Magnetic Resonance Imaging Of Cervical Spine Research Articles

Assessment of image quality and diagnostic accuracy for cervical spondylosis using T2w-STIR sequence with a deep learning-based reconstruction approach.

To investigate potential of enhancing image quality, maintaining interobserver consensus, and elevating disease diagnostic efficacy through the implementation of deep learning-based reconstruction (DLR) processing in 3.0T cervical spine fast magnetic resonance imaging (MRI) images, compared with conventional images. The 3.0T cervical spine MRI images of 71 volunteers were categorized into two groups: sagittal T2-weighted short T1 inversion recovery without DLR (Sag T2w-STIR) and with DLR (Sag T2w-STIR-DLR). The assessment covered artifacts, perceptual signal-to-noise ratio, clearness of tissue interfaces, fat suppression, overall image quality, and the delineation of spinal cord, vertebrae, discs, dopamine, and joints. Spanning canal stenosis, neural foraminal stenosis, herniated discs, annular fissures, hypertrophy of the ligamentum flavum or vertebral facet joints, and intervertebral disc degeneration were evaluated by three impartial readers. Sag T2w-STIR-DLR images exhibited markedly superior performance across quality indicators (median = 4 or 5) compared to Sag T2w-STIR sequences (median = 3 or 4) (p < 0.001). No statistically significant differences were observed between the two sequences in terms of diagnosis and grading (p > 0.05). The interobserver agreement for Sag T2w-STIR-DLR images (0.604-0.931) was higher than the other (0.545-0.853), Sag T2w-STIR-DLR (0.747-1.000) demonstrated increased concordance between reader 1 and reader 3 in comparison to Sag T2w-STIR (0.508-1.000). Acquisition time diminished from 364 to 197s through the DLR scheme. Our investigation establishes that 3.0T fast MRI images subjected to DLR processing present heightened image quality, bolstered diagnostic performance, and reduced scanning durations for cervical spine MRI compared with conventional sequences.

Brain and cervical spinal cord MRI correlates of sensorimotor impairment in patients with multiple sclerosis.

Cervical spinal cord (cSC) lesions and atrophy contribute to disability in multiple sclerosis (MS), but associations with specific sensorimotor dysfunction require further exploration. To investigate the associations of brain and cSC magnetic resonance imaging (MRI) measures with sensorimotor impairment in MS. One hundred fifty-one MS patients and 69 healthy controls underwent 3T MRI and clinical assessments including Expanded Disability Status Scale (EDSS), 9-hole peg test (9-HPT), finger tapping test (FTT), timed 25-foot walk test (T25FWT), and vibration detection threshold (VDT). Random forest ranked brain (T2-hyperintense lesion volume (T2-LV) and normalized deep gray matter (GM), cortical and white matter (WM) volumes) and cSC (T2-LV and total, GM, and WM cross-sectional areas (CSAs) at C2/C3 level) MRI measures relevance in explaining EDSS milestones (EDSS ⩾3.0, ⩾4.0, and ⩾6.0), VDT, pyramidal and sensory functional systems (P-FS and S-FS ⩾2), and motor tests impairment. Various combinations of brain and cSC MRI measures explained EDSS milestones (area under the curve (AUC) =0.879-0.900), VDT (R2 = 0.194), and impaired P-FS (AUC = 0.820), S-FS (AUC = 0.795), 9-HPT (AUC = 0.793), FTT (AUC = 0.740), and T25FWT (AUC = 0.825). cSC GM CSA was the most informative feature for all outcomes, except 9-HPT. cSC MRI measures, especially GM CSA, explain EDSS and sensorimotor dysfunction better than brain measures in MS.

Design of a novel deep network model for spinal cord injury prediction

Degenerative cervical myelopathy must be diagnosed with magnetic resonance imaging (MRI) which predicts spinal cord injury (SCI). The growing volume of medical imaging data can be managed by deep learning models, which provide a preliminary interpretation of images taken in basic care settings. Our main goal was to create a deep-learning approach that could identify SCI using MRI data. This work concentrates on modeling a novel 2D-convolutional neural networks (2D-CNN) approach for predicting SCI. For holdouts, training, and validation, various datasets of patients were created. Two experts assigned labels to the images. The holdout dataset was used to evaluate the performance of our deep convolutional neural network (DCNN) over the image data from the available dataset. The dataset is acquired from the online resource for training and validation purpose. With the available dataset, the anticipated model attains 94% AUC, 0.1 p-value, and 92.2% accuracy. The anticipated model might make cervical spine MRI scan interpretation more accurate and reliable.

