Spine CT Research Articles

Rare case of vertebral hemangioma causing spinal compression - diagnosis and treatment: Space Occupying Lesion (SOL) study

Background. This case report highlights the importance of accurate diagnosis and treatment for intramedullary spinal cord hemangioma, which is a rare condition that can present with common symptoms of various spinal cord pathologies. The report recommends decompression laminectomy as the appropriate intervention for this condition. This report adds to the existing clinical literature on intramedullary spinal cord hemangioma and can assist clinicians in the diagnosis and treatment of similar cases. Case report. The patient is a 30-year-old female who complained of left leg heaviness, cramps, numbness, and urinary incontinence. MRI revealed a suspected intradural intramedullary lesion, as high as VTh5, suspected to be ependymoma or astrocytoma. The patient underwent decompressive laminectomy on thoracalis vertebra 5-7 and spinal cord mass with hemorrhage and calcification components was observed on post-operative Spinal CT Angiography. The mass was found to have a feeder artery from spinal branches of the left right a. intercostalis at T5 level and spinal branches of the left a. intercostalis at T6 level. Thoracolumbar spondylosis was also observed. Conclusion. The clinical impact of vertebral hemangioma lies in its potential to cause neurological deficits due to spinal cord or nerve root compression. Early diagnosis and treatment through imaging modalities such as MRI and surgical intervention, such as laminectomy, can alleviate symptoms and prevent disability or mortality. However, careful consideration of the patient’s clinical history, imaging findings, and neurological status is necessary for accurate diagnosis and appropriate management.

Lumbosacral endplate contour defect is frequently observed concurrent with other lumbosacral abnormalities on spinal CT of French Bulldogs.

Lumbosacral osteochondrosis has been previously described in large breed dogs with variable clinical signs. Its CT features are a contour defect at the dorsal aspect of either vertebral endplate, commonly with an adjacent fragment. Descriptions of this condition have not been previously published in an increasingly popular breed, French Bulldogs. Aims of this retrospective, descriptive, single center study were to evaluate CT lumbosacral abnormalities and the frequency of lumbosacral endplate contour defect in a large sample of French Bulldogs. The presence and location of lumbosacral endplate contour defect and the presence of a concurrent osseous fragment were recorded. Other abnormal CT findings such as L7-S1 disc herniation, cauda equina nerve roots compression or thickening, disc mineralization, endplate sclerosis, spondylosis deformans, S1 articular processes hypertrophy, transitional vertebrae, hemivertebrae, spina bifida, and block vertebrae were recorded. Lumbosacral CT abnormalities were present in 91.8% of dogs (168/183). The most common abnormality was an L7-S1 dorsal disc herniation (77.4%, 130/168). Among dogs with lumbosacral abnormalities, the frequency of a lumbosacral endplate contour defect was 47% (79/168). It mostly involved L7 (78.5%, 62/79) at its dorsolateral aspect (61.3%, 38/62). A mineralized fragment was identified in 62% of the defects (49/79). Endplate contour defects were most frequently seen with a concurrent disc herniation (93.7%, 74/79) causing nerve root compression in 63.3% (50/79) and with sclerosis (65.8%, 52/79). There was no definitive evidence of a relationship with clinical presentation in this sample of French Bulldogs; therefore, this finding should be interpreted with caution. The etiology remains unclear.

Weight-bearing gantry-free cone-beam CT of the lumbar spine: Image quality analysis and dose efficiency

