In another 28% (95% CI: 18–39), the clinical evaluation identified an adjacent level to that identified on MRI.ConclusionsIn cervical radiculopathy, the clinical‐neurological examination diagnosed the same in 31% or an adjacent cervical root in 28% of the patients in relation to the most affected cervical root on MRI.

Diagnostic performance evaluation of adult Chiari malformation type I based on convolutional neural networks

PurposeThis study aimed to evaluate the diagnostic performance of convolutional neural network (CNN) models in Chiari malformation type I (CMI) and to verify whether CNNs can identify the morphological features of the craniocervical junction region between patients with CMI and healthy controls (HCs). To date, numerous indicators based on manual measurements are used for the diagnosis of CMI. However, the corresponding postoperative efficacy and prognostic evaluations have remained inconsistent. From a diagnostic perspective, CNN models may be used to explore the relationship between the clinical features and image morphological parameters. MethodsThis study included a total of 148 patients diagnosed with CMI at our institution and 205 HCs were included. T1-weighted sagittal magnetic resonance imaging (MRI) images were used for the analysis. A total of 220 and 355 slices were acquired from 98 patients with CMI and 155 HCs, respectively, to train and validate the CNN models. In addition, median sagittal images obtained from 50 patients with CMI and 50 HCs were selected to test the models. We applied original cervical MRI images (CI) and images of posterior cranial fossa and craniocervical junction area (CVI) to train the CI- and CVI-based CNN models. Transfer learning and data augmentation were used for model construction and each model was retrained 10 times. ResultsBoth the CI- and CVI-based CNN models achieved high diagnostic accuracy. In the validation dataset, the models had diagnostic accuracy of 100% and 97% (p = 0.005), sensitivity of 100% and 98% (p = 0.016), and specificity of 100% (p = 0.929), respectively. In the test dataset, the accuracy was 97% and 96% (p = 0.25), sensitivity was 97% and 92% (p = 0.109), and specificity was 100% (p = 0.123), respectively. For patients with cerebellar subungual herniation less than 5 mm, three out of the 10 CVI-based retrained models reached 100% sensitivity. ConclusionsOur results revealed that the CNN models demonstrated excellent diagnostic performance for CMI. The models had higher sensitivity than the application of cerebellar tonsillar herniation alone and could identify features in the posterior cranial fossa and craniocervical junction area of patients. Our preliminary experiments provided a feasible method for the diagnosis and study of CMI using CNN models. However, further studies are needed to identify the morphologic characteristics of patients with different clinical outcomes, as well as patients who may benefit from surgery.

Cervical disc degeneration is associated with a reduction in mobility: A cross-sectional study of 1211 asymptomatic healthy subjects

The aim of this study was to establish the age-related changes and gender-specific differences of cervical disc degeneration using magnetic resonance image (MRI) and to evaluate the correlation between the severity of cervical disc degeneration and mobility in asymptomatic subjects. A total of 1,211 relatively healthy volunteers (606 males and 605 females, mean age 49.5 years) without neurological symptoms underwent MRI. At least 100 males and 100 females in each decade of life between the 20 s and the 70 s were included. This study was part of a larger project and used some previously published data. Cervical disc degeneration was defined according to the modified Pfirrmann classification system. A total disc degeneration score (DDS) was calculated by the summation of individual Pfirrmann scores from C2/C3 to C7/T1. Cervical range of motion (ROM) was measured by radiograph. The total DDS increased gradually with increasing age in both genders. DDSs were lower in females than in males in all decades. A DDS of 13 or more was found in more than half the cases in the 40 s or older age groups. The total DDS was 13 or more in over 95% of the cases in the 70 s age group. The total DDS was significantly and negatively correlated with cervical ROM overall (r = − 0.46, p < 0.0001) and in both men (r = − 0.52, p < 0.0001) and women (r = − 0.40, p < 0.0001). This large-scale cross-sectional analysis of cervical spine MRI data in healthy subjects demonstrated that cervical disc degeneration progresses with age, and is correlated with a reduction in mobility.

Sleep-disordered breathing in pediatric neurofibromatosis type 1.

