Lumbosacral Magnetic Resonance Imaging Research Articles

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.

Lumber Spine Incidental Findings During Discopathy Evaluation Using MRI

Magnetic Resonance Imaging (MRI) of the lumbar spine with the standard protocol can be useful in the diagnosis of incidental extraspinal lesions. The study aims to find the frequency and types of incidental findings (IF)of lumbosacral spine MRI in adult patients with suspected discopathy. It was a prospective analytical study involving MRI scans performed on a group of 50 patients (22 males and 28 females) in the age range of 25-85 years old reporting clinically chronic back pain without a histo

Prevalence and clinical potential of extraspinal incidental findings in lumbosacral spine MRI of patients with suspected disc diseases

BACKGROUND Incidental findings could be observed in organs close to the spine while reporting lumbosacral spine magnetic resonance imaging (MRI). This study aimed to report the prevalence and clinical potential of extraspinal incidental findings in lumbosacral MRI of patients with suspected disc diseases.&#x0D; METHODS This single-centered cross-sectional study was carried out on 420 consecutive adult patients who underwent lumbar spine MRI for suspected disc disease from January to July 2019. The MRI was checked for the presence of extraspinal incidental findings, and each finding was categorized according to the body organ and its clinical significance. Each MRI plane that best displayed the findings was recorded, and the association between the findings and patient's age and sex was determined.&#x0D; RESULTS Of 420 samples, 135 cases showed extraspinal findings (32.1%), and 7.6% of the patients displayed suspicious lesions. The urinary tract was the most common system (18.6%) to display both clinically significant (5.0%) and benign findings (13.6%), and the axial MRI section was the plane which showed most of the incidental findings. Incidental findings in any body system were rarely found in the younger patients. Females had significantly higher benign findings than males (p = 0.002).&#x0D; CONCLUSIONS The prevalence of extraspinal findings in lumbosacral spine MRI is high, and some are significant. Most findings are related to the urinary tract and best displayed in the axial plane.

Translocation of the conus medullaris during dynamic lumbosacral magnetic resonance imaging in dogs.

To investigate the change in the lumbosacral angle (ΔLSA) and conus medullaris (CM) displacement in healthy dogs undergoing dynamic MRI with changes in the posture of their pelvic limbs from neutral posture to flexion or extension posture and to evaluate for potential correlation between ΔLSA and CM displacement. 9 healthy adult Beagles. Dogs underwent dynamic MRI with their pelvic limbs positioned in neutral, flexion, and extension postures. From T2-weighted sagittal midline plane MRI images, 2 observers measured the lumbosacral angle and CM location in duplicate for each posture for each dog. Intra- and interobserver agreement was assessed, and the Spearman rank correlation coefficient (ρ) was used to assess for potential correlation between ΔLSA and CM displacement for changes in pelvic limb posture from neutral to flexion or extension. Overall, the mean ΔLSA and CM displacement for changes in posture were 23° and 9.09 mm (caudal displacement) for the change from neutral to flexion posture, 8.4° and -2.5 mm (cranial displacement) for the change from neutral to extension posture, and 32.2° and 11.64 mm (caudal displacement) for the change from extension to flexion posture. The ΔLSA strongly correlated (ρ = 0.705; 95% CI, 0.434 to 0.859) with displacement of the CM. The use of dynamic MRI, compared with conventional MRI, will better help to characterize clinically normal and abnormal features of the lumbosacral region of the vertebral column and associated spinal cord during postural changes. Further, when limited translocation of the CM is evident on dynamic MRI, veterinarians should suspect underlying lumbosacral pathophysiologic processes or anatomic abnormalities.

Deep Vein Thrombosis Associated With COVID-19

The novel coronavirus disease 2019 (COVD-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The immunothrombosis could occur during infectionwith viruses. Deep vein thrombosis (DVT) is a devastating condition that usually involves the lower extremities. The typical course of DVT is associated with an episode of enormous limbswelling and pain. In this case report, we aimed to present one of the COVID-19 possible complications: DVT in a 38 years old man infected with SARS-CoV-2. A 38 years old manpresented with leg pain. He had a dry cough and fatigue suspicious symptoms of COVID-19. For further evaluations, the lung Computed Tomography scan (CT-scan), labratoricalassessments, and doppler sonography of the common femoral vein (CFV) of both legs were done. Also, for investigating the other underlying causes of DVT, abdominopelvic CT-scan andlumbosacral Magnetic Resonance Imaging (MRI) were done. The CT-scan showed GroundGlass Opacity (GGO) view. Labratorical assessment proposed a thrombotic condition. Thedoppler sonography of the CFV of both legs revealed a massive thrombosis in the left CFV suggesting an acute DVT. Abdominopelvic CT-scan and lumbosacral MRI were negativefor other underlying causes of DVT. COVID-19 is associated with the classical syndrome named disseminated intravascular coagulation and the subsequent consumption coagulopathypresented as DVT.

