Lumbosacral Magnetic Resonance Imaging Research Articles

Correlation Between Common Carotid Artery Intima-Media Thickness and Lumbosacral Intervertebral Disc Degeneration

Background: Lumbosacral intervertebral disc degeneration (IDD) is a common cause of low back pain and has recently been attributed to ischemic causes. Magnetic resonance imaging (MRI) can accurately assess the presence and degree of IDD, while the common carotid artery (CCA) intima-media thickness (IMT) measured on ultrasound (US) has been accepted as a reliable imaging marker for the presence of atherosclerosis. Aim of the Study: To assess the association between CCA-IMT with the presence and grade of lumbosacral IVD as evident on MRI in patients with LBP. Patient and Methods: This cross-sectional study was done on 200 patients with LBP (115 females and 85 males) referred for lumbosacral spinal MRI at the MRI unit in AL-Sader Medical City for eight months duration. MRI examination involved L1/L2 ,L2/L3,L3/4 ,L4/L5 \& L5/S1 intervertebral discs levels. Patients with a history of lumbosacral surgery, trauma, or tumor were excluded. CCA-IMT was measured using a B-mode US scan, while the degree of IDD was assessed on MRI using I-V Pfirrmann's grading system. Results: Older age, male gender, higher body mass index, presence of cardiovascular comorbidities, and specific occupations were associated with a higher grade of IDD. However, the mean CCA-IMT was independently associated with the advancing grade of IDD at all levels with a statistically significant difference (P<0.001). A significantly larger mean CCA-IMT was found in relation to grade V (0.946 ±0.28), and the lowest mean was found in those with grade I (0.468 ±0.1). The grading of IDD was fair in the prediction of thicker CCA-IMT. Conclusion: IDD was directly correlated with CCA-IMT, and patients with higher grades of IDC tend to have thicker mean CCA-IMT. IDD may be a manifestation or predictor of atherosclerosis. However, future long-term cohort studies to assess causal association are recommended.

MRI imaging pattern of metastasis and tuberculous spondylitis in the spine: serial case report

Background: Tuberculous spondylitis and spinal metastasis manifestations have a similar clinical manifestation. Spinal metastasis prevalence is high in malignant process while tuberculosis is frequent in endemic areas. Back pain, paresthesia, and paralysis are commonly caused by vertebral fractures, soft tissue mass, and spinal canal involvement. The magnetic resonance imaging (MRI) is a useful modality in the pattern differentiation of these diseases. This case series aimed to provide a differentiation between those two diseases using MRI. Case report: In the first case, we presented a 24-year-old female complained of hip pain without history of tuberculosis infection or malignancy. Whole spine MRI showed kyphotic deformity, compression of T9 vertebral body, erosion of anterior aspect T8 and T10 vertebral body, and subligamentous abscess at T7-T12 vertebrae level. Tuberculous infection was proven. The second case was a 39-year-old female complained of leg weakness without complaint of cough or breathing difficulty. Whole spine MRI showed kyphotic thoracic vertebrae, compression T10 vertebral body, destruction of inferior endplate T9 vertebrae, bone marrow changes on thoracic vertebral body, and paravertebral soft tissue mass on anterior T6 to T11 vertebral body. Tuberculosis etiology was proven. The third case was a 51-year-old female that came to the hospital due to waist pain with no history of tuberculosis infection or malignancy. Whole spine MRI revealed T8 and T9 vertebral body compression and bone marrow replacement on cervical, thoracic, and lumbar vertebrae, spinous process of thoracic and lumbar, bilateral posterior rib T4-T5, and soft tissue mass at the posterior T9 vertebrae. In the last case, we presented a 58-year-old male that complianed pain in the back and both legs. Lumbosacral MRI showed compression fracture with signal intensity change on L3 vertebral body, bone marrow replacement on thoracic, lumbar, and sacral vertebrae, expanding to epidural and cause spinal canal stenosis. CT-scan thorax showed lung malignancy proven to be non-small cell lung carcinoma. A spinal biopsy revealed malignant infiltration. Conclusion: Tuberculous spondylitis and metastasis differentiation can be a challenge. Early complaints mostly are back pain, paresthesia, and paralysis. Spine MRI can differentiate the pattern of both diseases and identify the possible etiology.

