Body Of L5 Research Articles

Integrated Whole-Body PET/MRI With 18F-FDG, 18F-FDOPA, and 18F-FDA in Paragangliomas in Comparison With PET/CT

Purpose Paragangliomas (PGLs) are tumors that can metastasize and recur; therefore, lifelong imaging follow-up is required. Hybrid PET/CT is an essential tool to image PGLs. Novel hybrid PET/MRI scanners are currently being studied in clinical oncology. We studied the feasibility of simultaneous whole-body PET/MRI to evaluate patients with PGLs. Methods Fifty-three PGLs or PGL-related lesions from 8 patients were evaluated. All patients underwent a single-injection, dual-modality imaging protocol consisting of a PET/CT and a subsequent PET/MRI scan. Four patients were evaluated with 18F-FDG, 2 with 18F-fluorodihydroxyphenylalanine, and 2 with 18F-fluorodopamine. PET/MRI data were acquired using a hybrid whole-body 3-tesla integrated PET/MRI scanner. PET and MRI data (Dixon sequence for attenuation correction and T2-weighted sequences for anatomic allocation) were acquired simultaneously. Imaging workflow and imaging times were documented. PET/MRI and PET/CT data were visually assessed (blindly) in regards to image quality, lesion detection, and anatomic allocation and delineation of the PET findings. Results With hybrid PET/MRI, we obtained high-quality images in an acceptable acquisition time (median, 31 minutes; range, 25–40 minutes) with good patient compliance. A total of 53 lesions, located in the head and neck area (6 lesions), mediastinum (2 lesions), abdomen and pelvis (13 lesions), lungs (2 lesions), liver (4 lesions), and bones (26 lesions), were evaluated. Fifty-one lesions were detected with PET/MRI and confirmed by PET/CT. Two bone lesions (L4 body, 8 mm, and sacrum, 6 mm) were not detectable on an 18F-FDA scan PET/MRI, likely because 18F-FDA was washed out between PET/CT and PET/MRI acquisitions. Coregistered MRI tended to be superior to coregistered CT for head and neck, abdomen, pelvis, and liver lesions for anatomic allocation and delineation. Conclusions Clinical PGL evaluation with hybrid PET/MRI is feasible with high-quality image and can be obtained in a reasonable time. It could be particularly beneficial for the pediatric population and for precise lesion definition in the head and neck, abdomen, pelvis, and liver.

CORRIGENDA

Context:The role and importance of circulating sclerostin is poorly understood. High bone mass (HBM) caused by activating LRP5 mutations has been reported to be associated with increased plasma sclerostin concentrations; whether the same applies to HBM due to other causes is unknown.Objective:Our objective was to determine circulating sclerostin concentrations in HBM.Design and Participants:In this case-control study, 406 HBM index cases were identified by screening dual-energy x-ray absorptiometry (DXA) databases from 4 United Kingdom centers (n = 219 088), excluding significant osteoarthritis/artifact. Controls comprised unaffected relatives and spouses.Main measures:Plasma sclerostin; lumbar spine L1, total hip, and total body DXA; and radial and tibial peripheral quantitative computed tomography (subgroup only) were evaluated.Results:Sclerostin concentrations were significantly higher in both LRP5 HBM and non-LRP5 HBM cases compared with controls: mean (SD) 130.1 (61.7) and 88.0 (39.3) vs 66.4 (32.3) pmol/L (both P < .001, which persisted after adjustment for a priori confounders). In combined adjusted analyses of cases and controls, sclerostin concentrations were positively related to all bone parameters found to be increased in HBM cases (ie, L1, total hip, and total body DXA bone mineral density and radial/tibial cortical area, cortical bone mineral density, and trabecular density). Although these relationships were broadly equivalent in HBM cases and controls, there was some evidence that associations between sclerostin and trabecular phenotypes were stronger in HBM cases, particularly for radial trabecular density (interaction P < .01).Conclusions:Circulating plasma sclerostin concentrations are increased in both LRP5 and non-LRP5 HBM compared with controls. In addition to the general positive relationship between sclerostin and DXA/peripheral quantitative computed tomography parameters, genetic factors predisposing to HBM may contribute to increased sclerostin levels.