Prevalence and Association of Occult Spinal Dysraphism with Anorectal Malformation

Background: Anorectal malformation (ARM) is associated with occult spinal dysraphism (OSD). The guideline for screening for OSD in patients with ARM is still controversial. Objective: 1) To evaluate the prevalence of OSD in each type of ARM and to elucidate which types of ARM should be screened for underlying OSD. 2) To compare the methods used in radiologic screening for OSD, such as plain lumbosacral X-ray, spinal ultrasound (U/S), and spinal magnetic resonance imaging (MRI). Materials and Methods: The medical records of all patients with ARM treated at Siriraj Hospital between 2006 and 2016 were reviewed. Spinal dysraphism screening with lumbosacral X-ray, U/S, or MRI were performed depending on the surgeon’s request. Associated urinary tract anomalies were noted. Data of the surgical treatments, outcomes, and complications of treatments were collected. Results: Among the 204 ARM patients treated, 150 patients were screened for OSD, involving 150 lumbosacral X-ray, 65 U/S, and 39 MRI. The prevalence of OSD (n=33) in all types of ARM was 16.2%. The higher types of ARM had higher prevalence of OSD, except for vestibular fistula (20.5%). The prevalence of OSD in cloaca malformation, rectobladder neck fistula, rectoprostatic urethral fistula, rectobulbar urethral fistula, and perineal fistula were 28.6%, 33.3%, 16.7%, 12.5%, and 9.8%, respectively. Lumbosacral X-ray had a sensitivity of 51.7% and was not a good screening method. Sixteen of 65 U/S revealed OSD (24.6%). Tethered cord and syringomyelia were noted in nine and seven, respectively. Spinal MRI (n=39) revealed 27 OSD (69.2%) comprising 16 tethered cords, 12 spinal lipoma, and 10 syringomyelia. ARM associated with KUB anomalies had a statistically significant correlation with OSD. In 33 OSD, 17 patients (51.1%) were operated on. Fourteen received untethering spinal cord, while five had intradural lipoma excised. Conclusion: Patients with ARM had a high prevalence of OSD and should be screened for. U/S is the first-line method. MRI is strongly recommended in cloaca malformation, rectobladder neck fistula, rectoprostatic urethral fistula, vestibular fistula, and all ARM associated with KUB anomalies. Other types of ARM should be screened by MRI if feasible. Keywords: Spinal dysraphism, Tethered cord, Anorectal malformation

Prostat Kanserinin Tanısında D-dimer

Objective: To investigate the value of D-dimer, a marker of fibrinolysis, in metastatic and non-metastatic prostate cancer. Materials and Methods: A retrospective analysis was performed on 138 male patients including 52 patients with prostate cancer and 86 with benign prostatic hyperplasia. Participants who had factors that altered D-dimer levels were excluded. The mean ages of the groups were similar (70 ± 8 vs 68 ± 8, p= NS). In addition, data regarding biochemical findings, prostate-specific antigen and hemostatic markers, including D-dimer, were retrieved from the database of our hospital. The cut-off point of D-dimer was 0.5 mg/L. Data from scintigraphy and magnetic resonance imaging (MRI) scans related to metastasis were also considered. Patients who showed findings of metastasis according to scintigraphy and lumbosacral MRI were accepted as having metastases. Positive findings in only scintigraphy in any area were considered suspicious for metastasis. Results: Patients with prostate cancer had higher D-dimer levels than benign prostate hyperplasia patients (p= 0.024). Sixteen patients with metastatic prostate cancer and suspicious for metastasis had markedly high D-dimer levels compared to benign prostate hyperplasia and non-metastatic prostate cancer patients.