Safety of Magnetic Resonance Imaging in Orthopaedic Trauma Patients with External Fixation: A Two Center Case Series.

OBJECTIVES: To report on adverse events during magnetic resonance imaging (MRI) on patients with external fixators. METHODS: Design: Retrospective case series. Setting: Two Level 1 Trauma Centers. Patient Selection Criteria: Patients with external fixators on the appendicular skeleton or pelvis undergoing MRI between January 2005 and September 2023. Outcome Measures and Comparisons: Adverse events, defined as any undesirable event associated with the external fixator being inside or outside the MRI bore during imaging, including: (subjective) heating, displacement or pullout of external fixator, or early MRI termination for any reason. RESULTS: Ninety-seven patients with 110 external fixators had at least one MRI with an external fixator inside or outside of the MRI bore. The median age was 51 years (IQR: 39 – 63) and 56 (58%) were male. The most common external fixator locations were the ankle (24%), knee (21%), femur (21%), and pelvis (19%). The median duration of an MRI was 40 minutes (IQR: 26 – 58), 86% were performed using 1.5 Tesla MRI, and 14% were performed using 3.0 Tesla MRI. Ninety-five percent of MRI were performed for the cervical spine/head. Two MRI scans (1.6%), one of the shoulder and one of the head and cervical spine, with the external fixator outside of the bore were terminated early due to patient discomfort. There were no documented events of displacement or pullout of the external fixator. CONCLUSIONS: These findings suggest that MRI of the (cervical) spine and head can be safely obtained in patients with external fixators on the appendicular skeleton or pelvis. Given the low numbers of MRIs performed with the external fixator inside the bore, further studies are necessitated to determine the safety of this procedure. The results from this study can aid orthopaedic surgeons, radiologists, and other stakeholders in developing local institutional guidelines on MRI scanning with external fixators in situ. LEVEL OF EVIDENCE: Prognostic Level lV. See Instructions for Authors for a complete description of levels of evidence.

Prediction of Motor Myelopathic Severity in Patients with Cervical Spondylotic Myelopathy: How to Approach?

Background: Cervical spondylotic myelopathy (CSM) is a challenging thing to diagnose as it has subtle symptoms and insidious onset. But, there is a relationship between signal intensity change of the spinal cord on MRI and cervical spondylotic myelopathy through which motor myelopathic severity in these patients can be predicted. Objective: The purpose of this study was to predict the motor myelopathic severity in patients with CSM with the help of magnetic resonance imaging (MRI). Methodology: This cross-sectional study was carried out in the Department of Neurosurgery at Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from October, 2011 to March, 2013 for a period of one and half year. All patients who presented with cervical spondylotic myelopathy were included in this study. MRI of cervical spine was performed to all patients. Results: A total number of 36 patients with cervical spondylotic myelopathy were included in this study. Among the 36 study patients, all had normal intensity in the spinal cord on sagittal T1WI of MRI; however, there was variable intensity on sagittal T2WI of MRI. Low Nurick score was found in 24 (66.6%) patients who had type 0signal intensity on (T2WI) MRI. High Nurick score was found in 3 (8.3%) patients who had type 0 signal intensity on (T2WI) MRI. Low Nurick score was found in 2 (5.5%) patients who had type 1 signal intensity on (T2WI) MRI. High Nurick score was found in 6 (16.6%) patients who had type 1 signal intensity on (T2WI) MRI. Only 1 patient (2.7%) having high Nurick score (3- 5) had type-2 signal intensity on (T2WI) MRI (p&lt;0.001). Conclusion: Prediction of motor myelopathic severity in patients with cervical spondylotic myelopathy can be done perfectly with the help of signal intensity change of the spinal cord on MRI which is very much helpful in patients’ management. Bang. J Neurosurgery 2023; 12(2): 71-75

Advanced MRI metrics improve the prediction of baseline disease severity for individuals with degenerative cervical myelopathy