Low back pain tied to spinal endometriosis

Case report. We present a case of endometriosis of lumbar vertebrae. The literatures are reviewed with endometriosis of spine. Endometriosis is a common condition, which is defined as endometrial tissue lying outside the endometrial cavity. It is usually found within the peritoneal cavity, predominantly within the pelvis, commonly on the uterosacral ligaments. It can also be found in other sites such as umbilicus, abdominal scars, nasal passages and pleural cavity. But it is very rarely seen in the spine, with no report of endometriosis found in the lumbar vertebrae. A 33-year-old woman presented with severe low back pain. She had the low back pain periodically for 3 years, and the pain was associated with menstruation. Radiographs showed a lesion in the posterior L3 body. After surgery, tissue biopsy indicated the presence of endometrial tissue in the lesion and thus confirmed endometriosis. Most cases of spine endometriosis that have been reported are usually found inside spinal canal, endorachis or spinal cord. But spinal vertebrae can also be involved in endometriosis. Although endometriosis is a rare possible cause of periodical low back pain in women of childbearing age, we suggest that if a woman suffering from periodical low back pain is encountered, do not ignore the possibility of endometriosis in the spine.

Are Spinal or Paraspinal Anatomic Markers Helpful for Vertebral Numbering and Diagnosing Lumbosacral Transitional Vertebrae?

ObjectiveTo evaluate the value of spinal and paraspinal anatomic markers in both the diagnosis of lumbosacral transitional vertebrae (LSTVs) and identification of vertebral levels on lumbar MRI.Materials and MethodsLumbar MRI from 1049 adult patients were studied. By comparing with the whole-spine localizer, the diagnostic errors in numbering vertebral segments on lumbar MRI were evaluated. The morphology of S1-2 disc, L5 and S1 body, and lumbar spinous processes (SPs) were evaluated by using sagittal MRI. The positions of right renal artery (RRA), superior mesenteric artery, aortic bifurcation (AB) and conus medullaris (CM) were described.ResultsThe diagnostic error for evaluation of vertebral segmentation on lumbar MRI alone was 14.1%. In lumbarization, all patients revealed a well-formed S1-2 disc with squared S1 body. A rhombus-shaped L5 body in sacralization and a rectangular-shaped S1 body in lumbarization were found. The L3 had the longest SP. The most common sites of spinal and paraspinal structures were: RRA at L1 body (53.6%) and L1-2 disc (34.1%), superior mesenteric artery at L1 body (55.1%) and T12-L1 disc (31.6%), and AB at L4 body (71.1%). CM had variable locations, changing from the T12-L1 disc to L2 body. They were located at higher sacralization and lower lumbarization.ConclusionThe spinal morphologic features and locations of the spinal and paraspinal structures on lumbar MRI are not completely reliable for the diagnosis of LSTVs and identification on the vertebral levels.

Level of Bifurcation of Aorta and Iliocaval Confluence and Its Clinical Relevance

Purpose: The best approach to the body of the lumbar vertebrae is from the anterior aspect. The lower lumbar vertebrae are more prone to mechanical and degenerative changes. The disadvantage is that the front of the lower lumbar vertebrae are related intimately to important neurovascular structures like the abdominal aorta, inferior venacava, sympathetic chain etc. There is a need for the preoperative evaluation of the vascular structures related to the lumbar vertebrae. Methods: The abdominal cavity of the cadavers were opened, the intra abdominal structures were retracted to expose the posterior abdominal wall. The structures related to the anterior aspect of the lumbar vertebrae were dissected and cleaned to expose the great vessels, the Abdominal Aorta and the Inferior Vena cava. The sacral promontory was identified and the level of the bifurcation of the AA and IVC formation were identified with respect to the lumbar vertebrae. Variations were also looked for. Results: The bifurcation of Aorta was seen at the body of L4 (55%) and L3 (27.5%). The IVC formation was seen on the body of L5 and L5-S1 spine. The IVC was more prone to variation when compared to AA. The variation observed with IVC was mainly in the form of multiple unnamed tributaries draining into the IVC. The variation observed in the abdominal aorta was high level of bifurcation at L3 body which is unusual. Conclusion: Preoperative evaluation of the vascular anatomy of the lower lumbar vertebra is essential to avoid

Lumbosacral sagittal alignment in association to intervertebral disc diseases.