Pre-operative magnetic resonance imaging as a predictor of success in lumbar disc herniation patients undergoing laminectomy

Introduction. Lumbar disc herniation is a condition in which annulus fibrosus in the lumbar area is herniated with numerous etiologies, such as degenerative. One of the mainstay treatment for lumbar disc herniation is decompressive laminectomy. Magnetic Resonance Imaging (MRI) with the diagnostic accuracy of 97% also has an excellent resolution for soft tissue. The aim of this study is whether pre-operative MRI may be a predictor of successful clinical outcome in lumbar disc herniation patients undergoing laminectomy surgery. Methods. In this cross-sectional study, we consecutively collected all patients in Radiology Department “Prof. Dr. IGNG Ngoerah” Hospital, Denpasar Bali between January 2021 to December 2022. We enrolled patients with older than 18 years old who had undergone pre-operative lumbosacral MRI and had laminectomy surgery within the sampling time period. The following variables were recorded from each patient: age, gender, Body mass index (BMI), history of diabetes mellitus, hypertension, number of herniated discs, herniation grade, spinal canal stenosis grade, neural foramen stenosis grade, lateral recess stenosis grade, annular tear, disc degeneration, facet disc degeneration, thickening of ligamentum flavum, modic changes, cerebrospinal liquor obstruction, and clinical outcome. Outcomes. We collected 30 patients who underwent laminectomy surgery and had their pre-operative MRI. Patients’ mean age ± SD was 57.7±10.9 years old with 20 male (66.7%) and 10 female (33.3%). There was no significant association between gender, hypertension, diabetes mellitus, body mass index, number of disc herniation, spinal canal stenosis, lateral recess stenosis, neural foramen stenosis, disc degeneration, facet joint degeneration, ligamentum flavum hypertrophy, Modic changes and cerebrospinal liquor obstruction with clinical outcome post laminectomy patients. Conclusion. Pre-operative MRI can reliably diagnose lumbar disc herniation but are not a predictive tool in assessing the clinical outcome of post-laminectomy patients. Laminectomy has an excellent management value for lumbar disc herniation patients especially in reducing the pain, and for them to have better quality of life.

Lumbar spine epidural abscess and facet joint septic arthritis in a pediatric patient.

A 13-year-old girl presented with lower back pain that began 7 days earlier after a volleyball workout. She had no history of trauma or fever. On physical examination, a contraction of the left paravertebral muscles associated with pain on flexion-extension of the spine and a positive left Lasègue's sign were evident. She had no neurological deficits in the lower limbs. Chest and lumbosacral X-rays were unremarkable, and a laboratory investigation revealed neutrophilia and elevated C-reactive protein (75.7 mg/L; normal value < 5). Urine and blood cultures were carried out before starting ceftriaxone. She developed a fever (38.8 °C) 1 day after admission, and the blood culture was positive for methicillin-sensitive Staphylococcus aureus. A lumbosacral magnetic resonance imaging (MRI) scan was performed considering the clinical and microbiological evidence and suspecting an osteoarticular infection. The MRI revealed a small amount of interarticular fluid in the left L4-L5 hemivertebral region and a posterior spinal epidural abscess on the left side extending from L4 to L5-S1 (Fig. 1). The diagnosis was lumbar spine epidural abscess (SEA) and facet joint septic arthritis (SAFJ). As the girl did not present with neurological symptoms, no surgical treatment was indicated, and cefazolin was administered intravenously with rapid resolution of the fever and pain. She was discharged after 4 weeks of intravenous antimicrobial therapy, which was followed by 4 more weeks of oral antibiotic therapy with levofloxacin. The 3-month follow-up MRI showed complete regression of the epidural fluid and almost complete normalization of the signal abnormalities in the L4-L5 soft tissues (Fig. S1). Facet joint septic arthritis is a rare condition.1Mas-Atance J. Gil-García M.I. Jover-Sáenz A. Curià-Jové E. Jové-Talavera R. Charlez-Marco A. et al.Septi carthritis of a posteriorlumbarfacet joint in an infant: a case report.Spine (Phila Pa 1976). 2009; 34: E465-E468Crossref PubMed Scopus (10) Google Scholar Few pediatric cases have been described, mainly in immunosuppressed patients. The most commonly associated pathogen is S. aureus.2Cabet S. Perge K. Ouziel A. Vandergugten S. Guibaud L. Ferry T. et al.Septic arthritis of facet joint in children: a systematic review and a 10-year consecutive case series.Pediatr Infect Dis J. 2021; 40: 411-417Crossref PubMed Scopus (0) Google Scholar The mechanism of the spread of this infection is not understood, but contamination may originate from direct inoculation, contiguity, or hematogenous dissemination. In the present case, the patient had no history of lumbar or epidural injections, so the most likely origin was hematogenous dissemination. The coexistence of localized epidural, articular, and paravertebral abnormalities on an MRI examination acquired only a few days after symptom onset led us to speculate that the infection originated in the left L4-L5 zygoapophyseal joint and spread to contiguous tissues, both inside and outside the lumbar canal. The three most common presenting symptoms of spinal epidural abscess are back pain, fever, and neurological deficit; however, these symptoms do not always occur together, contributing to the delayed diagnosis, which is reported in 50%–75% of cases.3Reihsaus E. Waldbaur H. Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients.Neurosurg Rev. 2000; 23: 175-204Crossref PubMed Google Scholar Surgery is reserved for nonantibiotic responders or in cases of neurologic deficit. Lumbar SEA and SAFJ are clinical emergencies with significant morbidity and mortality, particularly when there is a delayed diagnosis. Therefore, early clinical suspicion, diagnosis, and treatment are essential to obtain a favorable outcome.4Davis D.P. Wold R.M. Patel R.J. Tran A.J. Tokhi R.N. Chan T.C. et al.The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.J Emerg Med. 2004; 26: 285-291Abstract Full Text Full Text PDF PubMed Scopus (220) Google Scholar The authors declares that there is no conflict of interest regarding the publication of this paper. The following is the supplementary data to this article: Download .docx (2.14 MB) Help with docx files Multimedia component 1

