Evaluation Of Degenerative Changes Research Articles

Longitudinal MR-based proton-density fat fraction (PDFF) and T2* for the assessment of associations between bone marrow changes and myelotoxic chemotherapy

ObjectivesMR imaging-based proton density fat fraction (PDFF) and T2* imaging has shown to be useful for the evaluation of degenerative changes in the spine. Therefore, the aim of this study was to investigate the influence of myelotoxic chemotherapy on the PDFF and T2* of the thoracolumbar spine in comparison to changes in bone mineral density (BMD).MethodsIn this study, 19 patients were included who had received myelotoxic chemotherapy (MC) and had received a MR imaging scan of the thoracolumbar vertebrates before and after the MC. Every patient was matched for age, sex, and time between the MRI scans to two controls without MC. All patients underwent 3-T MR imaging including the thoracolumbar spine comprising chemical shift encoding-based water-fat imaging to extract PDFF and T2* maps. Moreover, trabecular BMD values were determined before and after chemotherapy. Longitudinal changes in PDFF and T2* were evaluated and compared to changes in BMD.ResultsAbsolute mean differences of PDFF values between scans before and after MC were at 8.7% (p = 0.01) and at −0.5% (p = 0.57) in the control group, resulting in significantly higher changes in PDFF in patients with MC (p = 0.008). BMD and T2* values neither showed significant changes in patients with nor in those without myelotoxic chemotherapy (p = 0.15 and p = 0.47). There was an inverse, yet non-significant correlation between changes in PDFF and BMD found in patients with myelotoxic chemotherapy (r = −0.41, p = 0.12).ConclusionTherefore, PDFF could be a useful non-invasive biomarker in order to detect changes in the bone marrow in patients receiving myelotoxic therapy.Clinical relevance statementUsing PDFF as a non-invasive biomarker for early bone marrow changes in oncologic patients undergoing myelotoxic treatment may help enable more targeted countermeasures at commencing states of bone marrow degradation and reduce risks of possible fragility fractures.Key PointsQuantifying changes in bone marrow fat fraction, as well as T2* caused by myelotoxic pharmaceuticals using proton density fat fraction, is feasible.Proton density fat fraction could potentially be established as a non-invasive biomarker for early bone marrow changes in oncologic patients undergoing myelotoxic treatment.

3D zero-echo time and 3D T1-weighted gradient-echo MRI sequences as an alternative to CT for the evaluation of the lumbar facet joints and lumbosacral transitional vertebrae.

Computed tomography (CT) is the reference standard for assessment of the bone. Magnetic resonance imaging (MRI) developments enable a CT-like visualization of the osseous structures. To assess the diagnostic performance of 3D zero-echo time (3D-ZTE) and 3D T1-weighted gradient-echo (3D-T1GRE) MRI sequences for the evaluation of lumbar facet joints (LFJs) and the detection of lumbosacral transitional vertebrae (LSTV) using CT as the reference standard. In total, 87 adult patients were included in this prospective study. Evaluation of degenerative changes of the facet joints at the L3/L4, L4/L5, and L5/S1 levels on both sides was performed by two readers using a 4-point Likert scale. LSTV were classified according to Castelvi et al. Image quality was quantitatively measured using the signal-to-noise (SNR) and contrast-to-noise (CNR) ratios. Intra-reader, inter-reader, and inter-modality reliability were calculated using Cohen's kappa statistic. Intra-reader agreement for 3D-ZTE, 3D-T1GRE, and CT was 0.607, 0.751, and 0.856 and inter-reader agreement was 0.535, 0.563, and 0.599, respectively. The inter-modality agreement between 3D-ZTE and CT was 0.631 and between 3D-T1GRE and CT 0.665. A total of LSTV were identified in both MR sequences with overall comparable accuracy compared to CT. Mean SNR for bone, muscle, and fat was highest for 3D-T1GRE and mean CNR was highest for CT. 3D-ZTE and 3D-T1GRE MRI sequences can assess the LFJs and LSTV and may serve as potential alternatives to CT.