Study DesignA cross-sectional case-control study was designed to compare the sagittal alignment of lumbosacral regions in two groups of patients suffering from low back pain, one with intervertebral disc pathologies and one without.PurposeTo evaluate the correlation between lumbosacral sagittal alignment and disc degeneration.Overview of LiteratureChanges in lumbar lordosis and pelvic parameters in degenerative disc lesions have been assessed in few studies. Overall, patients with discopathy were shown to have lower lumbar lordosis and more vertical sacral profiles.MethodsFrom patients with intractable low back pain undergoing lumbosacral magnetic resonance imaging, 50 subjects with disc degeneration and 50 controls with normal scans were consecutively enrolled. A method was defined with anterior tangent-lines going through anterior bodies of L1 and S1 to measure global lumbosacral angle, incorporating both lumbar lordosis and sacral slope. Global lumbosacral angle using the proposed method and lumbar lordosis using Cobb's method were measured in both groups.ResultsLumbar lordosis based on Cobb's method was lower in group with discopathy (20°-67°; mean, 40.48°±9.89°) than control group (30°-62°; mean, 44.96°±7.68°), although it was not statistically significant. The proposed global lumbosacral angle in subject group (53°-103°; mean, 76.5°±11.018°) was less than control group (52°-101°; mean, 80.18°±9.95°), with the difference being statistically significant (p=0.002).ConclusionsPatients with intervertebral disc lesions seem to have more straightened lumbosacral profiles, but it has not been proven which comes first: disc degeneration or changes in sagittal alignment. Finding an answer to this dilemma demands more comprehensive long-term prospective studies.

Influence of the two-dimension computer-aided navigation system to the concordance of lumbar spine pedicle screw fixation on both sides

Objective To investigate the influence of the two-dimension computer-aided surgery navigation system to the concordance of lumbar spine pedicle screw fixation on both sides.Methods 1355 patients were undergone lumbar spinal pedicle screw fixation during January 2004 to December 2009.All patients were divided into tow groups:the navigation group (743cases) and the fluoroscopy assistant group (612 cases).All patients got standard A-P and lateral X-ray plate of lumbar spine within seven days after surgery.The X-ray images were analyzed by the software of Image-pro plus 5.0 to evaluate the concordance of lumbar spine pedicle screw fixation on both sides.The angle between axial line of pedicle screw and superior lamina terminals (α angle) and the angle between axial lines of pedicle screw on both sides (γangle) were measured.The position of the pedicle screw was checked weather it was in the lumbar pedicle partially.Results There were no significant differences (P＞0.05) between the α angle on both sides of L1-S5 vertebral body in navigation assistant group (L:3.89°±0.47°,R:3.94°±0.37°).The differences of the α angle on both sides of L2 (L:4.55°±1.27°,R:5.12°±1.87°) and L4 (L:4.22°±1.89°,R:6.62°±1.97°) vertebral body in the fluoroscopy assistant group had statistical significance (P＜0.05).There were no significant differences between the α angle on both sides of other bodies (L:4.32°±1.47°,R:4.37°±1.59°,P＞0.05).The γangle in navigation assistant group (2.32°± 0.27°) was obviously smaller than fluoroscopy assistant group (3.32°±1.51°),the differences had statistical significance (P＜0.05).Accuracy of pedicle screw in navigation assistant group was 91.5％ (3604/3938).Accuracy of pedicle screw in fluoroscopy assistant group was 87.6％ (2426/2768).The difference in accuracy of pedicle screw in both groups had statistical significance (x2=26.913,P＜0.0001).Conclusion The accuracy of pedicle screw and the concordance of pedicle screw on both sides can be significantly improved using the two-dimension perspective computer-aided surgery navigation system. Key words: Lumbar vertebrae; Surgery, computer-assisted; Internal fixators