Assessment of Bone Mineral Density from Lumbosacral MRI: A Retrospective Study with Texture Analysis Radiomics

Osteoporosis is a common condition characterized by low bone mineral density (BMD) and deterioration of bone microarchitecture, leading to increased risk of fractures. Early diagnosis and treatment of osteoporosis are critical for preventing fractures and their associated morbidity and mortality. Currently, dual-energy X-ray absorptiometry (DXA) is the gold standard for assessing BMD; however, it has limitations such as radiation exposure, cost, and limited availability in certain regions. Magnetic resonance imaging (MRI) of the lumbar spine is routinely performed for various indications, and it provides high-resolution images of the bone and tissue without ionizing radiation. Recently, texture analysis (TA) of MRI images has shown promise in assessing BMD by quantifying the spatial distribution and heterogeneity of bone marrow fat and trabecular bone. In this article, we present our experience with the opportunistic use of lumbar spine MRI for BMD assessment using TA, and we compare the results with DXA measurements. We also discuss the potential clinical implications of this approach, including its use in patients who cannot undergo DXA or in whom BMD assessment is not routinely performed. MRI should provide information in a single examination in regard to degenerative disk pathology and arthritis, with the addition of BMD prediction.

The Role of Magnetic Resonance Imaging in the Diagnosis of Spinal Dumbell Neurofibromatosis: A Case Report from a Specialist Hospital in Port Harcourt

Neurofibromatosis occurring in the spine also known as spinal neurofibromatosis (SNF) is a rare disease entity and they occur either unilaterally or bilaterally at the spinal roots. The low prevalence rate of the disease and scarcity of previous literatures is the main aim for this report.&#x0D; Our case study is a 29-years-old lady who presented to the Radiology department for a lumbosacral spine MRI, on account of both lower limb weakness, paresthesia, unsteady gait and finally inability to walk. The symptoms have been there since she was 14 years (15 years of progressive symptoms). She also presented with multiple macules on the skin (café au lait spots). Magnetic Resonance Imaging (MRI) of the lumbosacral spine revealed bilateral spinal neurofibromas at the spinal roots of the fourth lumbar vertebra to the sacral/coccygeal vertebrae with destruction of the sacro-coccygeal bones. MRI of the brain revealed no abnormalities in the brain and optic tract. The patient fulfilled the National Institutes of Health (NIH) criteria and that of revised diagnostic criteria for Neurofibromatosis (NF1).&#x0D; The patient also presented with lack of pain which could be due to impairment in sensory neurons. We describe a case of spinal neurofibromatosis diagnosed by MRI in a young lady with progressive lower limb weakness, paresthesia, sensory loss, café-au- lait spots and paraplegia.