Deep learning reconstruction for 1.5 T cervical spine MRI: effect on interobserver agreement in the evaluation of degenerative changes.

To investigate whether deep learning reconstruction (DLR) provides improved cervical spine MR images using a 1.5 T unit in the evaluation of degenerative changes without increasing imaging time. This study included 21 volunteers (age 42.4 ± 11.9 years; 17 males) who underwent 1.5 T cervical spine sagittal T2-weighted MRI. From the imaging data with number of acquisitions (NAQ) of 1 or 2, images were reconstructed with DLR (NAQ1-DLR) and without DLR (NAQ1) or without DLR (NAQ2), respectively. Two readers evaluated the images for depiction of structures, artifacts, noise, overall image quality, spinal canal stenosis, and neuroforaminal stenosis. The two readers read studies blinded and randomly. Values were compared between NAQ1-DLR and NAQ1 and between NAQ1-DLR and NAQ2 using the Wilcoxon signed-rank test. The analyses showed significantly better results for NAQ1-DLR compared with NAQ1 and NAQ2 (p < 0.023), except for depiction of disc and foramina by one reader and artifacts by both readers in the comparison between NAQ1-DLR and NAQ2. Interobserver agreements (Cohen's weighted kappa [97.5% confidence interval]) in the evaluation of spinal canal stenosis for NAQ1-DLR/NAQ1/NAQ2 were 0.874 (0.866-0.883)/0.778 (0.767-0.789)/0.818 (0.809-0.827), respectively, and those in the evaluation of neuroforaminal stenosis were 0.878 (0.872-0.883)/0.855 (0.849-0.860)/0.852 (0.845-0.860), respectively. DLR improved the 1.5 T cervical spine MR images in the evaluation of degenerative spine changes. • Two radiologists demonstrated that deep learning reconstruction reduced the noise in cervical spine sagittal T2-weighted MR images obtained using a 1.5 T unit. • Reduced noise in deep learning reconstruction images resulted in a clearer depiction of structures, such as the spinal cord, vertebrae, and zygapophyseal joint. • Interobserver agreement in the evaluation of spinal canal stenosis and foraminal stenosis on cervical spine MR images was significantly improved using deep learning reconstruction (0.874 and 0.878, respectively) versus without deep learning (0.778-0.818 and 0.852-0.855, respectively).

Developing a grading scale for the evaluation of degenerative changes in uncovertebral (Luschka) joints.

The study aimed to develop a grading scale for evaluating degenerative changes in uncovertebral joints (UVJs) found on computed tomography (CT) scans, and assess the intra- and inter-rater reliability of this scale. The study included 50 subjects (average age 55.12 ± 13.76 years) referred for CT examinations due to cervical complaints. Three researchers developed a reading protocol using a semiquantitative grading scale of UVJ degenerative changes. CTs were read and reread several times to refine the protocol. Subsequently, the reader read and reread 20 CTs (C3-C7 bilateral, altogether 200 UVJs) 2 weeks apart in order to assess the intra-rater reliability. The second reader, after the training, read the same 20 CTs (yet, C4-C6 bilateral, altogether 120 UVJs) in order to assess the inter-rater reliability. The additional 30 CTs were evaluated to analyze the prevalence and associations between the studied parameters. The final grading scale included joint space narrowing, osteophyte, subchondral sclerosis, subchondral cyst, hypertrophy, cortical erosion, and vacuum phenomenon. The intra-rater agreement ranged from very good in joint space narrowing (k= 0.757), osteophyte grade (k= 0.748), subchondral cyst (k= 0.716), hypertrophy (k= 0.728), vacuum phenomenon (k= 0.712) to good (k= 0.544) in subchondral sclerosis, and fair in cortical erosion (k= 0.36). For the overall UVJ degeneration grade, the intra-rater agreement was very good (k= 0.616) and the inter-rater reliability was good (k= 0.468). 77.6% of the evaluated UVJs exhibited some degenerative changes. Our grading scale is the first to evaluate UVJs presenting good-very good intra-rater and inter-rater reliability which can be utilized in further clinical studies and assess degenerative changes in UVJs.