PurposeThe effect of static forces under load limits the prognostic value of lumbar spine CT in a horizontal position. Using a gantry-free scanner architecture, this study was designed to assess the feasibility of weight-bearing cone-beam CT (CBCT) of the lumbar spine and to establish the most dose-effective combination of scan parameters. MethodsEight formalin-fixated cadaveric specimens were examined with a gantry-free CBCT system in upright position with the aid of a dedicated positioning backstop. Cadavers were scanned with eight combinations of tube voltage (102 or 117 kV), detector entrance dose level (high or low), and frame rates (16 or 30 fps). Five radiologists independently analyzed datasets for overall image quality and posterior wall assessability. Additionally, image noise and signal-to-noise ratio (SNR) were compared based on region-of-interest (ROI) measurements in the gluteal muscles. ResultsRadiation dose ranged from 6.8 ± 1.6 (117 kV, dose level low, 16 fps) to 24.3 ± 6.3 mGy (102 kV, dose level high, 30 fps). Both image quality and posterior wall assessability were favored with 30 over 16 fps (all p ≤ 0.008). In contrast, both tube voltage (all p > 0.999) and dose level (all p > 0.096) did not significantly impact reader assessment. Image noise decreased considerably with higher frame rates (all p ≤ 0.040), while SNR ranged from 0.56 ± 0.03 to 1.11 ± 0.30 without a significant difference between scan protocols (all p ≥ 0.060). ConclusionsEmploying an optimized scan protocol, weight-bearing gantry-free CBCT of the lumbar spine allows for diagnostic imaging at reasonable radiation dose.

Two-year Skeletal Effects of Sleeve Gastrectomy in Adolescents with Obesity Assessed with Quantitative CT and MR Spectroscopy.

Background Sleeve gastrectomy (SG) is effective in the treatment of cardiometabolic complications of obesity but is associated with bone loss. Purpose To determine the long-term effects of SG on vertebral bone strength, density, and bone marrow adipose tissue (BMAT) in adolescents and young adults with obesity. Materials and Methods This 2-year prospective nonrandomized longitudinal study enrolled adolescents and young adults with obesity who underwent either SG (SG group) or dietary and exercise counseling without surgery (control group) at an academic medical center from 2015 to 2020. Participants underwent quantitative CT of the lumbar spine (L1 and L2 levels) to assess bone density and strength, proton MR spectroscopy to assess BMAT (L1 and L2 levels), and MRI of the abdomen and thigh to assess body composition. Student t and Wilcoxon signed-rank tests were used to compare 24-month changes between and within groups. Regression analysis was performed to evaluate associations between body composition, vertebral bone density, strength, and BMAT. Results A total of 25 participants underwent SG (mean age, 18 years ± 2 [SD], 20 female), and 29 underwent dietary and exercise counseling without surgery (mean age, 18 years ± 3, 21 female). Body mass index (BMI) decreased by a mean of 11.9 kg/m2 ± 5.21 [SD] after 24 months in the SG group (P < .001), while it increased in the control group (mean increase, 1.49 kg/m2 ± 3.10; P = .02). Mean bone strength of the lumbar spine decreased after surgery compared with that in control subjects (mean decrease, -728 N ± 691 vs -7.24 N ± 775; P < .001). BMAT of the lumbar spine increased after SG (mean lipid-to-water ratio increase, 0.10 ± 0.13; P = .001). Changes in vertebral density and strength correlated positively with changes in BMI and body composition (R = 0.34 to R = 0.65, P = .02 to P < .001) and inversely with vertebral BMAT (R = -0.33 to R = -0.47, P = .03 to P = .001). Conclusion SG in adolescents and young adults reduced vertebral bone strength and density and increased BMAT compared with those in control participants. Clinical trial registration no. NCT02557438 © RSNA, 2023 See also the editorial by Link and Schafer in this issue.

MRI-based detection of cervical ossification of the posterior longitudinal ligament using a novel automated machine learning diagnostic tool.