Lumbar endoscopic spine surgery for persistent genital arousal disorder/genitopelvic dysesthesia resulting from lumbosacral annular tear-induced sacral radiculopathy.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by distressing, abnormal genitopelvic sensations, especially unwanted arousal. In a subgroup of patients with PGAD/GPD, cauda equina Tarlov cyst-induced sacral radiculopathy has been reported to trigger the disorder. In our evaluation of lumbosacral magnetic resonance images in patients with PGAD/GPD and suspected sacral radiculopathy, some had no Tarlov cysts but showed lumbosacral disc annular tear pathology. The aims were 2-fold: (1) to utilize a novel multidisciplinary step-care management algorithm designed to identify a subgroup of patients with PGAD/GPD and lumbosacral annular tear-induced sacral radiculopathy who could benefit from lumbar endoscopic spine surgery (LESS) and (2) to evaluate long-term safety and efficacy of LESS. Clinical data were collected on patients with PGAD/GPD who underwent LESS between 2016 and 2020 with at least 1-year follow-up. LESS was indicated because all had lumbosacral annular tear-induced sacral radiculopathy confirmed by our multidisciplinary management algorithm that included the following: step A, a detailed psychosocial and medical history; step B, noninvasive assessments for sacral radiculopathy; step C, targeted diagnostic transforaminal epidural spinal injections resulting in a temporary, clinically significant reduction of PGAD/GPD symptoms; and step D, surgical intervention with LESS and postoperative follow-up. Treatment outcome was based on the validated Patient Global Impression of Improvement, measured at postoperative intervals. Our cohort included 15 cisgendered women and 5 cisgendered men (mean ± SD age, 40.3 ± 16.8 years) with PGAD/GPD who fulfilled the criteria of lumbosacral annular tear-induced sacral radiculopathy based on our multidisciplinary management algorithm. Patients were followed for an average of 20months (range, 12-37) post-LESS. Lumbosacral annular tear pathology was identified at multiple levels, the most common being L4-L5 and L5-S1. Twenty-two LESS procedures were performed in 20 patients. Overall, 80% (16/20) reported improvement on the Patient Global Impression of Improvement; 65% (13/20) reported improvement as much better or very much better. All patients were discharged the same day. There were no surgical complications. Among the many recognized triggers for PGAD/GPD, this subgroup exhibited lumbosacral annular tear-induced sacral radiculopathy and experienced long-term alleviation of symptoms by LESS. Strengths include long-term post-surgical follow-up and demonstration that LESS effectively treats patients with PGAD/GPD who have lumbosacral annular tear-induced sacral radiculopathy, as established by a multidisciplinary step-care management algorithm. Limitations include the small study cohort and the unavailability of a clinical measure specific for PGAD/GPD. LESS is safe and effective in treating patients with PGAD/GPD who are diagnosed with lumbosacral annular tear-induced sacral radiculopathy.

Positive sharp waves and fibrillation potentials in polio survivors with sequelae: Are they due to late deterioration or radiculopathy?

Background &amp; Objective: Needle electromyography (EMG) abnormalities can be observed in clinically affected or unaffected muscles in polio survivors. The primary aim of this study is to evaluate the positive sharp waves (PSWs) and fibrillation potentials (FPs) that can be observed in polio survivors. In addition, the presence of post-polio syndrome and radiculopathy was investigated in patients with PSWs/FPs. Methods: Clinical features and needle EMG findings of polio survivors with sequelae who applied to our neurophysiology laboratory between August 2018 and January 2021 were analyzed retrospectively. Cervical and lumbosacral magnetic resonance imaging (MRI) of polio survivors with PSWs/FPs were included in the analyses. In addition, polio survivors were divided into groups with and without post-polio syndrome. Results: Fifty-one polio survivors (33 male, 18 female) were included in the study. The mean age of the patients was 49.5±7.5 years. There were 13 (25.5%) polio survivors with post-polio syndrome. Needle EMG findings of 590 muscles were analyzed. PSWs/ FPs were found in 11 medial gastrocnemius, four iliopsoas, four tibialis anterior, two vastus lateralis muscles, and one deltoid muscle. PSWs or FPs were present in 12 (23.5%) of patients. PSWs/FPs were present in three (23.1%) and nine (23.7%) polio survivors with and without post-polio syndrome, respectively (p&gt;0.05). Of the 12 patients with PSWs/FPs, 11 had cervical and lumbosacral MRIs. In eight (72.7%) of these 11 patients with PSWs/FPs, the nerve segment of the muscle with PSWs/FPs and the segment of radiculopathy detected by MRI were compatible with each other. Conclusions: This study indicated that PSWs/FPs may be present in polio survivors. PSWs/FPs may be due to radiculopathy and/or late deterioration. It was concluded that PSWs/FPs are not a parameter that can be used to differentiate polio survivors with and without post-polio syndrome.