BACKGROUND CONTEXTDegenerative cervical myelopathy (DCM) is the most common form of atraumatic spinal cord injury globally. Degeneration of spinal discs, bony osteophyte growth and ligament pathology results in physical compression of the spinal cord contributing to damage of white matter tracts and grey matter cellular populations. This results in an insidious neurological and functional decline in patients which can lead to paralysis. Magnetic resonance imaging (MRI) confirms the diagnosis of DCM and is a prerequisite to surgical intervention, the only known treatment for this disorder. Unfortunately, there is a weak correlation between features of current commonly acquired MRI scans (“community MRI, cMRI”) and the degree of disability experienced by a patient. PURPOSEThis study examines the predictive ability of current MRI sequences relative to “advanced MRI” (aMRI) metrics designed to detect evidence of spinal cord injury secondary to degenerative myelopathy. We hypothesize that the utilization of higher fidelity aMRI scans will increase the effectiveness of machine learning models predicting DCM severity and may ultimately lead to a more efficient protocol for identifying patients in need of surgical intervention. STUDY DESIGN/SETTINGSingle institution analysis of imaging registry of patients with DCM. PATIENT SAMPLEA total of 296 patients in the cMRI group and 228 patients in the aMRI group. OUTCOME MEASURESPhysiologic measures: accuracy of machine learning algorithms to detect severity of DCM assessed clinically based on the modified Japanese Orthopedic Association (mJOA) scale. METHODSPatients enrolled in the Canadian Spine Outcomes Research Network registry with DCM were screened and 296 cervical spine MRIs acquired in cMRI were compared with 228 aMRI acquisitions. aMRI acquisitions consisted of diffusion tensor imaging, magnetization transfer, T2-weighted, and T2*-weighted images. The cMRI group consisted of only T2-weighted MRI scans. Various machine learning models were applied to both MRI groups to assess accuracy of prediction of baseline disease severity assessed clinically using the mJOA scale for cervical myelopathy. RESULTSThrough the utilization of Random Forest Classifiers, disease severity was predicted with 41.8% accuracy in cMRI scans and 73.3% in the aMRI scans. Across different predictive model variations tested, the aMRI scans consistently produced higher prediction accuracies compared to the cMRI counterparts. CONCLUSIONSaMRI metrics perform better in machine learning models at predicting disease severity of patients with DCM. Continued work is needed to refine these models and address DCM severity class imbalance concerns, ultimately improving model confidence for clinical implementation.

The Sensitivity of Limited-Sequence MRI in Identifying Pediatric Cervical Spine Injury: A Western Pediatric Surgery Research Consortium Multicenter Retrospective Cohort Study.

Clinical clearance of a child's cervical spine after trauma is often challenging due to impaired mental status or an unreliable neurologic examination. Magnetic resonance imaging (MRI) is the gold standard for excluding ligamentous injury in children but is constrained by long image acquisition times and frequent need for anesthesia. Limited-sequence MRI (LSMRI) is used in evaluating the evolution of traumatic brain injury and may also be useful for cervical spine clearance while potentially avoiding the need for anesthesia. The purpose of this study was to assess the sensitivity and negative predictive value of LSMRI as compared to gold standard full-sequence MRI as a screening tool to rule out clinically significant ligamentous cervical spine injury. We conducted a ten-center, five-year retrospective cohort study (2017-2021) of all children (0-18y) with a cervical spine MRI after blunt trauma. MRI images were re-reviewed by a study pediatric radiologist at each site to determine if the presence of an injury could be identified on limited sequences alone. Unstable cervical spine injury was determined by study neurosurgeon review at each site. We identified 2,663 children less than 18 years of age who underwent an MRI of the cervical spine with 1,008 injuries detected on full-sequence studies. The sensitivity and negative predictive value of LSMRI were both >99% for detecting any injury and 100% for detecting any unstable injury. Young children (age < 5 years) were more likely to be electively intubated or sedated for cervical spine MRI. LSMRI is reliably detects clinically significant ligamentous injury in children after blunt trauma. To decrease anesthesia use and minimize MRI time, trauma centers should develop LSMRI screening protocols for children without a reliable neurologic exam. 2 (Diagnostic Tests or Criteria).

Radiology Reports Do Not Accurately Portray the Severity of Cervical Neural Foraminal Stenosis.