Dichotomizing Sensory Nerve Fibers Innervating Both the Lumbar Vertebral Body and the Area Surrounding the Iliac Crest

Animal study. To determine the existence of dichotomizing sensory nerve fibers innervating both the lumbar vertebral body and the area surrounding the iliac crest (ASIC). Elderly patients with osteoporosis sometimes experience lumbar vertebral fracture and may feel diffuse nonlocalized pain in the back, the lateral portion of the trunk, and the ASIC. The pattern of sensory innervation of vertebral bodies remains unclear. DRG neurons with dichotomizing axons have been reported and are thought to be related to referred pain. The purpose of this study was to investigate the existence of dichotomizing axons to the lumbar vertebral bodies and the ASIC in rats. Two kinds of neurotracers (1,1´-dioctadecyl-3,3,3´,3´-tetramethylindocarbocyanine perchlorate [DiI] and Fluoro-Gold [FG]) were used. DiI crystals were placed in the left ASIC, and FG was applied into the L2 vertebral body in 10 rats. Four weeks later, left DRGs from L1 to L6 were resected, sectioned, and observed under a fluorescence microscope. DiI-labeled DRG neurons innervating the ASIC and FG-labeled DRG neurons innervating the vertebral L2 body were distributed from L1 to L6. The ratio of total double-labeled per total DiI-labeled DRG neurons was 10.2%, and that of total double-labeled per total FG-labeled DRG neurons was 14.7%. These double-labeled DRG neurons innervating the L2 vertebral body had other axons that extended to the ASIC. This finding provides a possible neuroanatomical explanation for referred pain in the ASIC from vertebral bodies.

Focal 18F-FDG uptake in bone marrow on PET/CT in a patient with JAK2 mutation without overt myeloproliferative neoplasm

A 58-year-old female diagnosed with early stage esophageal carcinoma in our hospital underwent endoscopic resection by endoscopic submucosal dissection (ESD) in April 2013. F-FDG PET/CT performed immediately prior to the ESD showed focal F-FDG accumulations in the vertebral body of Th8, and vertebral body and arch of L4 with SUV max of 3.98–4.42 (Fig. 1a–c). No masses or osteoclastic lesions were observed. MRI findings of the lesions showed low intensity on T1WI and high intensity on STIR image (Fig. 2a–d). To clarify the cause of the FFDG accumulation in the bone, we performed bone biopsy from the vertebral arch of L4. Histopathological findings revealed hypercellular marrow (80 % cellularity) and increases in number and size of megakaryocytes, most of which were in maturated form with hyperlobulated nuclei, which are usually found in cases with myeloproliferative neoplasm (MPN) (Fig. 3a, b). Reticulin fibrosis of marrow was observed minimally by Gitter staining (Fig. 3c), and collagen fibrosis was not observed. In contrast, laboratory workup for peripheral blood showed no abnormality: WBC 6,920/lL (stab 0.0 %, seg 61.0 %, lymph 30.0 %, mono 6.0 %, eosino 1.5 %, and baso 1.5 %), RBC 452 9 10/ lL, Hb 14.1 g/dL, Ht 40.6 %, PLT 33.3 9 10/lL, reticulocytes 1.2 %, LDH 229 U/L, VB12 351 mg/dL, and NAP score 223. Bone marrow biopsy subsequently performed from the left iliac bone showed normocellular marrow, but the number of megakaryocytes was also increased (Fig. 3d). Furthermore, JAK2 V617F mutation was detected in the bone marrow sample by real-time qualitative PCR with a sensitivity of more than 2 % of all alleles. G-banding showed normal diploid karyotype, and BCR–ABL translocation was not detected by FISH analysis. 5 months after the first visit, her laboratory data of peripheral blood was within the normal range, and FFDG PET/CT also showed similar F-FDG accumulation in the bone, without new lesions. We will continue to follow her progress carefully. The JAK2 V617F mutation is present in patients with Philadelphia-negative MPN, including over 90 % of polycythemia vera cases and about half of essential thrombocythemia and primary myelofibrosis cases [1]. The JAK2 V617F mutation may also be detected in healthy individuals without overt MPN [2]. Nielsen et al. [2] reported that the JAK2 V617F mutation was detected in 18 of 10,507 participants (0.2 %) in the general population, and three of these 18 individuals with the JAK2 V617F mutation developed overt myeloproliferative disorder during up to 17.6 years of follow-up. In the present case, focal F-FDG accumulation in bone marrow and histopathological findings, other than the finding of the left iliac bone marrow as positive for JAK2 V617F mutation, suggest that the patient is more likely to develop some form of overt MPN in the A. Fujimi (&) Y. Kanisawa Department of Hematology and Oncology, Oji General Hospital, 3-4-8 Wakakusa-cho, Tomakomai 053-8506, Japan e-mail: Akihito.fujimi@ojihosp.or.jp