Currently, CT is considered the gold standard for the diagnosis of ossification of the posterior longitudinal ligament (OPLL). The objective of this study was to develop artificial intelligence (AI) software and a validated model for the identification and representation of cervical OPLL (C-OPLL) on MRI, obviating the need for spine CT. A retrospective evaluation was performed of consecutive imaging studies of all adult patients who underwent both cervical CT and MRI for any clinical indication within a span of 36 months (between January 2017 and July 2020) in a single tertiary-care referral hospital. C-OPLL was identified by a panel of neurosurgeons and a neuroradiologist. MATLAB software was then used to create an AI tool for the diagnosis of C-OPLL by using a convolutional neural network method to identify features on MR images. A reader study was performed to compare the performance of the AI model to that of the diagnostic panel using standard test performance metrics. Interobserver variability was assessed using Cohen's kappa score. Nine hundred consecutive patients were found to be eligible for radiological evaluation, yielding 65 identified C-OPLL carriers. The AI model, utilizing MR images, was able to accurately segment the vertebral bodies, PLL, and discoligamentous complex, and detect C-OPLL carriers. The AI model identified 5 additional C-OPLL patients who were not initially detected. The performance of the MRI-based AI model resulted in a sensitivity of 85%, specificity of 98%, negative predictive value of 98%, and positive predictive value of 85%. The overall accuracy of the model was 98%, with a kappa score of 0.917. The novel AI software developed in this study was highly specific for identifying C-OPLL on MRI, without the use of CT. This model may obviate the need for CT scans while maintaining adequate diagnostic accuracy. With further development, this MRI-based AI model has the potential to aid in the diagnosis of various spinal disorders and its automated layers may lay the foundation for MRI-specific diagnostic criteria for C-OPLL.

A Case of Hematomyelia in a Teenager with Behcet’s Disease due to both Warfarin and Intramedullary Cavernous Malformation (P6-5.029)

<h3>Objective:</h3> Highlight the importance of recognizing bleeding of intramedullary cavernous malformation or cavernoma as a cause of spinal cord lesion. <h3>Background:</h3> Intramedullary spinal cord hemorrhage, or hematomyelia, is a rare cause of acute myelopathy. Vascular malformations, anticoagulation therapy, and other bleeding diathesis are the most common causes. Cavernoma is a vascular malformation made of closely clustered, enlarged capillaries with a single layer of endothelium and without the elements of normal vascular structure or normal intervening brain parenchyma. Although they can bleed, cavernomas have a relatively benign prognosis. Hemorrhage of an intramedullary cavernoma during anticoagulation with warfarin was not previously reported. <h3>Design/Methods:</h3> Nineteen-year-old man with Behçet’s disease taking warfarin for intraventricular thrombus and multiple pulmonary emboli complained of acute back pain, unilateral leg weakness, and urinary retention. He had no personal or family history of vascular malformations. Examination was remarkable for paraplegia, a sensory level at T10, lower limb hyporeflexia and Babinski reflex bilaterally. INR was supratherapeutic at 3.6. CT of head, cervical and thoracic spine was unremarkable. <h3>Results:</h3> MRI of spine showed an enhancing intramedullary lesion at T8–T9, 3.8 cm in length, with surrounding edema. The mixed T1 hyperintensity and T2 hypointensity was suggestive of hemorrhage caused by a cavernoma. Warfarin was reversed with prothrombin complex concentrate. He was not a candidate for neurosurgical intervention. At discharge, the patient had not regained any motor or sensory function. <h3>Conclusions:</h3> This case highlights the need to suspect hematomyelia as a cause of acute myelopathy in a patient taking anticoagulation. While anticoagulation is not contraindicated in patients with known cavernoma, there should be a low threshold for considering the presence of a bleeding intramedullary cavernoma in a patient with acute myelopathy. <b>Disclosure:</b> Dr. Sacks has nothing to disclose. Dr. Treidler has nothing to disclose.