Neurolymphomatosis with Spinal Nerve Root Involvement Demonstrated on 18F-FDG PET/CT.

A 56 years old woman with a diagnosis of diffuse large B-cell lymphoma had dyspnea, weakness in the left upper extremity and vocal cord paralysis after chemotherapy. She underwent cervical, thoracal and lumbosacral magnetic resonance imaging (MRI) however findings on MRI could not entirely explain the symptoms of the patient. Therefore, the patient underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography and the scan revealed focal symmetrical 18F-FDG uptake on the cervical, thoracal and lumbal spinal nerve roots. Considering the symptoms of the patient and cerebrospinal fluid cytology findings, hypermetabolic spinal nerve roots were interpreted as lymphoma involvement.

EVALUATION OF COCCYX MORPHOLOGY WITH MAGNETIC RESONANCE IMAGING IN CHILDHOOD AGE

AMAÇ: Koksiks, vertebral kolonun distalinde yer alan, sakrum alt ucu ile eklem yapan ve sıklıkla 3 veya 4 vertebral segmentten oluşan üçgen şeklinde bir kemiktir. Bu çalışmanın amacı çocukluk çağı yaş grubunda koksiks morfolojisinin ve morfometrisinin manyetik rezonans görüntüleme (MRG) ile değerlendirilmesidir.GEREÇ VE YÖNTEM: Bu retrospektif çalışmada, Ocak 2020- Ocak 2021 tarihleri arasında hastanemizde lumbosakral veya pelvik MRG ile tetkik edilmiş olan çocuk hastalar çalışmaya dahil edildi. Sakral ve koksigeal vertebraların en iyi şekilde görüntülendiği mid-sagittal, T1 ağırlıklı MRG kesitlerinde vertebraların dizilimleri, listezis varlığı/yokluğu ve koksiks vertebra sayısı kaydedildi. Ayrıca aynı kesitte morfometrik değerlendirmede doğrusal koksiks uzunluğu, sakrokoksigeal açı, sakrokoksigeal eklem açısı ve interkoksigeal açı ölçüldü.BULGULAR: Toplam 47 hasta (36 kız, 11 erkek) çalışmaya dahil edildi. Hastaların yaş ortalaması 13.7±2.1 idi. Kız ve erkek hasta-lar arasında ve farklı yaş grupları arasında (grup 1: 7-10 yaş, grup 2: 11-13 yaş, grup 3: 14-16 yaş); koksiks uzunluğu, sakrokoksi-geal açı, sakrokoksigeal eklem açısı, interkoksigeal açı arasında anlamlı fark saptanmadı (sırasıyla; p= 0,728, p=0,262, p=0,105 ve p=0.191, p= 0.684, p=0.927).SONUÇ: Bu çalışmaya göre çocukluk çağı yaş grubunda sakrokoksigeal açı, sakrokoksigeal eklem açısı ve interkoksigeal açılar değerlendirildiğinde kız ve erkek hastalar arasında ve farklı yaş grupları arasında farklılık saptanmamıştır. Çocukluk çağı yaş grubunda koksikse ait morfolojik özelliklerin bilinmesi, hastalıkların değerlendirilmesinde kolaylık sağlayacaktır.

Frequency of Positive Lumbosacral MRI Results in Patients Ton-traumatic low Back Pain Based on the Specialty of the Referring Physician

Background and Objectives This study aims to assess the frequency of positive lumbosacral magnetic resonance imaging (MRI) results in patients with non-traumatic low back pain (LBP) based on the specialty of the referring physician. Subjects and Methods In this retrospective study, 335 patients with non-traumatic LBP aged &gt;18 years participated. Their demographic information and MRI findings and the specialty of the referring physician were extracted and recorded from the imaging information system of a hospital. Frequency of positive lumbosacral MRI results based on the specialty of the referring physician were compared. To avoid bias, the MRIs with a same imaging protocol were selected, and reporting was done by a same radiologist. Results Of 335 patients, 145(43.3%) were male and 190(57.6%) were female. Among the referring physicians, 139(41.5%) were neurosurgeon, 114(34%) were orthopedists, 61(18.2%) were neurologists, and 21(6.3%) were physical medicine specialist. There was no significant difference in positive MRI results between different specialties of the referring physicians (P&gt;0.05). Conclusion There is no difference in the frequency of positive lumbosacral MRI results in patients with non-traumatic LBP treated by orthopedics, neurologists, neurosurgeons, and physical medicine specialists.