Percutaneous treatment of symptomatic aneurysmal bone cyst of L5 by percutaneous injection of osteoconductive material (Cerament)

We present a case report of a 33-year-old woman with back pain for several months which was resistant to medical treatment. Thoracolumbar MRI and multidetector CT showed an aneurysmal bone...

Measurement of transverse and sagittal diameter of the lumbar vertebral canal in people from Western region of Nepal

INTRODUCTION: Size of the canal diameter is one among several factors responsible for lumbar canal stenosis. The study aims to measure the transverse and sagittal diameter of the lumbar vertebral canal in people from Western region of Nepal and compare with the published results. MATERIALS AND METHODS: Fifty young patients (24 males and 26 females) complaining of LBP were done X-ray of lumbar spine in Antero- Posterior (AP)/ Lateral in supine views. From the images, midsagittal (AP) dimensions, transverse (interpedicular) distances and width of vertebral body were measured at each level with the help of electronic calipers. RESULTS: The mean transverse diameter of lumbar canal ranged from 24.8 mm at L1 to 33.25 mm at L5. This gradual increase in the transverse diameter from L1 to L5 was statistically significant. Measurement of lumbar vertebral width ranged from 41.37 mm at L1 and 52.96 mm at L5. There was gradual increase in the size from L1 to L5. But the measurement of AP distance showed a gradual decrease in diameter from L 1 to L 5. The decrease in the AP diameter from L 1 to L2 and Canal body ratio was not constant at all levels. CONCLUSIONS: Our hospital based data showed that the patients from western region of Nepal have smaller canal size. Therefore, the patients from western region of Nepal may be more prone to develop spinal canal stenosis. DOI: http://dx.doi.org/10.3126/ijim.v2i2.8323 Int J Infect Microbiol 2013;2(2):55-58

Digital Three‐Dimensional Model of Lumbar Region 4–5 and its Adjacent Structures Based on a Virtual Chinese Human

To study the methods for constructing a digitized three-dimensional (3D) model of a virtual lumbar region and its adjacent structures in order to assist anatomical study and virtual surgery. Images of DSCF5375-p1 to DSCF5745-p1 were taken from the database of the digitized Virtual Chinese human of Southern Medical University in Guangzhou. This region encompasses the superior facet joint of L4 to the inferior edge of the intervertebral body of L5. The regions of interest were interactively segmented from the images utilizing Adobe Photoshop software. The images were further processed using format conversion and segmentation. Finally, a 3D model of the L4-5 region and its neighboring structures was reconstructed with the assistance of Mimics 10.01 software. A digitized 3D model of this part of the virtual lumbar spine and its adjacent structures was reconstructed. This model allows all constructed structures to be displayed individually or jointly, moved or rotated arbitrarily, setting of different transparencies and convenient measurement of the diameters and angles of the reconstructed structures. The 3D model precisely displays the anatomical relationships between all structures and provides a reliable 3D model for a spinal endoscopic surgery simulation system. Visualization of the digitized 3D reconstruction of the virtual lower lumbar region displays this region and its adjacent structures stereoscopically and in actuality, thus providing morphological data concerning anatomy, image diagnosis and virtual operations in this region.