The relationship between neurofibromatosis type 1 (NF1) and sleep-disordered breathing (SDB) has not been widely studied. The aim of the study was to analyze SDB in children with NF1 of the respiratory system. All children with NF1 followed between September 2008 and July 2020 who had a respiratory polygraphy (RP) were included. The clinical charts, cerebral and cervical magnetic resonance imaging (MRI), and RP were analyzed. Twenty-two patients (11 girls, median age at RP 8.3 [0.2-18.2] years) were included in the study. Nine patients (41%) had a NF1 involvement of the upper airways, 13 (59%) patients of the central nervous system (CNS), the cranial nerves (CN) and/or medulla, and 17 (77%) patients had a hypertrophy of the adenoids and/or tonsils. Five patients were treated with Continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) before their first evaluation because of severe obstructive sleep apnea (OSA). Accordingly, 10 (45%) patients had no OSA, one (5%) mild OSA, 2 (9%) moderate OSA, and nine (41%) severe OSA. None of the patients had central sleep apnea. Despite upper airway surgery, three patients required CPAP, two could be weaned and one died after a switch to tracheostomy. None of the patients treated with CPAP/NIV could be weaned, one patient required tracheostomy. Neither the clinical nor the MRI findings were able to predict OSA on a RP. The prevalence of OSA in NF1 is high, regardless of the nature of airway obstruction and the clinical and MRI findings, underlining the value of a systematic RP. CPAP may reduce the need of tracheostomy.

Comparison between the coronal diameters of the cervical spinal canal and spinal cord measured using computed tomography and magnetic resonance imaging in Korean patients.

BackgroundIf the proportion of the spinal cord in the epidural space can be determined under C-arm fluoroscopy during cervical epidural block, a safe entry point for the epidural needle can be established. The aim of this study was the measurement of the cord to canal transverse diameter ratio of each cervical spines. MethodsWe retrospectively evaluated the imaging data of 100 patients who underwent both cervical computed tomography (CT) and cervical magnetic resonance imaging (MRI) at our hospital. We measured the diameters of the spinal canal and spinal cord from the 3rd cervical vertebra to the 1st thoracic vertebra (T1) at each level by using the patients’ cervical CT and MRI images. The spinal cord and spinal canal diameters were measured in the transverse plane of the cervical MRI and CT images, respectively.ResultsThe spinal cord to spinal canal diameter ratio was the highest at the 4th and 5th cervical vertebrae (0.64 ± 0.07) and the lowest at T1 (0.55 ± 0.06, 99% CI [0.535, 0.565].ConclusionsOur findings suggest that the cord to canal transverse diameter ratio could be used as a reference to reduce direct spinal cord injuries during cervical epidural block under C-arm fluoroscopy. In the C-arm fluoroscopic image, if an imaginary line connecting the left and right innermost lines of the pedicles of T1 is drawn and if the needle is inserted into the outer one-fifth of the left and right sides, the risk of puncturing the spinal cord would be relatively reduced.

Cocaine-related cervical spinal cord infarction: a\xa0case report and review of the\xa0literature

Study designCase report.ObjectivesTo report a clinical case of spinal cord infarction due to cocaine use.SettingSpinal Center, IRCCS Fondazione S. Lucia, Rome (Italy).Case presentationTwo days after recreational use of cocaine, a 27-year-old Caucasic man was admitted to the emergency department for acute cervical pain, weakness in all four limbs, and urinary retention. A cervical spinal magnetic resonance imaging scan, performed after 2 days, showed a “pencil-like” lesion extending from C4 to T1 metamer, compatible with acute ischemia in the anterior spinal artery territory. Other causes of vascular disorders, as well as inflammatory and infectious disorders were ruled out. At admission in our department, the patient had an incomplete tetraplegia at level C6, an indwelling catheter, and was unable to stand and walk. After 3 months of rehabilitation, he had an AIS score D tetraplegia at level C7, was able to stand and walk using parallel bars, and indwelling catheter was replaced by intermittent catheterization.Discussion and conclusionsThe etiology of medullary infarction may remain unexplained in nearly 30–40% of cases. Even if rare, cocaine-induced ischemic myelopathy should be considered and ruled out in the differential diagnosis of any acute nontraumatic myelopathy, especially in young patients.