Retrospective study. (1) To compare cervical magnetic resonance imaging (MRI) radiology reports to a validated grading system for cervical foraminal stenosis (FS) and (2) to evaluate whether the severity of cervical neural FS on MRI correlates to motor weakness or patient-reported outcomes. Radiology reports of cervical spine MRI are often reviewed to assess the degree of neural FS. However, research looking at the association between these reports and objective MRI findings, as well as clinical symptoms, is lacking. We retrospectively identified all adult patients undergoing primary 1 or 2-level anterior cervical discectomy and fusion at a single academic center for an indication of cervical radiculopathy. Preoperative MRI was assessed for neural FS severity using the grading system described by Kim and colleagues for each level of fusion, as well as adjacent levels. Neural FS severity was recorded from diagnostic radiologist MRI reports. Motor weakness was defined as an examination grade <4/5 on the final preoperative encounter. Regression analysis was conducted to evaluate whether the degree of FS by either classification was related to patient-reported outcome measure severity. A total of 283 patients were included in the study, and 998 total levels were assessed. There were significant differences between the MRI grading system and the assessment by radio-logists (P< 0.001). In levels with moderate stenosis, 28.9% were classified as having no stenosis by radiology. In levels with severe stenosis, 29.7% were classified as having mild-moderate stenosis or less. Motor weakness was found similarly often in levels of moderate or severe stenosis (6.9% and 9.2%, respectively). On regression analysis, no associations were found between baseline patient-reported outcome measures and stenosis severity assessed by radiologists or MRI grading systems. Radiology reports on the severity of cervical neural FS are not consistent with a validated MRI grading system. These radiology reports underestimated the severity of neural foraminal compression and may be inappropriate when used for clinical decision-making. Level III.

Limited utility of adding 3T cervical spinal cord MRI to monitor disease activity in multiple sclerosis

Background: Performing routine brain magnetic resonance imaging (MRI) is widely accepted as the standard of care for disease monitoring in multiple sclerosis (MS), but the utility of performing routine spinal cord (SC) MRI for this purpose is still debatable. Objective: This study aimed to measure the frequency of new isolated cervical spinal cord lesions (CSLs) in people with MS (pwMS) undergoing routine brain and cervical SC-MRI for disease monitoring and determine the factors associated with the development of new CSLs and their prognostic value. Methods: We retrospectively identified 1576 pwMS who underwent follow-up 3T brain and cervical SC-MRI over a 9-month period. MRI was reviewed for the presence of new brain lesions (BLs) and CSLs. Clinical records were reviewed for interval relapses between sequential scans and subsequent clinical relapse and disability worsening after the follow-up MRI. Results: In 1285 pwMS (median interval: 13–14 months) who were clinically stable with respect to relapses, 73 (5.7%) had new CSLs, of which 49 (3.8%) had concomitant new BLs and 24 (1.9%) had new isolated CSLs only. New asymptomatic CSLs were associated with ⩾ 3 prior relapses (p = 0.04), no disease-modifying therapy (DMT) use (p = 0.048), and ⩾ 3 new BLs (p < 0.001); ⩾ 3 new BLs (OR: 7.11, 95% CI: 4.3–11.7, p < 0.001) remained independently associated with new CSLs on multivariable analysis. Having new asymptomatic CSLs was not independently associated with subsequent relapse or disability worsening after the follow-up MRI (median follow-up time of 26 months). Conclusion: Routine brain and cervical SC-MRI detected new isolated CSLs in only < 2% of clinically stable pwMS. Developing new asymptomatic CSLs was associated with concomitant new BLs and did not confer an independent increased risk of relapse or disability worsening. Performing SC-MRI may not be warranted for routine monitoring in most pwMS, and performing only brain MRI may be sufficient to capture the vast majority of clinically silent disease activity.

A quantitative evaluation of the deep learning model of segmentation and measurement of cervical spine MRI in healthy adults.

To evaluate the 3D U-Net model for automatic segmentation and measurement of cervical spine structures using magnetic resonance (MR) images of healthy adults. MR images of the cervical spine from 160 healthy adults were collected retrospectively. A previously constructed deep-learning model was used to automatically segment anatomical structures. Segmentation and localization results were checked by experienced radiologists. Pearson's correlation analyses were conducted to examine relationships between patient and image parameters. No measurement was significantly correlated with age or sex. The mean values of the areas of the subarachnoid space and spinal cord from the C2/3 (cervical spine 2-3) to C6/7 intervertebral disc levels were 102.85-358.12 mm2 and 53.71-110.32 mm2 , respectively. The ratios of the areas of the spinal cord to the subarachnoid space were 0.25-0.68. The transverse and anterior-posterior diameters of the subarachnoid space were 14.77-26.56mm and 7.38-17.58mm, respectively. The transverse and anterior-posterior diameters of the spinal cord were 9.11-16.02mm and 5.47-10.12mm, respectively. A deep learning model based on 3D U-Net automatically segmented and performed measurements on cervical spine MR images from healthy adults, paving the way for quantitative diagnosis models for spinal cord diseases.