Development of the Lumbar Lordotic Curvature in Children From Age 2 to 20 Years

Cross-sectional retrospective study. The purpose of this study was to provide data for the normal values of the lumbar lordotic curvature and segmental angles throughout childhood and to explore the relative contribution of the vertebral bodies and intervertebral discs to the developing lordosis during childhood. Although early detection of spinal abnormalities such as hyper lordosis or scoliosis is important for preventative intervention, published data regarding normal lordosis development is sparse. The lumbar lordotic curvature is formed by the wedging of the lumbar vertebral bodies and of the intervertebral discs, but there are no data to indicate how these 2 components changes during childhood development. Spinal angle parameters were measured on midsagittal reformatted images from 210 abdominal computed tomographic scans of children aged 2 to 20 years. Four different angles were measured: the lordosis angle, the body wedge angle (B), the total segmental angle (S), and the intervertebral disc angle (D). Measurements B, S, and D were taken for each of the 5 lumbar segments. Measurements B and D were used to calculate ΣB, the sum of the lumbar L1-L5 body angles; and ΣD, the sum of the lumbar L1-L5 intervertebral disc angles. Computed tomographic scans were divided into 6 groups according to patients' ages. RESULTS.: The lordosis angle increased from 30° ± 6° in the 2- to 4-year-old group to 44° ± 9° in the 17- to 20-year-old group. The ΣB slightly decreased (less lordotic wedging) with age, whereas the ΣD increased significantly with age. Our results indicate that the lordosis angle continues to develop at least until 14 to 16 years of age and that this increase is the result of the increased lordotic wedging of the intervertebral discs. N/A.

A Case of Focal Haematopoietic Hyperplasia of a Vertebral Body and Review of the Modern Literature

We report on a case of focal haematopoietic hyperplasia occurring in the haematopoietic marrow in a lumbar vertebral body, of a young man. The PET scan performed showed high uptake of the radiotracer in the vertebral body of L3 and a MRI of the lumbar spine confirmed the vertebral lesion. A biopsy of the L3 vertebral body lesion was performed and the histological result was of chronic myeloproliferative disease but the analysis performed consequently excluded the diagnosis of chronic myeloproliferative disorder, according to the WHO criteria. Focal benign hyperplasia is regarded a late reactive process after trauma, as well as the case reported

The Development of Vertebral Deformities in a Preschool Child with Dysplastic Spondylolisthesis: A 16-Year Follow-Up

Study design: A case report describing the development of vertebral deformities associated with dysplastic spondylolisthesis that was managed conservatively until skeletal maturity was achieved. Objective: To describe development of wedging and rounding vertebral deformities. Summary of Background Data: There are no reports of preschool children with dysplastic spondylolisthesis that were managed conservatively until skeletal maturity. Methods: A 5-year-old girl presented with a postural deformity associated with congenital scoliosis and dysplastic spondylolisthesis. Surgery was performed for scoliosis at the age of 13 years, but spondylolisthesis was managed conservatively up to skeletal maturity. Results: The wedging of the L5 body and the rounding of the sacrum progressed during her growth period, and no progression was observed thereafter. The slippage progressed gradually during and after her growth period, and posterior lumbar interbody fusion was performed at the age of 21 years. Conclusion: We speculate that the slippage associated with dysplastic spondylolisthesis occurs at the growth plate, and vertebral deformities are the results rather than the causative factors of the slippage as observed in the case of slippage associated with isthmic spondylolisthesis.