Tip 1 Nörofibromatoziste Kliteromegali Olarak Gözlenen Ekstensif Plexiform Nörofibrom

Neurofibromatosis type 1 (NF1) is an autosomal-dominant disorder with multisystem involvement. Genitourinary involvement of neurofibromatosis type 1 is rare condition and involvement of plexiform neurofibroma can cause painful clitoromegaly. A 9-year-old girl with neurofibromatosis type-1 referred with clitoromegaly to our endocrinology clinic. Pelvic magnetic resonance imaging (T2W images) showed that plexiform neurofibroma was found on the pelvic floor and peripubic region, which was 8x7x13 cm in size, extending to the external genital region and progressing to subcutaneous soft tissue. Cranial and lumbosacral magnetic resonance imaging revealed two neurofibromas in the cerebellar region and the basal ganglia. We emphasize it should be kept in mind that suspicious genitalia may develop due to infiltration of space occupying formations such as neurofibromas.

Functional Recovery after Surgery for Lumbar Spinal Stenosis in Patients with Hypertension.

Hypertension is a prevalent condition that is associated with lower health status in patients with lumbar spinal stenosis. The study determined whether hypertension is a prognostic factor associated with functional recovery after spine surgery for lumbar spinal stenosis. This was a secondary analysis of the Alberta Lumbar Spinal Stenosis Study in which patients were identified as participants at the time of lumbosacral magnetic resonance imaging or computed tomography in Calgary, Alberta, Canada. Multivariable linear regression analyses were performed to examine hypertension as a prognostic factor of functional recovery after surgery (Oswestry Disability Index, the Swiss Spinal Stenosis (SSS)-Symptom Severity and SSS-Physical Function scales). Of the 97 surgical participants, 49 who were hypertensive were older (76.8, SD 11.4 years) than the 48 non-hypertensive participants (66.7, SD 12.4 years) (p < 0.001). No significant associations between hypertension and post-operative function in any of the three multivariable models were seen. The Oswestry Disability Index mean score improved after surgery (effect size: 1.73; 95%CI: 1.39, 2.06), with no differences seen between those with and without hypertension (p = 0.699). Large changes were seen after surgery for the SSS-Symptom Severity (effect size: 1.0, 95%CI 0.7, 1.3) and SSS-Physical Function (effect size: 0.9, 95%CI 0.6, 1.2) scales. Hypertension alone does not negatively impact functional recovery following surgery.

Intracranial Mimics of Cauda Equina Syndrome: Heads or Tails?

To report cases of extraspinal mimics of cauda equina syndrome (CES) to enable prompt diagnosis and treatment in the future. CES results from compression of spinal nerve roots. Current practice mandates lumbosacral magnetic resonance imaging (MRI) scanning to diagnose CES. However, it may not reveal compression or provide an explanation for the presentation. We present 3 cases of suspected CES who went on to have intracranial pathology. Retrospective review of all patients presenting with CES-type features who were subsequently found to have causative intracranial pathology over a 6-month period. Three cases were found, and these are hereby presented. Case 1: A 57-year-old lady presented with urinary retention and bilateral leg weakness. She underwent an MRI spine which showed no evidence of CES. She was diagnosed with haemorrhagic intracranial metastases. Case 2: A 52-year-old lady presented with lower back and right buttock pain, with right-sided leg numbness, saddle hypoesthesia, and bowel and bladder incontinence. MRI spine showed no cauda equina compression. MRI neuraxis revealed a subdural haematoma. Case 3: A 69-year-old lady presented with a 6-day history of urinary incontinence, right foot drop, and leg weakness. MRI spine was negative for CES. She was diagnosed with an intraparenchymal haematoma of posterior left frontal lobe. Negative lumbosacral MRI will not exclude extraspinal mimics of CES and, although rare, these cases should be considered.