Case report of a retropharyngeal synovial cyst originate from atlantoaxial joint and review of the literature

Synovial cysts of the atlantoaxial joint are rare entities [1] and could possibly grow in any direction and compress adjacent structure. Synovial cysts of the atlantoaxial joint have been associated with atlantoaxial instability because of trauma or chronic inflammation. They could grow in the retropharyngeal space, lateral to the spine or towards the spinal canal either epidural or intradural and cause progressive myelopathy [2]. Rarely synovial cysts could cause acute clinical symptoms because of hemorrhage [5]. In this article, we present a case report of a 72 years old man presented with subtle upper neck pain and after cervical MRI (Magnetic Resonance Imaging) has been diagnosed with a retropharyngeal cystic mass originating from atlantoaxial arthrosis. Patient treated conservatively with analgetic medication. Neck pain went off without remission and there was no relapse during the last 5 years of follow up. Repeated cervical MRI revealed no change of the cyst size and morphology and patient remained asymptomatic. Atlantoaxial instability was not present in flexion extension x-rays. Laboratory results for rheumatoid arthritis were negative.

Cervical facet joint effusion: A sign of instability in cervical degenerative spondylolisthesis.

Aims:The aim of this study was to trace the association between cervical facet joint effusion and cervical degenerative spondylolisthesis (CDS). CDS has not received as much attention as its lumbar counterpart. Identification of features of instability on magnetic resonance imaging (MRI) is crucial to avoid missing presence of CDS.Materials and Methods:The authors retrospectively reviewed cervical spine MRI scans and upright lateral flexion-extension radiographs of 17 consecutive patients at a single institution between January 2017 and June 2018 that revealed CDS. Presence of cervical facet joint effusion and CDS was recorded. Data were analyzed to deduce possibility of an association between cervical facet joint effusion and CDS.Results:Seventeen patients fulfilled the inclusion criteria of cervical spondylotic myelopathy associated with CDS. Out of these, 10 patients revealed facet joint effusion at C3-C4 (4 patients) and C4-C5 (6 patients) levels. The mean age of patients was 65.8 years (49–79) and M:F was 2.2:1. Amount of facet joint effusion varied and ranged from 1.6 mm to 4.7 mm on the axial images. Ten patients (58.82%) demonstrated facet joint effusion associated with mobile CDS. Seven patients (41.17%) with CDS and without facet effusion did not demonstrate mobility of more than 0.5 mm in flexion-extension radiographs.Conclusion:The current study acknowledges the association of “cervical facet effusion” and CDS. Clinically measurable facet joint effusion on MRI suggests the need for further attempts to diagnose CDS.

Radiologic utility of the Gehweiler and AO spine classification systems for C1 Trauma: A retrospective review from a Level I trauma center.

The purpose of our study was to identify adult trauma patients with an acute C1 burst fracture, evaluate for concomitant transverse atlantal ligament (TAL) injury, and apply the modified Gehweiler and AO spine classification systems to determine the utility of these classification systems in accurately defining C1 trauma. Adult trauma patients with an acute C1 fracture were identified retrospectively using Nuance mPower software. The C1 fracture was described based on whether the fracture involved the anterior arch, posterior arch, lateral mass, medial tubercle, and/or transverse process. If follow-up cervical magnetic resonance imaging (MRI) was performed, the presence and location of an associated TAL injury was recorded. The anatomic location of the C1 burst fracture and TAL injury, if present, were compared with the descriptive classification systems outlined by Gehweiler/Dickman (modified) and the AO Spine society. Any additional osseous trauma of the skull base and C1-C2 was also recorded along with relevant clinical history and management. Thirty-nine patients were identified with an acute C1 burst fracture on cervical computed tomography (CT) with seventy-seven percent of patients undergoing follow-up cervical MRI. Observed fracture patterns were divided into five distinct types based on CT findings and further subdivided based on the integrity of the transverse altantal ligament on MRI. TAL tears were observed exclusively in type 3 fractures (anterior and posterior arch fractures) and type 4 fractures (anterior arch, posterior arch, and lateral mass fractures). The modified Gehweiler classification system failed to accurately describe the anatomic location of the C1 fracture in forty-four percent of patients, whereas the AO spine was too broad and failed to accurately describe fracture location in our cohort. The Gehweiler and AO spine classifications demonstrated significant shortcomings in the accurate description of patients with C1 trauma. Whereas the Gehweiler system did not accurately describe the anatomic location of the various C1 fractures, the AO spine system was too broad and failed to radiologically classify fracture location. Moreover, there was a high number of patients with AO spine type B injuries without atlantoaxial translation that nevertheless required C1-C2 fusion for atlantoaxial instability. We suggest the need for an updated classification system that takes into account both the CT (fracture location) and MRI (TAL integrity) appearance of C1 trauma. An updated classification strategy will offer a radiologic standardization of C1 trauma that will aid in future research studies and help optimize patient management.