Analysis of dispersion of lumbar interlaminar epidural injectates

Analysis of dispersion of lumbar interlaminar epidural injectates

Estudo epidemiológico das fraturas de coluna em centro de referência para patologia espinhal no Paraná

Resumo Objetivo: Realizar um estudo epidemiológico das fraturas de coluna ocorridas no período de março de 2007 até dezembro de 2011 em um centro de referência para patologia espinhal. Métodos: Análise retrospectiva dos prontuários de pacientes submetidos a tratamento neurocirúrgico para artrodese da coluna vertebral por causa de patologia traumática, realizada de março de 2007 até dezembro de 2011. Os dados foram compilados a partir do setor de arquivo médico do Hospital Universitário Evangélico de Curitiba (HUEC). Os elementos encontrados foram analisados observando-se as variáveis idades, sexo, o nível e a vértebra mais acometida. Resultados: Dos 104 pacientes submetidos a tratamento neurocirúrgico visando à artrodese por causa de fratura de coluna, houve uma predominância considerável do sexo masculino, com 73,07% (76). A média de idade na data do procedimento cirúrgico foi de 38,08 anos. A idade mínima registrada foi de12 anos e a máxima, de 73 anos. Houve predomínio das fraturas em coluna lombar de 59,61% (62) dos casos. O corpo de L1 foi mais acometido (30,76%). Conclusão: Há escassez de trabalhos epidemiológicos no que se refere à patologia traumática da coluna vertebral. A falta de dados em nosso país dificulta a elaboração de medidas preventivas que respeitem as características regionais, vislumbrando um melhor manejo dessa patologia que atinge, em sua maior parte, a população economicamente ativa, gerando prejuízos crescentes ao sistema de saúde.

Spontaneous fusion of L5 spondyloptosis: should we learn from nature?

A 36-year-old man with spondylolisthesis diagnosed at age 9 presented as an outpatient complaining of episodic low back pain. There were no neurologic signs or symptoms. Plain radiographs demonstrated L5 spondyloptosis, with a large fragment of the body of L5 apparently fused to the anterosuperior aspect of the sacrum (Fig. 1, arrows). This was confirmed on computed tomography (Fig. 2, arrows). Magnetic resonance imaging revealed spinal stenosis (Fig. 3). Physical therapy was prescribed, and the patient has kept up his active lifestyle that includes working as a plumber and participating in motocross.

Pathology of bone tumours

Answer 1 The lesion is composed of medium-to-large, adipocyte-like scan of the lumbar spine demonstrated a lesion in the superior aspect of the vertebral body of L4. The imaging appearances were non-specific and, therefore, a CT-guided biopsy was performed (Figure 1). (a) What is your differential diagnosis? (b) Which immunohistochemical stains would help to arrive at the diagnosis? (c) Why is radiological correlation essential? (d) How should the patient be treated/followed-up?

CT volumetry of lumbar vertebral bodies in patients with hypoplasia L5 and bilateral spondylolysis and in normal controls

To examine the feasibility and results of calculating the volume of lumbar vertebral bodies in normal patients and patients with suspected hypoplasia of L5. Lumbar multi-detector CT was performed in 38 patients with bilateral spondylolysis and hypoplasia of L5 and in 38 normal patients. Lumbar vertebral body volume of L3, L4 and L5 was measured by CT volumetry with a semi-automated program, created with MeVisLab. In the control group, the average vertebral body volume (in cubic centimeters) of L3 was 35.93 (±7.33), 36.34 (±7.13) for L4 and 34.63 (±6.88) for L5. In patients with suspected hypoplasia L5 the average body volume (in cubic centimeters) of L3 was 36.85 (±7.37), 36.90 (±6.99) for L4 and 33.14 (±6.57) for L5. The difference in mean vertebral body volume for L3, L4 and L5 between both groups was statistically not significant. However, there was a statistically significant difference of the ratio L5/L4 (P < 0.001) between both groups: the mean ratio L5/L4 in the control group was 95.3 ± 3.9%, the ratio for the hypoplastic L5 group was 89.9 ± 6.3%. There was no significant difference in the vertebral body volume for L3, L4 and L5 between both groups due to inter-patient variability. However, the relation between the body volume of L5 and L4 is significantly different between both groups. The volume of the vertebral body of L5 proved to be on average 10.2% smaller than the volume of L4 in the group with hypoplasia L5 versus 4.7% in the control group.