A STUDY ON CLINICAL PROFILE OF NEURAL TUBE DEFECT IN A TERTIARY CARE HOSPITAL

Background And Objectives: - Neural tube defects (NTDs) are birth defects of the central nervous system, adversely affecting the development of the brain, spinal cord, and the spinal nerves. Neural tube defects are a group of severe congenital disorders associated with substantial mortality, morbidity, long-term disability, and psychological and economic costs. Aims And Objectives Of The Study: 1. To study clinical profile of neural tube defects. 2. To study complications of neural tube defects. Materials And Methods: After obtaining ethical committee clearance and informed consent from the parents, 30 subjects diagnosed with neural tube defect, were included in the study based on inclusion criteria. A detailed history was taken from each subject's informant including, age, gender, birth details, consanguinity, antenatal visits/investigations, family history of congenital malformations. Clinical examination of each subject was performed. Relevant investigations were done such as ultrasonography, CT and MRI of brain and spine. Results: Among 30 study subject females: male ratio is 3:2, Lower socioeconomic status and consanguineous marriage were statistically significantly associated with neural tube defect with p value of 0.0001 and 0.020 respectively. Lack of Folic acid supplementation was associated with increased risk of neural tube defect with a p value of 0.001 which is statistically significant. In our study, we observed that Myelomeningocele was most common which accounted for 36.6% of cases followed by Spina bifida occulta (20%), Myelomeningocele with diastematomyelia(10%), Encephalocele(10%), Meningocele(6.6%), Diastematomyelia(6.6%), Holoprosencephaly with Tethered spinal cord(3.3%), Lipomeningomyelocele(3.3%), Anencephaly (3.3%). Within the constraints of the present study, it ca Conclusion: n be concluded Folic acid supplementation is helps to prevent neural tube

Application of artificial intelligence centric workflows for evaluation of neuroradiology emergencies

The goal of this study was to perform a pilot study to assess user-interface of radiologists with an artificial-intelligence (AI) centric workflow for detection of intracranial hemorrhage (ICH) and cervical spine fractures (CSFX). Over 12-month period, interaction and usage of AI software implemented in our institution, Aidoc, on head and cervical spine CT scans were obtained. Several interaction variables were defined, assessing different types of interaction between readers of different training level and AI software. The median usage of AI-centric workflow for detection of ICH and CSFX were 28.8% and 21.8%, respectively, demonstrating a significant additional engagement beyond Native workflow (worklist and PACS). Further studies are warranted to expand interaction assessments to further understand the value unlocked by the AI-centric workflows.

The anatomic study and surgical technique for canal decompression with “pedicle-plasty” strategy in lumbar burst fractures with pedicle rupture

ABSTRACT In the treatment of lumbar burst fractures with nerve injury, fusion is often required to rebuild spinal stability, but it can lead to the loss of motor units and increase the occurrence of adjacent segment diseases. Thus, a novel approach of lumbar canal decompression with “pedicle-plasty” strategy (DDP) was needed in clincal treatment. Firstly, image measurement analysis, the images of 60 patients with lumbar spine CT examinations were selected to measure osteotomy angle (OA), distance from the intersection of osteotomy plane and skin to the posterior midline (DM),transverse length of the osteotomy plane (TLOP), and sagittal diameter of the outer edge of superior articular process (SD). Secondary, cadaver study, distance between the intermuscular space and midline (DMSM), anterior and posterior diameters of the decompression (APDD), and lateral traction distance of the lumbosacral plexus (TDLP) were measured on 10 cadaveric specimens. Finally, procedure of DDP was demonstrated on cadaver specimens. OA ranged from 27.68°+4.59° to 38.34°+5.97°, DM ranged from 43.44+6.29 to 68.33+12.06 mm, TLOP ranged from 16.84+2.19 to 19.64+2.36 mm, and SD ranged from 22.49+1.74 to 25.53+2.21 mm. DMSM ranged from 45.53+5.73 to 65.46+6.43 mm. APDD were between 10.51+3.59 and 12.12+4.54 mm, and TDLP were between 3.28+0.81 and 6.27+0.62 mm.DDP was successfully performed on cadaveric specimens. DDP, as a novel approach of decompression of burst fractures with pedicle rupture, can fully relieve the occupation and at the same time preserve the spinal motor unit because of no resection of intervertebral discs and no destruction of facet joints,and has certain developmental significance.

Leveraging GPT-4 for Post Hoc Transformation of Free-text Radiology Reports into Structured Reporting: A Multilingual Feasibility Study.

Leveraging GPT-4 for Post Hoc Transformation of Free-text Radiology Reports into Structured Reporting: A Multilingual Feasibility Study.

Alternatives to DEXA for the assessment of bone density: a systematic review of the literature and future recommendations.