Cervicogenic Headache due to Lower Segment Cervical Disk Herniation: A Case Report

Introduction: Commonly, cervicogenic headache (CGH) pathology originates from the upper cervical nerve ranging from C1–C3, with C2–C3 most frequently involved. The pathophysiology and etiology of this syndrome have been the subject of ongoing controversy in the past decade. Most literature regarding CGH, mainly research about relationship between upper cranial nerves (C1–C3) indicating that the possibility it originates from other cervical levels is poorly understood. Case Report: A 64-year-old man arrived with a 6-month history of occiput pain, followed by severe shooting pain in both arms, with a greater intensity on the right side. A cervical spine magnetic resonance imaging reveals disk herniations at the C5–6 and C6–C7 levels, producing neural compression. The operation involved an anterior cervical discectomy and fusion. Six months of follow-up revealed that the patient was headache-free; ultimately, the diagnosis was CGH caused by a herniated lower cervical disk. Conclusion: Through reporting this unusual case, we emphasized the potential correlation between lower cervical disk herniation and CGH. Keywords: Cervicogenic headache, lower cervical segment herniation, anterior discectomy and fusion.

Coexistence of Pseudotumor Cerebri and Chiari Malformation Type 1

Objective: To identify different radiological markers for the diagnosis of the coexistence of pseudotumor cerebri and Chiari malformation type 1. Method: Patients who were clinically suspected to have Chiari malformation type 1 and were referred to the Department of Radiology between 2007 and 2020, and whose diagnosis was radiologically confirmed through magnetic resonance imaging (MRI), were retrospectively evaluated. A total of 49 Chiari malformation type 1 patients with both cervical and cerebral examinations and 49 control subjects of the same age and gender without a diagnosis of Chiari malformation type 1 were included in the study. In Chiari malformation type 1 diagnosed patients, the presence of pseudotumor cerebri, the presence of syringomyelia in cervical spinal MRI images, and the distance of cerebellar tonsils and obex according to McRae line were evaluated in millimeters. Result: In Chiari malformation type 1 clinically and radiologically diagnosed cases, the cerebellar tonsils and obex were located lower in patients with a radiological diagnosis of pseudotumor cerebri compared to those without, and the rate of accompanying syringomyelia appeared to be higher. However, no statistically significant difference was observed between the two groups. Conclusion: The coexistence of pseudotumor cerebri and Chiari malformation type 1 is more common than previously estimated. Different treatment protocols in the coexistence of pseudotumor cerebri and Chiari malformation type 1 emphasize the importance of making this diagnosis. Further radiological imaging studies are needed to identify different radiological markers for the diagnosis of the coexistence of pseudotumor cerebri and Chiari malformation type 1.

Prevalence and Risk Factors for Modic Changes in Symptomatic Cervical Ossification of the Posterior Longitudinal Ligament: A Retrospective Study of 203 Patients.

BACKGROUND Modic changes (MC) are abnormal bone signals under the vertebral endplates on magnetic resonance imaging (MRI) of the spine. Three types of MC may be seen on MRI as abnormal bone signals of the vertebral endplate and adjacent bone marrow. This retrospective study of 203 patients with symptomatic cervical ossification of the posterior longitudinal ligament (OPLL) aimed to evaluate factors associated with MC on cervical spine MRI. MATERIAL AND METHODS We included 203 patients with symptomatic cervical ossification of the OPLL. All patients underwent MRI with T1 and T2 sequences to assess the presence and type of MC. Univariate and multivariate logistic regression analyses were used to identify the risk factors for MC. RESULTS The prevalence of MC in patients with symptomatic cervical OPLL was 21.18%. Type 2 MC accounted for 88.64% of the cases. Local type and MC share the same segment (100.00%), followed by segmental type (77.27%), mixed type (75.00%), and continuous type (75.00%). Age (OR=1.05, 95% CI: 1.01-1.09, P=0.013) and neck pain (OR=2.67, 95% CI: 1.04-6.83, P=0.041) were significantly correlated with MC. Further receiver operating characteristic (ROC) analysis displayed an area under the curve (AUC) of 0.657 (P=0.002) for age, and the optimal cutoff was 60.50 years (sensitivity 0.67, specificity 0.68). CONCLUSIONS The results of this study found that older age and neck pain were significantly associated with development of cervical spine MC. Patients ≥60.5 years with symptomatic cervical OPLL had a higher probability of developing MC.