Pattern of cervical magnetic resonance imaging findings in diagnosed cases of degenerative disc disease among adult patients with persistent neck pain

Pattern of cervical magnetic resonance imaging findings in diagnosed cases of degenerative disc disease among adult patients with persistent neck pain

Study on Dangerous Acupuncture Needling Depth at Yamen (GV15) for Atlantoaxial Dislocation based on MRI and CT

Background: The depth of acupuncture at GV15 significantly changes with atlantoaxial dislocation (AAD). Magnetic resonance imaging (MRI) and computed tomography (CT) are the current methods for assessing acupuncture depth. However, the acupuncture depth in patients with AAD and the best evaluation method for acupuncture have not been thoroughly studied. Objectives: Based on MRI and 3D CT imaging measurements, dangerous needling depths for perpendicular acupuncture and oblique acupuncture in patients with AAD and normal anatomy were obtained. The application value of MRI and 3D CT in evaluating acupuncture depth is discussed. Methods: From January 2018 to December 2021, patients with AAD (120 patients) and control patients without AAD (124 patients) diagnosed and treated at the Upper Cervical Spine Research Center of the China-Japan Friendship Hospital were selected. All patients were enrolled. Both groups included patients with normal body types (BMI 18.5-23.9). The two groups of patients underwent plain cervical MRI scans and three-dimensional plain CT scans, and the dangerous needling depth of the perpendicular spur and the oblique spur were measured on sagittal images. Results: No significant differences were observed between the two measurements (MRI and CT) (P&lt;0.05). The dangerous needling depths in the AAD group were as follows: male straight stab: 45.33±5.17 mm, male oblique stab: 48.58±4.41 mm, female straight thorn: 44.17±7.80 mm, and female oblique thorn: 47.49±7.32 mm. The dangerous needling depths for the control group were as follows: male straight thorn: 47.72±5.06 mm, male oblique thorn: 42.69±5.53 mm, female straight thorn: 44.63±5.85 mm, and female oblique thorn: 39.88 ± 6.18 mm. Conclusions: Acupuncture depth at the dumb point of the AAD changed significantly. The clinical acupuncture depth should not exceed this safe depth. Both CT and MRI can be used to assess dangerous needling depth at GV15.

Magnetic Resonance Imaging of the Cervical Spine: Frequency of Abnormal Findings with Relation to Age.

Background: Patients with neck pain are frequently encountered in cervical spine (C-spine) magnetic resonance imaging (MRI) practice. However, the exact distribution and prevalence of cervical abnormalities are not known. Aim: The aim of this study is to evaluate the association between age, gender, and prevalence of abnormal cervical MRI findings. Methods: Records of 111 cervical MRIs were collected in 12 months from January to December 2019 from adults aged 20–89 years who were referred from neurosurgery, neurology, and orthopedic clinics. Findings were classified and analyzed using the Statistical Package for Social Science (SPSS), version 24.0 (IBM, Armonk, NY, USA). The chi-square test was used to determine the association between demographics and abnormalities using a significance of p = 0.05. Results: The majority of patients were female (72.1%). The number of abnormal incidences increased with age until it reached a peak at ages 50–59. Spondylodegenerative changes were the most frequent finding, which was present in 52.2% of the total sample, and was followed by disc bulge (25.2%). Incidences increased in lower discs, with C5–C6 being the most frequent in 65% of the total sample. Younger males in their 20s had more injuries than females of the same age. However, this rate was reversed in patients over 40, as women were the dominant gender among patients in their 40s with cervical injuries, with a rate of 81.5%. Conclusion: In our study, we found that older patients developed more C-spine injuries. Gender may play a role in the rate of incidents. However, we did not find any significant differences between men and women or between different types of abnormalities.