Coincidence of Sarcoidosis With Ankylosing Spondylitis in a 48-Year-Old Woman; A Therapeutic Challenge

Introduction: A case of pulmonary sarcoidosis is reported because of difficulties in diagnosis and treatment, including the co-existence of ankylosing spondylitis (AS) and severe corticosteroid dependence. Case Presentation: A 48-year-old nonsmoking woman referred to the hospital because of chronic nonproductive cough and dyspnea with a 10-year history of AS. Bilateral rhonchi was detected in lung auscultation. There was a significant limitation in lumbar activity and range of motion in flexion (positive Schober’s test), extension, and lateral bending. In lumbosacral magnetic resonance imaging (MRI), irregularities in the sacroiliac joint and bilateral sacroiliitis were evident. The angiotensin-converting enzyme level was elevated. Biopsy in hilar lymphadenopathy by transbronchial lung biopsy was done, and the histopathological findings showed chronic nonnecrotizing granulomatosis inflammation compatible with sarcoidosis. Anti-tumor necrosis factor drugs was effective on steroiddependent coexisting of sarcoidosis and AS. The symptoms were absent in regular follow up. Conclusion: Pulmonary fibrosis due to sarcoidosis can be prevented by suitable treatment. Clinical trials are needed to confirm the impact of treatments with monoclonal antibodies against tumor necrosis factor (TNF), for curing sarcoidosis.

Association of Lower Lumbar Facet Joint Osteoarthritis With Demographic Factors And Intervertebral Disc Degeneration In Patients With Low Back Pain

Background: Facet joint osteoarthritis (FJO) is an important element of lumbosacral degenerative disease. However, its association with other possible risk factors is still controversial. This study was conducted to investigate the association of FJO with risk factors and with presence of lumbar intervertebral disc degeneration (IVDD).&#x0D; Patient and method: Lumbosacral magnetic resonance imaging (MRI) examinations of 100 patients (36 male and 64 female) with low back pain (LBP) were reviewed in this cross-sectional retrospective study for the presence of FJO. The overall prevalence of FJO as well as the number of levels affected was correlated with the age, gender, body weight, height, BMI, female parity. FJO was also correlated with presence of corresponding IVDD.&#x0D; Results: Overall prevalence of FJO was 23%. The prevalence of FJO was significantly associated with advancing age (p=0.018). Females were more affected than males but without statistical significance (p value = 0.79). Similarly, FJO were more frequent in women with advanced multiparity but the association was statistically not significant (p value 0.1) there was statistically significant association between BMI and number of levels affected by FJO (p value 0.037). IVDD was significantly associated with higher prevalence of FJO especially at L3/4 and L4/5 levels (p values P&lt;0.0001 and 0.04 respectively).&#x0D; Conclusion: Age was the single most important factor significantly associated with both overall higher prevalence of FJO and higher number of involved levels. BMI was statistically associated with increasing number of level affected. IVDD was significantly associated with presence of FJO at L3/4 &amp; L4/5 levels.

Pediatric sciatic neuropathy: Clinical presentation and long term follow up.

Sciatic neuropathy is rare and difficult to diagnose in pediatrics, and its long-term course has not been completely understood. To analyze the clinical presentation and evolution of a group of pediatric patients with sciatic neuropathy. Retrospective anal ysis of the clinical characteristics of pediatric patients with sciatic neuropathy treated in two hospitals of Santiago between 2014 and 2018. Locomotor examination, muscle trophism, deep tendon reflexes, gait, sensation, and pain were assessed. Sciatic nerve conduction study and electromyography (EMG) were performed, and magnetic resonance imaging (MRI) in three patients. Six patients were included with an average age of 11.8 years. The etiologies were traumatic (N = 2), by compression (N = 2), vascular (N = 1), and tumor (N = 1). All of the 6 patients presented foot drop and Achilles tendon hyporeflexia/areflexia, and 5 patients presented severe neuropathic pain. The EMG showed involvement of the sciatic nerve rami and dependent muscles. In two patients, a pelvic girdle and lower limbs MRI was performed, showing selective muscle involvement in sciatic territory. One patient underwent a lumbosacral plexus MRI, and subsequently histological study showing a benign neural tumor. Out of the three patients who were followed-up longer than one year presented motor sequelae and gait disorder. Sciatic neuropathy in the study group was secondary to different causes, predominantly traumatic and compressive etiologies. The three patients that were ina long-term follow-up presented significant motor sequelae. In most of the cases, neural injury wasassoci- ated with preventable causes, such as accidents and positioning in unconscious children, which is crucial in the prevention of a pathology with a high sequelae degree.

Long Term Radiological and Clinical Outcome of Symptomatic Lumbar Intraspinal Synovial Cyst: A Retrospective 4-Year Study.