Magnetic resonance imaging evaluation of degenerative changes of cervical spine

Magnetic resonance imaging evaluation of degenerative changes of cervical spine

Fifth metacarpal instability and its effect on hamatometacarpal arthritis patterns–a cadaver study

Osteoarthritis (OA) of the fifth carpometacarpal joint is a rare diagnosis with most cases occurring post-traumatically. The joint's ligamentous supports have not been described extensively; however we know that the volar and intermetacarpal ligaments acts as the primary stabilizers. The major deforming forces on this joint are the extensor carpi ulnaris (ECU) dorsally and the flexor carpi ulnaris volarly, via the pisimetacarpal ligament. The aim of this study was to determine how the different joint stabilizers contribute to fifth carpometacarpal joint stability and biomechanics. We also sought to describe the OA patterns affecting the fifth carpometacarpal joint. A study was performed on 10 embalmed cadavers. The fifth carpometacarpal joint was evaluated biomechanically through ECU traction and sequential transection of the joint stabilizers. Gross macroscopic evaluation of degenerative changes in the articular surface was conducted and graded on a scale of 0–3 (with 0 representing normal cartilage with no visible lesions). Biomechanical data were available from 18 specimens (10 right; 8 left) and arthritic patterns were available from all 20 specimens (10 right; 10 left). Based on the biomechanical data, the proximal and distal intermetacarpal ligaments were found to be major contributors to stability. The volar stabilizer was a minor contributor to stability and the dorsal stabilizer was a minimal contributor to stability. OA was present in 16/20 specimens (80%) with an average arthritis grade of 1.6 on the right hand and 1.0 on the left hand. The most common site of OA was the dorso-ulnar quadrant.

Evaluation of degenerative changes in lumbar spine by MRI in rural population

Evaluation of degenerative changes in lumbar spine by MRI in rural population

Plain Radiographic Evaluation of Degenerative Changes of Lumbosacral Spine-Correlation with Magnetic Resonance Imaging Findings

Back pain resulting from degenerative disease of the spine is one of the most common causes of disability in adults of working age. The structures which may be responsible for the origin of the degenerative spine are bone (spondylolisthesis, spondylolysis), ligaments (hypertrophy of the spinal ligaments, particularly the ligamentum flavum), facet joints (facet hypertrophy, synovial cyst) and intervertebral disc (bulging and herniation)1. This was a cross sectional study of 105 patients with low back pain. All Plain X-ray and MRI findings were collected for each patient in a pre-designed structured data collection sheet. In plain X-ray 74 subjects had posterior disc height &lt;6mm; out of them nerve root compression found in 56, spinal stenosis found in 54. Those who had posterior osteophytes, (86.8%) found to have disc herniation. Among facetal hyperthrophy (72 subjects), 62 (86.1%) had disc herniation. In this study significant correlation found between plain radiographic findings of degenerative changes of lumbosacral spine with MRI.Faridpur Med. Coll. J. Jul 2015;10(2): 68-70

Quebec Back Pain Disability Scale, Low Back Outcome Score and Revised Oswestry Low Back Pain Disability Scale for Patients With Low Back Pain Due to Degenerative Disc Disease