Magnetic Resonance Image Findings in Radicular Low Back Pain

Introduction: Low back pain (LBP) is the most common symptom associated with degenerative disc disease. Common causes of radicular low back pain are narrowing of the space where nerve roots exit the spine, which can be result of stenosis or disc herniation. Magnetic Resonance Imaging (MRI) is the key investigation for diagnosis of radicular LBP. Objective: To find the association between radicular low back pain and MRI findings of degenerative disc disease. Materials &amp; Methods: This cross-sectional study was conducted in the Combined Military Hospital (CMH), Dhaka, from January to June 2018. A total of 128 patients with LBP with or without radiculopathy were included in the study. Lumbosacral MRI was carried out in all patients. Results: One third (34.4%) of the patients had LBP with radiculopathy. A substantial proportion (68%) of patients had history of trauma to back-bone. Majority (97.7%) of the patients had disc degeneration. Approximately 72% had nerve-root compression and over three-quarters (76.6%) had spinal canal stenosis. Radiculopathy was significantly associated with past history of trauma to the back-bone (p &lt; 0.01) and history of loadbearing (p &lt; 0.001). Signs of degenerative disease were evident as Modic changes in 80.5%, disc displacement in 100% and disc herniation in 75%. All degenerative lesions were predominantly found at L4/L5. Highly significant (p &lt;0.001) association of radiculopathy with Modic changes, disc herniation, nerve root compression and spinal canal stenosis was found. Conclusion: Signs of degenerative disc disease are significantly associated with radicular low back pain. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 47-51

Three-Dimensional Isotropic Versus Conventional Multisequence 2-Dimensional Magnetic Resonance Imaging of Sacroiliac Joints in Suspected Axial Spondyloarthritis.

The aims of the study were to systematically evaluate the sacroiliac joints of a consecutive series of patients with clinically suspected axial spondyloarthritis and to compare the diagnostic efficacy of 3-dimensional (3D) imaging versus conventional multisequence 2D techniques for sacroiliitis. In this cross-sectional multireader validation study, imaging studies of 104 consecutive patients with clinically suspected axial spondyloarthritis obtained with a rheumatology lumbosacral magnetic resonance imaging protocol were evaluated. Three-dimensional coronal oblique reconstructions parallel to the long axis of the sacrum were created. Two blinded readers evaluated 2D and 3D images separately for each study, and findings were compared with the reference standard for the final diagnosis and disease activity. Cohen κ and diagnostic performance measures on 2D and 3D imaging were evaluated and compared. With 2D versus 3D imaging, respectively, the sensitivity for detecting inflammatory cases was 57% versus 62% ( P = 0.1007), the sensitivity for detecting mechanical cases was 89% versus 76% ( P = 0.0312), the sensitivity for detecting active sacroiliitis was 49% versus 64% ( P = 0.0014), and the specificity for detecting active sacroiliitis was 87% versus 76% ( P = 0.0016). Interreader agreement of 2D imaging showed an overall range of κ = 0.27-0.85, and it was best for evaluation of bony ankylosis (κ = 0.85). Interreader agreement of 3D imaging was in an overall range of κ = 0.15-0.64. Single 3D isotropic magnetic resonance imaging provided adequate assessment of sacroiliac joints in this study and demonstrated significantly higher sensitivity and lower specificity for detecting active sacroiliitis. The initial results indicate that 3D imaging could be used for future works for screening sacroiliitis and abdominopelvic enthesopathy.

Multiparametric Large Field of View Rheumatology Imaging for Axial Spondyloarthropathy Detects Enthesitis in Setting of Inactive Sacroiliac Joint Disease and Impacts Clinical Diagnosis.