Osteoporosis has significant implications in spine fusion surgery, for which reduced spinal bone mineral density (BMD) can result in complications and poorer outcomes. Currently, dual-energy x-ray absorptiometry (DEXA) is the gold standard for radiographic diagnosis of osteoporosis, although DEXA accuracy may be limited by the presence of degenerative spinal pathology. In recent years, there has been an evolving interest in using alternative imaging, including CT and MRI, to assess BMD. In this systematic review of the literature, the authors assessed the use and effectiveness of MRI, opportunistic CT (oCT), and quantitative CT (qCT) to measure BMD. In accordance with the PRISMA guidelines, the authors conducted a systematic search for articles posted on PubMed between the years 2000 and 2022 by using the keywords "opportunistic CT, quantitative CT, MRI" AND "bone density" AND "spine." Inclusion criteria consisted of articles written in English that reported studies pertaining to human or cadaveric subjects, and studies including a measure of spinal BMD. Articles not related to spinal BMD, osteoporosis, or spinal surgery or reports of studies that did not include the use of spinal MRI or CT were excluded. Key study outcomes were extracted from included articles, and qualitative analysis was subsequently performed. The literature search yielded 302 articles. Forty-two articles reported studies that met the final inclusion criteria. Eighteen studies utilized MRI protocols to correlate spinal BMD with vertebral bone quality scores, M-scores, and quantitative perfusion markers. Eight studies correlated oCT with spinal BMD, and 16 studies correlated qCT with spinal BMD. With oCT and qCT imaging, there was consensus that Hounsfield unit (HU) values > 160 demonstrated significant reduction in risk of osteoporosis, whereas HU values < 110 were significantly correlated with osteoporosis. Osteoporosis is increasingly recognized as a significant risk factor for complications after spinal fusion surgery. Consequently, preoperative assessment of BMD is a critical factor to consider in planning surgical treatment. Although DEXA has been the gold standard for BMD measurement, other imaging modalities, including MRI, oCT, and qCT, appear to be viable alternatives and may offer cost and time savings.

Mild autonomous cortisol secretion in adrenal incidentalomas and risk of fragility fractures: a large cross-sectional study.

Mild autonomous cortisol secretion (MACS) has been associated with a higher prevalence of osteoporosis, although most data rely on single-center studies with limited sample size. We aimed to assess the prevalence of fragility fractures and contributing factors in a large cohort of patients with adrenal incidentalomas. Medical records of 1023 patients with adrenal incidentalomas from 1990 to 2019 were reviewed, and 735 patients were selected. Clinically obtained electronic radiological images closest to first endocrine evaluation, such as lateral views of spine X-rays or CT thoraco-abdominal scans, were reviewed to screen for asymptomatic morphometric vertebral fractures. Clinical fragility fractures, hormonal, and dual-energy x-ray absorptiometry (DXA) indices were also recorded. Four hundred seventy-four patients had nonfunctioning (NF) adrenal incidentalomas, 238 had MACS and 23 adrenal Cushing's syndrome (AC). Prevalence of fragility fractures was different (P = .018) between groups, respectively, 24.1% (NF), 34.0% (MACS), and 30.4% (AC), with significant difference between NF and MACS (P = .012). When analyzed separately by sex and menopausal status, this difference remained significant in postmenopausal women (P = .011), with a fracture prevalence of 22.2% (NF) and 34.6% (MACS). Fracture prevalence was similar in males. Women with MACS aged ≥65 years reported a 48.8% prevalence of fractures, as compared with 29.5% in NF (P < .01). In postmenopausal women, fragility fractures were associated with age (odds ratio [OR] 1.1, P < .001), smoking (OR 1.8, P = .048), and 1 mg-dexamethasone suppression test (DST) cortisol (OR 3.1, P = .029), while in men, only age was associated with fragility fractures. A considerable fracture burden was shown in postmenopausal women with adrenal incidentalomas and MACS, with clinical implications for the evaluation and management of bone metabolism.

Can you see with CT? Is cervical spine computed tomographic imaging sufficient in pediatric trauma?