Spinal Cord Signal Intensity Predicts Functional Outcomes in the Operative Management of Degenerative Cervical Myelopathy.

Prospective single institutional cohort study on degenerative cervical myelopathy (DCM) from 2009 to 2022. This study aims to assess the relationship among preoperative spinal cord signal change, postoperative signal change evolution, and functional outcome in patients undergoing surgery for DCM. There is conflicting evidence on whether spinal cord signal intensity influences functional outcomes in patients with DCM. This prospective study investigated 104 patients with DCM that underwent both preoperative and routine postoperative cervical spine magnetic resonance imaging (MRI) as part of a research protocol. Signal intensity/grade, modified Japanese Orthopedic Association (mJOA) scores, signal resolution, and patient demographics were assessed. Sixty-eight of the subjects were found to have abnormal T2 spinal cord signal intensity changes on their preoperative MRI. The total mean preoperative mJOA score was 13.6, increasing postoperatively to 16 (P < 0.001). The presence or absence of preoperative spinal cord signal change was not associated with the change in mJOA score or neurological recovery rate after surgery. Of the 68 patients with preoperative T2 signal change, 36 were found to have an improvement in the T2-weighted signal grade after surgery and 32 had no change in postoperative signal grade. The mean improvement in mJOA score (3.7) and neurological recovery rate (70.3%) was significantly higher in the patients with preoperative signal change whose postoperative MRI signal change grade improved by at least one point compared with those that did not (2.0, 50.5%), (P < 0.001, P < 0.003). The presence of preoperative T2-weighted signal change was associated with lower preoperative mJOA scores, but no change in mJOA after surgery or postoperative neurological recovery rate. However, improvement in T2-weighted spinal cord signal grade on postoperative MRI was significantly associated with a degree of neurological improvement after surgery.

Cervical Spine Magnetic Resonance Imaging Findings in Hirayama Disease.

Background Hirayama disease is an uncommon type of cervical cord myelopathy seen typically in young males due to trauma from flexion movements. This study aims to assess the clinical presentations and classify the extent of various cervical spine MRI findings for the local population. Methodology A retrospective study of 13 patients diagnosed with Hirayama disease oncervical MRI was performed from January 2017 to December 2022 at Dr. D. Y. Patil Medical College, Hospital and Research Center, Pune. Results Of the 13 patients, 12 (92%) were male, and one (8%) was female. Nine (69%) patients were in the 16-25-year age group, two (15%) were in the 26-35-year age group, and one (8%) each was in the 6-15-year and 66-75-year age groups. Upper limb weakness was the most common clinical symptom seen in 12 (92%) patients, followed by distal muscle atrophy in seven (54%) patients. Tremors in the hand were a rare symptom seen in two patients. Claw hand was an atypical symptom seen in one patient. On cervical MRI, all patients showed excessive forward shifting of the posterior dura on flexion, with resultant cord compression due to tightness of the dural sac. One (8%) patient had no signs of myelopathy, while 12 (92%) patients had developed chronic myelomalacia and showed abnormal cord hyperintensity and atrophy in the lower cervical cord. All 13 (100%) patients showed increased laminodural space on flexion; the mean thickness was 4.08 mm, with the minimum and maximum thickness being 2.4 mm and 6.7 mm, respectively. Classifying by length of the anterior bulging dura, one (8%) patient showed involvement of less than two vertebral body segments, eight (62%) patients showed involvement of two to four vertebral body segments, and four (30%) patients showed involvement of more than four vertebral body segments. Crescent-shaped post-contrast enhancement on flexion was seen in all eight (100%) patients who underwent a contrast study. Prominent epidural flow voids on flexion were seen in six (46%) patients. Conclusions Hirayama disease is an uncommon type of cervical myelopathy seen typically in juvenile males. The occult onset of distal upper limb weakness and atrophy during puberty, typical MRI features of lower cervical cord atrophy, and the presence of a crescent-shaped enhancing mass in the posterior epidural space are pathognomonic of the condition. A few atypical cases can also occur. Early diagnosis and treatment are crucial to avoiding serious dysfunction.