To test the diagnostic efficacy of a multiparametric rheumatology lumbosacral magnetic resonance (MR) imaging protocol in detection and characterization of axial spondylarthritis (SpA) and compare it with serology and clinical findings. A consecutive series of multiparametric rheumatology lumbosacral MR imaging examinations performed on 3T MR scanner. Three-dimensional inversion recovery turbo spin echo, precontrast and postcontrast fat-suppressed T1-weighted images, as well as diffusion-weighted images were used to detect active erosions and enthesitis using established criteria. Pearson χ2 was used for categorical variables. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were measured for magnetic resonance imaging (MRI) and serology, based on the final diagnosis from rheumatologists. An alpha error below 0.05 was considered statistically significant. The final study sample included 130 consecutive patients (80 women and 50 men; mean ± SD 44 ± 13 and 45 ± 14 years, respectively). Seventy-eight subjects were diagnosed with axial SpA and 52 with non-SpA arthropathy. In the non-SpA group, 27 patients were diagnosed with osteoarthritis, 6 had unremarkable imaging, whereas 19 were considered as clinically undetermined. There was positive correlation between positive MRI results and SpA diagnosis (P < 0.00001). No correlation existed between positive serology alone and SpA diagnosis (P = 0.0634). Although MRI and serology proved equally sensitive in detecting SpA, the specificity and overall accuracy of MRI were significantly higher. Inflammatory activity was detected in 45 (57.7%) cases, in the pelvic enthesis in 29 (37.2%) cases, in the lumbosacral spine in 16 (20.5%) cases, in the hip joints in 15 (19.2%) cases, and in the pubic symphysis in 5 (6.4%). Inactive sacral disease was seen in 7 of 35 enthesitis patients (20.0%), and in 2 SpA cases, there were no sacral lesions. The results suggest that in patients with suspected SpA, MRI should not be limited to the sacroiliac joints, but also include enthesitis sites and other joints of the axial skeleton. The multiparametric rheumatology protocol increases the efficacy of MRI in detecting enthesitis and joint inflammatory disease, thereby offering additional information to the clinician and assisting in the early diagnosis/detecting disease activity.

Clinical signs, diagnostic imaging and histopathology in a dog with granulomatous meningoencephalitis manifested as a polyneuropathy

AbstractAn 11‐year‐old, female, neutered Labrador retriever with a history of chronic and progressive right hindlimb lameness and facial asymmetry was referred for brain and lumbosacral magnetic resonance imaging and cerebrospinal fluid analysis. Multifocal non‐enhancing T2‐weighted images of hyperintense lesions were observed in the caudate nuclei and medulla oblongata. The right oculomotor nerve was markedly enlarged and showed marked enhancement on T1‐weighted images after contrast injection, and there was diffuse enlargement of the sciatic and femoral nerves in the right hindlimb. Cerebrospinal fluid analysis showed a mixed pleocytosis. Histopathology revealed granulomatous inflammation affecting the brain, oculomotor and pelvic limb nerves, consistent with a diagnosis of granulomatous meningoencephalomyelitis.

How Prone Position Affects the Anatomy of Lumbar Nerve Roots and Psoas Morphology for Prone Transpsoas Lumbar Interbody Fusion

Lumbar nerve root injury is a serious complication of transpsoas lumbar interbody fusion. Researchers have reported lumbar nerve roots and psoas muscle anatomy in the supine position, but no previous studies have used prone position magnetic resonance imaging to evaluate these structures. The purpose of this study was to show the changes in the lumbar nerve roots and psoas muscle related to the lumbar intervertebral disc using supine and prone magnetic resonance imaging. Thirty volunteers without spinal or hip abnormalities were included in this observational study. Each volunteer underwent supine and prone lumbosacral magnetic resonance imaging without abdominal compression. The lumbar nerve roots, psoas muscle, aorta, superior vena cava, common iliac artery, and vein were identified at each lumbar disc level. The lumbar plexus position relative to the transpsoas working channel, psoas muscle morphology, and great vessels relative to the anterior and posterior aspects of the annulus fibrosus in the axial plane were measured by 1 observer, and intraobserver reliability was calculated. Fifteen men and 15 women were included in this study. There were no significant differences in the axial image distance of the lumbar nerve roots, psoas/disc ratio, and location of other related anatomy between the supine and prone positions. More lordosis (both upper and lower arc lordosis) was noted in the prone position (51.98° ± 10.54°) than in the supine position (42.12°± 10.13°). Lumbar nerve roots, psoas morphology, and great vessel position were not affected by the prone position compared with the supine position.