Evaluation and comparison of translated and culturally adapted self-reported measurements. The aim of this prospective study was to cross-culturally adapt the Polish versions of Revised Oswestry Disability Index (RODI-PL), Quebec Back Pain Disability Scale (QDS-PL), and the Low Back Outcome Score (LBOS-PL). The application of instruments in English, which have undergone translation must be subjected to validation studies. Such studies are necessary above all for instruments that have been adapted to establish their value and usefulness in studies of patient populations where English is not the native language. The translation was carried out according to International Quality of Life Association (IQOLA) Project and consisted of the following stages: translation, synthesis of the translations, back translation, expert committee, and testing of the prefinal versions of questionnaires. Eighty-five consecutive patients with low back pain due to spinal disc herniation and degenerative changes completed the QDS-PL, RODI-PL, LBOS-PL, and a Visual Analogue Scale twice within 2-day intervals. Mean duration of LBP was 45.9 months SD 55.5. The evaluation of degenerative changes in the lumbar region was carried out according to the Modic scale. Twenty-nine patients were categorized at type I, 4 patients were registered as type II, and 52 patients were type III. Cronbach α values for the LBOS-PL equaled 0.77, for the RODI-PL 0.85, and 0.95 for the QDS-PL. Item-total correlation confirmed that all scales are internally consistent. Test-retest reliability was excellent for RODI-PL and QDS-PL, but poor for LBOS-PL (0.88, 0.93, and 0.34, respectively). All questionnaires were significantly intercorrelated. We identified the strongest correlation between QDS-PL and RODI-PL (0.823, P < 0.001). The statistically significant correlation was identified between the QDS-PL and Modic Classification (rS = 0.226 P = 0.038). QBPDS-PL and RODI-PL are reliable and valid. Furthermore, investigation of the psychometric properties of the LBOS-PL in different spinal conditions is required. There is a relation between the results of the QDS-PL, and different levels of advancement in degenerative disease of the lumbar spine, according to the Modic Classification.

Ultrasonographic evaluation of degenerative changes in the distal radioulnar joint: Correlation of findings with gross anatomy and MR arthrography in cadavers

Objective To determine the accuracy of ultrasonography (US) in the evaluation of degenerative changes in the distal radioulnar joint (DRUJ). Methods and materials Ten cadaveric specimens were obtained. US evaluation of cartilage degeneration and thickness was performed by two independent and blinded readers (R1 and R2). Gross anatomy and MR arthrography evaluated by two readers in consensus served as the reference standard. The joint surface not accessible to US was measured. Results US interreader agreement was non-existent for cartilage thickness measurements and moderate for cartilage degeneration grading (weighted kappa = 0.41). Comparing US and MR imaging evaluation, there was no correlation between US R1 and MR imaging (Pearson correlation coefficient [PCC] = 0.352) and a moderate correlation between US R2 and MR imaging (PCC = 0.570) concerning cartilage thickness measurements. Concerning cartilage degeneration grading, there was a moderate to strong (R1 Spearman correlation coefficient [SCC] = 0.729)/R2 SCC = 0.767) correlation concerning cartilage degeneration grading. Comparing US and gross anatomic evaluation, there was no correlation for US R1 (PCC = 0.220) and a strong correlation for US R2 (PCC = 0.922) concerning cartilage thickness measurements, and a strong to moderate correlation (R1 SCC = 0.808/R2 SCC = 0.597) concerning cartilage degeneration grading. The mean sector of the articular surface of the ulna head not accessible to US was 13°. Conclusion In conclusion the DRUJ is accessible to US except in the central 13° sector of the joint surface. US was approved to be sufficient in demonstrating advanced stages of cartilage degeneration. Thus, US of the DRUJ is recommended in patients suffering from ulnar-sided wrist pain.

Role of abdominal CT, when available in patients' records, in the evaluation of degenerative changes of the sacroiliac joints.

To determine the role of abdominal computed tomography (CT) that had been performed for other reasons, in the evaluation of degenerative changes of the sacroiliac joints, the authors performed a retrospective review of the sacroiliac joints of 100 patients, all of whom had an abdominal CT scan and a plain abdominal and/or pelvic roentgenogram in their files. The results indicate that, when available in the patient's record, abdominal CT scans provide substantial additional information in the evaluation of degenerative changes of the sacroiliac joints at no extra cost. The authors' results also suggest that after the age of 55, the patient's age does not seem to influence the extent of sacroiliac joint narrowing, which does appear to be affected by the presence of coexisting diffuse idiopathic skeletal hyperostosis.