BackgroundTraumatic cervical spine injury (CSI) is fundamentally different in children, and imaging recommendations vary; however, prompt diagnosis is necessary. MethodsWe conducted a retrospective cohort study, evaluating children who presented after traumatic injury from 7/1/2012 to 12/31/2019 receiving a cervical spine CT. Evaluation of the incidence and clinical significance of CSI undetected on CT subsequently diagnosed on MRI was conducted. Additionally, all with CSI underwent image review to evaluate for potential overlooked, but visible pathology. Results1487 children underwent a cervical spine CT, revealing 52 with CSI. 237 underwent MRI due to an abnormal CT or continued clinical concern. Ultimately, three were discovered to have clinically significant CSI missed on CT. In all cases, retrospective review demonstrated a retroclival hematoma when soft tissue windows were formatted in sagittal and coronal views. ConclusionsA normal CT may be sufficient to rule-out clinically significant CSI. However, the presence of a retroclival hematoma must be evaluated.

Postmortem kinetic CT of the cervical spine and an objective index for diagnosing anterior disc space widening: A retrospective utility analysis

Postmortem CT has limitations in identifying cervical spine injuries. Injuries at the level of the intervertebral disc (anterior disc space widening), such as rupture of the anterior longitudinal ligament or intervertebral disc, may be difficult to distinguish from normal images depending on the imaging position. We performed postmortem kinetic CT of the cervical spine in the extended position in addition to CT in the neutral position. The difference in intervertebral angles between the neutral and extended positions was defined as the intervertebral range of motion (ROM), and the utility of postmortem kinetic CT of the cervical spine for the diagnosis of anterior disc space widening and its objective index were examined based on the intervertebral ROM. Of 120 cases, 14 had anterior disc space widening: 11 had one lesion and 3 had two lesions. The intervertebral ROM for the 17 lesions was 11.85° ± 5.25° and that for the normal vertebrae was 3.78° ± 2.81°, with a significant difference between the two. ROC analysis of the intervertebral ROM between vertebrae with anterior disc space widening and the normal vertebral spaces showed an AUC of 0.903 (95 % confidence interval 0.803–1) and a cutoff value of 8.61° (sensitivity 0.96, specificity 0.82). Postmortem kinetic CT of the cervical spine revealed that the intervertebral ROM of the anterior disc space widening was increased, which facilitated identification of the injury. An intervertebral ROM that exceeds 8.61° facilitates a diagnosis of anterior disc space widening.

Chronic low back pain and its differential diagnoses: a case report

Low back pain is a common problem which accompanies a large part of the population. It is estimated that up to 84% of adults will have low back pain at some point in their lives. Rarely, low back pain may be the first manifestation of a serious illness. This case report presents the clinical history of a 79 year-old male, with multiple comorbities, including a report of a discal hernia treated by surgery approximately 30 years before presentation, with residual low back pain since then. The pain was progressively worsening, associated with loss of muscle strength and paresthesia in the right lower limb, with significant weight loss. During screening, significant anemia and acute kidney injury with associated hypercalcemia were observed. A spine CT scan revealed a large expansile lesion obliterating the medullary canal at T8/T9 segment. A monoclonal spike in protein electrophoresis was found, along with sparse lytic lesions in long bones leading to the diagnosis of multiple myeloma. Therefore, this report highlights the importance of considering different differential diagnoses as a cause of low back pain. The correct determination of the etiology is essential for adequate clinical management and improvement of the patient's quality of life.

Proposal of simplified CT syndesmophyte score (sCTSS) and comparison with CTSS in patients with ankylosing spondylitis