Underreporting of spinal epidural lipomatosis: A retrospective analysis of lumbosacral MRI examinations from different radiological settings

PurposeThe purpose of this study was to assess the rate with which radiologists reported spinal epidural lipomatosis (SEL) when interpreting lumbosacral magnetic resonance imaging (MRI) examination. Materials and methodsA total of 450 lumbosacral MRI examinations obtained in 450 patients were included (199 men, 251 women; mean age, 56.7 ± 13.5 [SD] years; age range: 18–91 years). Three senior radiologists assessed and classified independently SEL on MRI according to the Borré grading system (Grade 1 to Grade 3). Depiction of SEL on MRI reports (i. e., reporting rate) and association with patients’ symptoms were verified. ResultsSEL was found in 75/450 patients (prevalence = 16.7%), and classified as grade-1 (mild) in 49/75 (65.3%) patients, grade-2 (moderate) in 24/75 (32%), and grade-3 (severe) in 2/75 (2.7%). SEL was diagnosed on MRI report in 6/75 (8%) patients. SEL prevalence based on MRI reports was 1.3% (6/450), significantly lower than its actual prevalence based on MRI examinations (P < 0.0001). The reporting rate was 0% in grade-1 (0/19), 10.2% in grade-2 (5/49) and 50.0% in grade-3 (1/2), and variable on the radiologist subspecialty (10.0% among musculoskeletal radiologists, 11.1% among neuroradiologists, and 3.7% among generalists). SEL was considered as the only cause of symptoms in 7/75 patients (9.3%) and a concurrent cause in 9/75 (12%). ConclusionSEL reporting rate is extremely low, leading to an important underestimation of disease prevalence. SEL diagnosis and grading should be refined to improve reports quality and subsequently patient care.

Ultrasound, Fluoroscopic-Guided Caudal, Lumbar Epidural Steroid Injections and Blinding Paraspinal Lumbosacral Steroid Injections in Patients with Low Back Pain with Radiculopathy

Background and Aims: Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO); the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. Patients and Methods: This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. Results: In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). Conclusion: US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.

CASE REPORT OF ADULT-ONSET CHARCOT MARIE TOOTH TYPE X

Charcot-Marie-Tooth (CMT) or Hereditary Motor and Sensory Neuropathy (HMSN) is the most common hereditary peripheral nerve disease with progressive chronic weakness, muscle atrophy, and sensory disturbances. There are several types and subtypes of CMT with their respective clinical manifestations. In this article, we reported a patient with of CMT type X. A 43-year-old male patient was referred to a neurology clinic with weakness in both limbs for 2 years, accompanied by tingling and sensory disturbance in both hands and feet. There are several of his family members who had similar complaints. Lumbosacral magnetic resonance imaging (MRI) examination revealed mild nucleus pulposus herniation. Electroneuromyography (ENMG) examination revealed demyelinating sensory motor polyneuropathy. Histopathological examination of nerve biopsy showed demyelination of the sural nerve. It is hard to make a diagnosis of CMT, because it requires high suspicion from clinicians once encounter a suspected case and also need to supported by sophisticated equipment such as electrophysiological examinations, nerve biopsy examinations, and genetic examinations. It is vital for clinicians for being able to diagnose CMT correctly and provide treatment as soon as possible in order to maintain the patients’ quality of life.

Quantification Threshold Pixel Technique of Magnetic Resonance Imaging in Paraspinal Muscles Atrophy among Discopathy Patients

Purpose: To evaluate the relationship between lumbosacral discopathy status and paraspinal atrophic changes (Cross-sectional area (CSA) and fatty infiltration (FI)) among different age groups. Materials and Methods: We retrospectively evaluated 200 patients with confirmed discopathy who were examined by lumbosacral Magnetic Resonance Imaging (MRI) at the two main governmental hospitals in Gaza Strip. Using ImageJ software and quantification threshold technique, we measured the CSA and FI of paraspinal muscles {multifidus (MF) & erector spinae (ES)}. The interpretation of MRI images was performed by two radiologists with a good inter-observer agreement between the radiological discopathy findings. Results: The highest percentage and severity of discopathy were noticed at the level of L4/5 (89.5%), followed by L5/S1 (14.5%). The FI is increased towards lower levels of L3/4 to L5/S1. No correlation was found between discopathy level, the severity of discopathy, and CSA of MF & ES muscles. In contrast, a correlation was observed between FI of MF & ES muscles, discopathy level, and severity. Also, the results illustrated no significant relation was observed between CSA of MF & ES muscles and age groups (P > 0.05), while a significant correlation was reported between FI and age groups (P < 0.05). Conclusion: The MRI quantification threshold pixel technique for paraspinal muscles reflected the atrophic changes like CSA and FI in discopathy patients.