Effect of Body Mass Index on Chiari Malformation 1 Tonsil Ectopia Length in Adults

Diagnosis of Chiari I malformation (CM-1) is based on measurements of the inferior extension of the cerebellar tonsils into the foramen magnum on cranial or cervical spine magnetic resonance imaging. Imaging may be obtained before the patient is referred to the neurosurgical specialist. The length of time raises questions about the possibility that body mass index (BMI) fluctuations could affect the measurement of ectopia length. However, previous literature on BMI and CM-1 has reported conflicting findings on BMI. We conducted a retrospective chart review of 161 patients who were referred to a single neurosurgeon for CM-1 consultation. Patients with multiple recorded BMI values (n= 71) were compared to see if BMI changes correlated with changes in ectopia length. In addition, we compared and tested 154 recorded ectopia lengths from the patients (1 per patient) and patient BMI values with Pearson correlation and Welch t tests to determine if BMI changes either influenced or were associated with ectopia changes. For the 71 patients with multiple BMI values, change in ectopia length ranged from-4.6-9.8mm but was not statistically significant (r=0.019; P=0.88). For the 154 measured ectopia lengths, changes in BMI did not correlate with ectopia length (P>0.05). Likewise, differences in ectopia length between patients in normal, overweight, and obese categories were not statistically significant (|tstat|<|tcrit|, P>0.05). In individual patients, we found that BMI and changes in BMI were not accompanied by changes in tonsil ectopia length.

Prevalence of incidental thyroid abnormalities in patients with degenerative cervical spondylosis: a retrospective cross-sectional magnetic resonance imaging study.

Incidental thyroid abnormalities found on magnetic resonance imaging (MRI) of the neck are not uncommon. This study aimed to investigate the prevalence of incidental thyroid abnormalities in the cervical spine MRI of the degenerative cervical spondylosis (DCS) population indicated for surgery and to identify patients who require additional workup based on the recommendations of the American College of Radiology (ACR). All consecutive patients with DCS and indications for cervical spine surgery from October 2014 to May 2019 in the Affiliated Hospital of Xuzhou Medical University were reviewed. All MRI scans of the cervical spine routinely include the thyroid. Cervical spine MRI scans were retrospectively evaluated for the prevalence, size, morphologic characteristics, and location of incidental thyroid abnormalities. A total of 1,313 patients were included in the analysis, 98 (7.5%) of whom were found to have incidental thyroid abnormalities. The most frequent thyroid abnormality was thyroid nodules (5.3%), followed by goiters (1.4%). Other thyroid abnormalities included Hashimoto thyroiditis (0.4%) and thyroid cancer (0.5%). There was a statistically significant difference in age and sex between patients with DCS with and without incidental thyroid abnormalities (P=0.018 and P=0.007). Stratified by age, the results showed that the highest incidence of incidental thyroid abnormalities was found in patients aged 71 to 80 years (12.4%). Eighteen patients (1.4%) needed further ultrasound (US) and relevant workups. Incidental thyroid abnormalities are common in cervical MRI, with a prevalence of 7.5% identified in patients with DCS. Incidental thyroid abnormalities are large or have suspicious imaging features, and further evaluation with a dedicated thyroid US examination should be completed before cervical spine surgery is undertaken.

Study on the correlation between the thickness of superficial fascia at Dazhui(GV14) and cervical spondylosis