The CT syndesmophyte score (CTSS) can evaluate spinal progression more precisely than mSASSS in ankylosing spondylitis (AS); however, it is complex and time consuming. Here, we propose a simplified CTSS (sCTSS) for measuring spinal structural changes in AS. Patients with AS were recruited from a single tertiary hospital. Baseline and 2-year follow-up whole spine CT images were used to calculate CTSS and sCTSS. The sCTSS used the anterior and posterior vertebral corners, and ranged 0–184. Intraclass correlation coefficients (ICC) were calculated, as well as the smallest detectable changes. Fifty AS patients were included. For reader 1, the mean sCTSS at baseline and 2-year follow-up were 11.7 ± 14.6 and 15.8 ± 16.1, whereas those for reader 2 were 12.0 ± 12.5 and 15.8 ± 15.7, respectively. The ICCs for CTSS at baseline and at 2-year follow-up were 0.97 (95% confidence interval [CI] 0.96–0.99) and 0.98 (0.97–0.99), respectively, and that for changes over the 2 years was 0.48 (95% CI 0.23–0.67). For sCTSS, the ICCs were 0.96 (95% CI 0.92–0.97), 0.97 (95% CI 0.94–0.98), and 0.58 (95% CI 0.36–0.74), respectively. Detection rates for syndesmophyte progression were comparable between CTSS and sCTSS. The detection rate for syndesmophytes on only lateral side was 13.2 and 11.4%, and 11.4 and 15.2% at baseline and 2-year follow-up (reader 1 and 2). sCTSS and CTSS showed similar detection rates for syndesmophyte progression. sCTSS may be a reliable method for evaluating spinal structural damage in AS.

Development of a system to assess the two- and three-dimensional bone mineral density of the lumbar vertebrae from clinical quantitative CT images.

To date, the assessment of bone mineral density (BMD) using CT images has been made in three dimensions, leading to errors in detecting osteoporosis based on the two-dimensional assessments of BMD using dual-energy X-ray absorptiometry (DXA-BMD). Herein, we aimed to develop a system that measures two- and three-dimensional lumbar BMD from quantitative CT images and validated the accuracy of the system in diagnosing osteoporosis with regard to the DXA classification. Fifty-nine pairs of spinal CT and DXA images were analyzed. First, the three-dimensional BMD was measured at the axial slice of the L1 vertebra on CT images (L1-vBMD). Then, the L1-L4 vertebrae were segmented from the CT images to measure the three-dimensional BMD at the trabecular region of the L1-L4 vertebral bodies (CT-vBMD). Lastly, the segmented vertebrae were projected onto the coronal plane to measure the two-dimensional BMD (CT-aBMD). Each parameter was correlated with DXA-BMD, and the receiver operating characteristic (ROC) curve to diagnose osteoporosis was assessed. The correlation coefficients of DXA-BMD with L1-vBMD, CT-vBMD, and CT-aBMD were 0.364, 0.456, and 0.911, respectively (all p < 0.01). In the ROC curve analysis to diagnose osteoporosis, the area under the curve for CT-aBMD (0.941) was significantly higher than those for L1-vBMD (0.582) and CT-vBMD (0.657) (both p < 0.01). Compared with L1-vBMD and CT-vBMD, CT-aBMD could accurately predict DXA-BMD and detect patients with osteoporosis. Given that our method can quantify BMD in both two and three dimensions, it could be used to screen for osteoporosis from quantitative CT images.

How Sagittal Spinal Parameters Predict Anterolateral Spinal Ossification Severity: A Study Based on Ct Classification.

Retrospective observational study. The purpose of this study was to establish a CT classification system of anterolateral spinal ossification and analyze the effects of sagittal spinal parameters on ossification. Patients with Diffuse idiopathic skeletal hyperostosis (DISH) often present with anterolateral ossification of the spine. Few reports consider anterolateral spinal ossification at each spinal level or explore the influence of sagittal alignment. 120 patients (79 males and 41 females) over 60 years old who underwent whole spinal CT scans from October 2018 to November 2021 were analyzed. Volume rendering technique images were used to assess the degree of anterolateral spinal ossification in each intervertebral space, and a classification system was established. Sagittal parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), cervical lordosis (CL), sacral slope (SS), and thoracolumbar junction angle (TLJ) of the patients were measured. Multi-factor stepwise linear regression analysis and ordered logistic regression analysis were used to study the effects of the sagittal parameters on ossification grades. The median age of the study population was 67 years (63-72 IQR). The new classification system classifies the severity of anterolateral spinal ossification in each intervertebral space into grades 0 to 3 with an intra-observer ICC value of 0.909 and inter-observer ICC value of 0.900. Multivariate stepwise linear regression analysis showed that age (OR=1.30, P<0.001), weight (OR=1.23, P=0.013), and CL (OR=1.19, P<0.001) were significantly correlated with total ossification grade. Multi-factor ordered logistic regression analysis showed that there was a statistically significant correlation between CL and the ossification grades of each intervertebral space of T1~T4 (P≤0.005), between TK and each intervertebral space in T4~T12 (P≤0.019), and between TLJ and each intervertebral space in T10~L3 (P≤0.025). LL was significantly and positively correlated with the ossification grades of each intervertebral space in T7~T11 (P≤0.041). LL and SS was significantly negatively correlated with the ossification grades of each intervertebral space in L3~S1 (P≤0.047). Our new classification scheme demonstrated good accuracy and reliability for the evaluation of the severity of anterolateral spinal ossification. The effect of sagittal parameters on anterolateral spinal ossification was position-specific. The greater the kyphosis or the smaller the lordosis of a spinal region, the more severe the degree of ossification in the corresponding region. 3.