To examine the prevalence of symptomatic lumbar synovial facet cysts in lumbar spinal magnetic resonance imaging (MRI) of patients who admitted to neurosurgery clinic, retrospectively. Also, we aimed to report the clinic and radiologic outcome of patients with symptomatic spinal synovial cyst, who undergo conservative treatment. One thousand two hundred forty-three patients who admitted to Ordu University Neurosurgery outpatient clinic between 2015-2019 and underwent lumbosacral MRI and lumbosacral computed tomography examinations were reviewed retrospectively. The disappearance of cysts during radiologic follow up was accepted as spontaneous complete resolution, besides reduction in cyst dimensions and/or contrast enhancement were considered as radiologic regression. Decrease in radiculopathy, back pain and neurologic deficit complaints were also considered as clinical improvement. Thirteen patients (8 men, 5 women) with lumbar synovial cysts who admitted to the neurosurgery outpatient clinic with low back and radicular pain complaints were included in the study. Nine patients (69.2%) had clinical and radiological improvement, 1 female patient (7.7%) was operated due to the leg pain, progressive motor deficit and lumbar disc hernia. Radiological spontaneous complete resolution was detected in 3 patients (23.1%). Spontaneous complete resolution period was determined between 3 months to 24 months. The symptomatic lumbosacral synovial cyst treatment algorithm has not been fully demonstrated. However, as in our series, spontaneous complete resolution of cysts and effectiveness of conservative treatment in symptomatic patients should not to be underestimated and immediate invasive procedures should be postponed.

IMAGE CORRELATION BETWEEN FACET EFFUSION AND LUMBAR INSTABILITY

ABSTRACT Objective To assess the incidence of facet effusion in lumbosacral spine magnetic resonance imaging (MRI) and the relationship with radiographic segmental instability in patients submitted to spinal surgery. Methods Retrospective cohort study of patients submitted to lumbosacral spine surgery over a period of three years, through the evaluation of dynamic radiographs (X-ray) motion and facet effusion in axial section of MRI. Instability was defined as vertebral translation &gt; 3 mm or intervertebral angle &gt; 10º, and facet effusion as fluid in the facet joints &gt; 1.5 mm. Results The total number of patients that fulfilled the criteria for analysis was 244, of which 47 presented movement (≤ 3 mm) and 31 presented excessive movement (&gt; 3 mm), 115 had facet effusion (≤ 1.5 mm) and 46 presented excessive fluid (&gt; 1.5 mm). Statistical analysis did not demonstrate a significant association between increased segmental movement and facet effusion (p = 0.150). Conclusions The total incidence of facet effusion was 47.1% and the excessive fluid was 18.9%.There was no association between facet effusion in MRI and instability in dynamic X-ray. MRI does not replace dynamic X-ray in flexion and extension in the evaluations of lumbar instability. Level of evidence III; Retrospective Cohort.

Pelvic muscle size and myosteatosis: Relationship with age, gender, and obesity

Purpose:To evaluate interreader performance in the measurement of the cross-sectional area and myosteatosis of pelvic skeletal muscles using fat quantification magnetic resonance imaging (MRI) and correlate with patient anthropomorphic characteristics.Materials and Methods:A Health Insurance Portability and Accountability Act–compliant retrospective cross-sectional study was performed. Between January and April 2016, 61 patients (26 males and 35 females) underwent a lumbosacral plexus 3T MRI with a modified three-dimensional spoiled gradient echo sequence dedicated to fat quantification (mDixon Quant; Philips Healthcare). Two independent reviewers outlined muscle cross-sectional area on axial images using a freehand region of interest tool and documented proton-density fat fraction (FF) and muscle area (cm2) of the psoas, gluteus medius, gluteus maximus, and rectus femoris muscles on each side. Interreader agreement was assessed by intraclass correlation coefficient (ICC), and correlation between the measurements and subject's age, gender, and body mass index (BMI) was assessed using multiple linear regression analysis.Results:Excellent interreader agreement was obtained (ICC ≥0.74) for all muscle groups except for the left gluteus medius area and right psoas FF which showed good agreement (0.65 and 0.61, respectively). Statistically significant (P ≤ 0.05) positive correlation was seen between the gluteal muscle FF and area with BMI, and rectus muscle FF with age and BMI. Statistically significant negative correlation between the rectus femoris area and age was also observed.Conclusion:Fat quantification MRI is a highly reproducible imaging technique for the assessment of myosteatosis and muscle size. Intramuscular FF and cross-sectional area were correlated with age and BMI across multiple muscle groups.