To observe the correlation between the thickness of superficial fascia at Dazhui (GV14) acupoint and cervical spondylosis, so as to explore the essence of its morphological and structural changes of acupoint sensitivity. A retrospective study was conducted. According to the diagnostic criteria of "Guidelines for Diagnosis, Treatment and Rehabilitation of Cervical Spondylosis" (2017), 344 cases of cervical spine magnetic resonance imaging (MRI) examination were included and divided into control group (73 cases) and observation group (271 cases). The control group was healthy population, and the observation group was patients with cervical spondylosis conforming to the diagnostic criteria, including cervical spondylosis of neck type, cervical spondylosis radiculopathy, cervical spondylotic myelopathy, cervical spondylosis of vertebral artery type, and sympathetic cervical spondylosis. According to MRI images of cervical spine, the structure of GV14 acupoint including skin, superficial fascia layer and aponeurosis ligament layer were measured. The acupoint depth and the superficial fascia thickness at GV14 in the observation group were (56.6±8.8) mm and (22.8±7.6) mm, the acupoint depth and the superficial fascia thickness at GV14 were (49.8±7.0) mm and (16.6±6.6)mm in the control group, which were significantly greater in the observation group than in the control group (P<0.01). The superficial fascia thickness at GV14 of cervical spondylotic mye-lopathy, cervical spondylosis of neck type and cervical spondylosis radiculopathy in the observation group was (23.8±8.1)mm, (23.0±7.3)mm and (22.6±6.5)mm, the acupoint depth of GV14 was (58.7±8.8)mm, (56.2±9.1)mm and (55.8±6.4)mm, which were significantly thicker than the superficial fascia thickness and the acupoint depth in the control group (P<0.01). In the observation group，the superficial fascia thickness of GV14 of cervical spondylosis myelopathy was significantly thicker than those of sympathetic cervical spondylosis (17.8±8.1) mm and cervical spondylosis of vertebral artery type (19.9±5.9) mm (P<0.01, P<0.05). In the observation group, the depth of GV14 of cervical spondylosis myelopathy was thicker than that of cervical spondylosis of neck type, cervical spondylosis radiculopathy, sympathetic cervical spondylosis and cervical spondylosis of vertebral artery type(P<0.05，P<0.01)； the depth of GV14 of sympathetic cervical spondylosis was thinner than that of cervical spondylosis of neck type and cervical spondylosis radiculopathy (P<0.01). The superficial fascia thickness at GV14 was correlated with cervical spondylosis, and it is also related to cervical spondylotic myelopathy, cervical spondylosis of neck type and cervical spondylosis radiculopathy. The morphological and structural changes of GV14 in the state of cervical spondylosis were mainly the thickness of the superficial fascia.

Von Hippel-Lindau Disease Presenting With Cranial and Spinal Hemangioblastomas: MRI Findings

Hemangioblastoma (HB) is one of the most common primary neoplasms of the posterior fossa in adults. Although single tumors can be sporadic, multiple tumors are almost always associated with von Hippel-Lindau (VHL) disease. In our case report, we are describing a 39-year-old woman with complaints of severe headache, pain, and numbness in both arms. She had a history of VHL disease. We performed contrast-enhanced cranial and cervical spine magnetic resonance imaging (MRI) examinations. Given the patient’s history of VHL disease and characteristic MR imaging features of lesions, cranial and cervical HBs were considered for diagnosis. Surgical excision is the main treatment of these tumors and follow-up optimal imaging of these patients is crucial. In the screening of VHL patients, whole spinal axis imaging in conjunction with routine MRI studies must always be performed to rule out spinal HBs.

THE RELATIONSHIP OF CERVICAL SPINE FACET TROPISM AND CERVICAL SAGITTAL ALIGNMENT

Cervical spine facet tropism (CFT) defined as the facets’ joints angles difference between right and left sides of more than 7 degrees. This study aims to investigate the relationship between cervical sagittal alignment parameters and cervical spine facets’ tropism.A retrospective cross-sectional study carried out in a tertiary center where cervical spine magnetic resonance imaging (MRI) radiographs of patients in orthopedics/spine clincs were included. They had no history of spine fractures. Images’ reports were reviewed to exclude those with tumors in the c-spine.A total of 96 patients was included with 63% of them were females. The mean of age was 45.53± 12.82. C2-C7 cobb's angle (CA) and C2-C7 sagittal vertical axis (SVA) means were −2.85±10.68 and 1.51± 0.79, respectively. Facet tropism was found in 98% of the sample in at least one level on either axial or sagittal plane. Axial C 2–3 CFT and sagittal C4-5 were correlated with CA (r=0.246, P 0.043, r= −278, P 0.022), respectively. In addition, C2-C7 sagittal vertical axis (SVA) was moderately correlated with axial c2-3 FT (r= −0.330, P 0.006) Also, several significant correlations were detected in our model Cervical vertebral slopes and CFT at the related level. Nonetheless, high BMI was associated with multi-level and multiplane CFT with higher odd's ratios at the lower levels.This study shows that CFT at higher levels is correlated with increasing CA and decreasing SVA and at lower levels with decreasing CA. Obesity is a risk factor for CFT.