An Exceptional Cause of Increased 18F-Fluorodeoxyglucose Uptake on PET/CT in a Thyroid Nodule.

A 41-year-old female underwent a cervical spine CT for the workup of posterior neck pain irradiating to the shoulders for several months. An incidental thyroid nodule was found and classified as Bethesda III on the Fine-needle aspiration cytology (FNAC) results. Three months later, the patient developed mild shortness of breath, dry cough, and fever. Chest X-ray revealed a mild enlargement in the bilateral hilar regions. CT showed mediastinal and bilateral hilar enlarged lymph nodes and pulmonary micronodules. The workup was further completed with a 18F-FDG PET/CT, showing intense FDG uptake in the mediastinal and bilateral hilar lymph nodes and increased uptake in the thyroid nodule. Endobronchial Ultrasound-guided Transbronchial needle aspiration (EBUS-TBNA) of a left hilar lymph node showed epithelioid non-necrotizing granulomas. Because of the FNAC results, size of the nodule and tracheal shift, thyroid lobectomy was performed one month later. Histopathological results also revealed multiple non-necrotizing epithelioid granulomas, suggesting systemic sarcoidosis with involvement of the thyroid. To our knowledge, this is the first report of thyroid sarcoidosis detected on 18F-FDG PET/CT. Although an increased FDG uptake in a thyroid nodule is usually suggestive of thyroid malignancy, toxic nodule, or follicular hyperplasia, our case report shows that it could also suggest thyroid sarcoidosis.

Performance assessment and external validation of specific thresholds of total psoas muscle cross-sectional area as predictors of mortality in oncologic spine surgery for spinal metastases.

The purpose of this study was to assess the utility of low muscle mass (LMM) in predicting 90-day and 12-month mortality after spinal tumor surgery. We identified 115 patients operated on for spinal metastases between April 2012 and August 2022 who had available perioperative abdominal or lumbar spine CT scans and minimum 90-day follow-up. LMM was defined as a total psoas muscle cross-sectional area (TPA) at the L4 pedicle level less than 10.5 cm2 for men and less than 7.2 cm2 for women based on previously reported thresholds. A secondary analysis was performed by analyzing TPA as a continuous variable. The primary endpoint was 90-day mortality, and the secondary endpoint was 12-month mortality. Multivariate logistic regression analyses were performed. The 90-day mortality was 19% for patients without and 42% for patients with LMM (p = 0.010). After multivariate analysis, LMM was not independently associated with increased odds of 90-day mortality (odds ratio 2.16 [95% confidence interval 0.62 to 7.50]; p = 0.223). The 12-month mortality was 45% for patients without and 71% for patients with LMM (p = 0.024). After multivariate analysis, LMM was not independently associated with increased odds of 12-month mortality (OR 1.64 [95% CI 0.46 to 5.86]; p = 0.442). The secondary analysis showed no independent association between TPA and 90-day or 12-month mortality. Patients with LMM had higher rates of 90-day and 12-month mortality in our study, but this was not independent of other parameters such as performance status, hypoalbuminemia, or primary cancer type.