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Abstract Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5-C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, which may be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

A rare case\xa0as different cause of retropharyngeal and spinal epidural abscess: spondylodiscitis

BackgroundRetropharyngeal abscess (RPA) is a life-threatening, dangerous condition and uncommon in adults. The coexistence of RPA, cervical spinal epidural abscess (CSEA), and spondylodiscitis is extremely rare.Case presentationWe present a case with a retropharyngeal and epidural abscess caused by spondylodiscitis. A 61-year-old man was referred to our clinic with the complaints of sore throat, limitation in neck range of motion, numbness, and weakness in the left arm and the left ear for one month. The airway was not obstructed. Neurological deficits were detected in his left arm. Cervical computed tomography revealed a 50 × 30 × 15 mm retropharyngeal abscess. Cervical magnetic resonance imaging showed abscess, C5–6 spondylodiscitis and epidural abscess, and myelopathic signal changes in the C3–7 spinal cord. The abscess was drained, and C5–6 discectomy was performed. The patient was discharged with cervical collar and antibiotics.ConclusionsMultidisciplinary approach that consists of otolaryngologist, neurosurgeon, and infectious disease specialist is needed to avoid complications and any delay.

C1-C2 Dorsal Epidural Hematoma on Cervical Spine CT: A Novel Imaging Sign of Posterior Atlanto-Occipital Membrane Stripping Injury.

Background and Purpose: Identify patients with a dorsal epidural hematoma at C1-C2 and examine the major craniocervical junction ligaments for injury on follow-up magnetic resonance imaging.Materials and Methods: Adult and pediatric trauma patients who suffered a dorsal epidural hematoma at C1-C2 were identified using Nuance mPower software (Nuance Communications, United States). The cervical computed tomography and magnetic resonance imaging exams for these patients were reviewed for craniocervical junction osteoligamentous injuries. An age-matched control group was obtained.Results: Eight trauma patients were identified with a dorsal epidural fluid collection at C1-C2. All patients with a dorsal epidural hematoma, who underwent follow-up cervical magnetic resonance imaging demonstrated a stripping injury of the posterior atlanto-occipital membrane from the C1 posterior arch with increased short tau inversion recovery signal in the posterior atlanto-occipital membrane complex. Disruption of additional major craniocervcial ligaments on magnetic resonance imaging was relatively common with the most frequently associated ligamentous injuries involving the tectorial membrane (five patients) followed by the alar ligaments and anterior altanto-occiptial membrane (four patients each). Conclusions: A C1-C2 dorsal epidural hematoma is a rare injury that may be identified on cervical spine computed tomography but may be easily overlooked by the radiologist. We propose that a C1-C2 dorsal epidural hematoma is a direct result of a significant hyperflexion-hyperextension force with subsequent stripping of the posterior atlanto-occipital membrane from the posterior C1 arch. Trauma patients with a C1-C2 dorsal epidural hematoma on cervical spine computed tomography should undergo a cervical magnetic resonance imaging examination to evaluate the integrity of the posterior atlanto-occipital membrane complex and remaining craniocervical junction ligaments for injury.

AugMS-Net:Augmented multiscale network for small cervical tumor segmentation from MRI volumes

Cervical cancer is one of the leading causes of female-specific cancer death. Tumor region segmentation plays a pivotal role in both the clinical analysis and treatment planning of cervical cancer. Due to the heterogeneity and low contrast of biomedical images, current state-of-the-art tumor segmentation approaches are facing the challenge of the insensitive detection of small lesion regions. To tackle this problem, this paper proposes an augmented multiscale network (AugMS-Net) based on 3D U-Net to automatically segment cervical Magnetic Resonance Imaging (MRI) volumes. Since a multiscale strategy is considered one of the most promising algorithms to tackle small object recognition, we introduce a novel 3D module to explore more granular multiscale representations. Besides, we employ a deep multiscale supervision strategy to doubly supervise the side outputs hierarchically. To demonstrate the generalization of our model, we evaluated AugMS-Net on both a cervical dataset from MRI volumes and a liver dataset from Computerized Tomography (CT) volumes. Our proposed AugMS-Net shows superior performance over baseline models, yielding high accuracy while reducing the number of model parameters by nearly 20%. The source code and trained models are available at https://github.com/Cassieyy/AugMS-Net.

More autosomal dominant SPG18 cases than recessive? The first AD-SPG18 pedigree in Chinese and literature review.

ObjectiveHereditary spastic paraplegia (HSP) due to ERLIN2 gene mutations was designated as spastic paraplegia 18 (SPG18). To date, SPG18 families/cases are still rarely reported. All early reported cases shared the autosomal recessive (AR) inheritance pattern. Over the past 3 years, autosomal dominant (AD) or sporadic SPG18 cases had been continuously reported. Here, we reported the clinical and genetic features of the first autosomal dominant SPG18 pedigree in Chinese.MethodsWe conducted detailed medical history inquiry, neurological examinations of the proband and his family members, and charted the family tree. The proband underwent brain and cervical magnetic resonance imaging (MRI), electromyography (EMG), and whole exome sequencing. Sanger sequencing was performed to verify the genetic variation in the proband and some family members. A literature review of all reported SPG18 families/cases was carried out to summarize the clinical‐genetic characteristics of SPG18 under different inheritance patterns.ResultsFour patients were clinically diagnosed as chronic spastic paraplegia in three consecutive generations with the autosomal dominant inheritance model. All the patients presented juvenile‐adolescent onset and gradually worsening pure HSP phenotype. Clinical phenotypes were consistent within the family. Whole exome sequencing in the proband identified a previously reported heterozygous c.502G > A (p.V168M) mutation in exon 8 of ERLIN2 gene. This mutation was cosegregated with the phenotype in the family and was classified as likely pathogenic according to American College of Medical Genetics and Genomics (ACMG) guidelines. To date, eight AR‐SPG18 families, five AD‐SPG18 families, and three sporadic cases had been reported. Clinical phenotype of AD‐SPG18 was juvenile‐adolescent onset pure HSP, while the phenotype of AR‐SPG18 was mostly complicated HSP with earlier onset and more severe conditions. In rare cases, the initial spastic paraplegia could evolve to rapidly progressive amyotrophic lateral sclerosis (ALS).ConclusionsWe reported the first autosomal dominant SPG18 pedigree in Chinese Han population, which added more pathogenic evidence for V168M mutation. As more SPG18 cases reported, the essentials of SPG18 need to be updated in clinical practice. Special attentions should be given in gene test for upper motor neuron disorders in case of missing heterozygous mutations in ERLIN2.

Acute Paraplegia Due to Nucleus Herniation of a Mobi-C Implant without Trauma: Case Report of a Rare Complication

Cervical artificial discs (CADs) are a surgical option in selected patients with cervical spinal disc degeneration. Although CADs have been available for many years, concerns persist regarding long-term safety, durability, and implant-related failure. We report a case of nucleus herniation of a Mobi-C implant without trauma, which is a rare complication. Two years after implantation of a Mobi-C implant, a 47-year-old man presented with acute paraplegia without a history of trauma. On cervical magnetic resonance imaging, a T2-high signal intensity lesion was noted in the ventral aspect of the spinal cord at the T1-2 level. During emergent surgery, nucleus herniation of the Mobi-C was detected. After surgery, the patient could walk without assistance. Posterior herniation of the Mobi-C nucleus without trauma is a rare complication that should be considered in surgical planning and follow-up.