Paravertebral Involvement Research Articles

Unusual presentation of cat scratch disease: case report

Cat scratch disease (CSD) is an infection caused by Bartonella henselae, presents with non-specific symptoms like lymphadenopathy, fever, and fatigue. It can progress to disseminated disease, leading to complications such as liver and splenic micro abscesses, osteomyelitis, encephalitis, and uveitis. Diagnosis is challenging due to varied presentations and limited tests. Treatment involves supportive care, with severe cases requiring antimicrobial therapy. In this report, we present a case of Cat scratch disease characterized by an atypical clinical manifestation, hepatosplenic and paravertebral involvement.

Paravertebral involvement in IgG4-related disease.

Paravertebral involvement in IgG4-related disease.

STUDY OF MRI MORPHOLOGY OF SPINAL TUBERCULOSIS

OBJECTIVE: To study the morphology of tuberculosis of spine on MRI. METHODS AND MATERIALS: A retrospective study was done in the department of Radiodiagnosis, PESIMSR, Kuppam.This study includes 37 patients with suspected Spinal Tuberculosis, who were referred to the department of Radiodiagnosis between 2019 Jan to 2021 July. Informed consent was taken from all the patients. This study was done on GE Signa Explorer 1.5 Tesla. RESULTS: A total of 37 cases were included in the study. Of these 37 cases, 31 were males and 6 were females. The most common age group involved was between 20-40 years, seen in 15 cases followed by 41-60 yrs seen in 14 cases and 61-90 yrs seen in 8 cases. Lumbar vertebrae were commonly affected accounting for 86% of total cases (32cases) followed by dorsal and cervical vertebrae accounting for 8% and 5 % respectively (3 and 2 cases respectively). Intervertebral disc involvement (Discitis) was most commonly seen in 32 cases followed by vertebral endplate involvement (27 cases) in our study. Prevertebral & paravertebral involvement were found in 20 and 23 cases respectively . In our study,19 cases had shown the involvement of posterior elements .Epidural soft tissue component was seen in 22 cases. Psoas abscess and paraspinal involvement were seen in 9 and 8 cases respectively. CONCLUSION: MRI helps in the early assessment of the extent and severity of disease compared to X-ray and CT scan. It is valuable in detecting early marrow changes, intervertebral disc involvement, extradural abscess and cord compression.

Characteristics, Management and Outcome of DLBCL Patients Presenting with Simultaneous Systemic and CNS Disease at Diagnosis - a Retrospective Multicenter Study

▪Background: The incidence of lymphoma concurrently involving the central nervous system (CNS) and systemic organs is very rare. Data regarding this clinical setting are based on case reports and relatively small retrospective series, precluding the establishment of solid recommendation regarding prognosis and treatment.Objectives: The current retrospective multi-center study investigated the characteristics, treatment protocols and outcome of patients with B cell non-Hodgkin lymphoma (B-NHL), diagnosed with concomitant systemic and CNS involvement, between the years 2004 to 2017.Results: All consecutive patients with B- NHL, presenting with concomitant systemic and CNS involvement at diagnosis were reviewed. Thirty five patients were included (24 male; 11 females). Median age at diagnosis was 59 years (34-86). Histological subtype was diffuse large B-cell lymphoma in almost all patients (n=34; 97%). The International prognostic index was greater than 2 in 70% of the patients (n=24). The median number of extra nodal sites was 1 (range: 0-4), with bone being the most common extra nodal site (n=14).Concurrent indolent and aggressive lymphoma were reported in 2 out of 30 patients for which these data were available (6.7%). Twenty two patients had paranchymal involvement (63%). Eight patients had meningeal involvement per imaging (23%) and 4 had spinal disease. Cerebrospinal fluid (CSF) involvement, defined by a positive CSF cytology or immunophenotyping, was detected in 59% (13/22 patients).The most common induction chemotherapy was anthracycline-based (RCHOP / RCHOP like regimen) in combination with high-dose methotrexate (MTX), with or without cytarabine (23 of 35 patients, 66%). Seven patients were ineligible for intensive chemotherapy due to poor performance status. Overall, 14 patients died from the disease (40%). Six of them during induction and 8 due to relapsed/refractory disease. 2 patients died from other causes.Overall response rate following induction treatment was 80%, including 60% complete remissions (CRs) and 20% partial remissions (PRs). Most patients achieved CNS and systemic CR (evaluated by nervous system MRI/CT and PET/CT).14 patients were treated with high dose chemotherapy followed by autologous stem cell transplantation (ASCT) (12 in CR and 2 in PR). ASCT did not improve depth of response in any of the patients transplanted in less than CR.Nine patients (33.3%) relapsed within less than 2 years from diagnosis. Disease-free survival (DFS) and overall survival (OS) of the entire cohort were 50.4% and 70.2%, respectively (Figure 1), similar to patients receiving anthracycline-based / high-dose MTX regimen (47.8% and 79.2% respectively). ASCT did not improve the outcome of patients treated with anthracycline-based / high-dose MTX chemotherapy (figure 2). Paravertebral mass (HR=14.8, p=0.002) rather than brain disease (parenchyma, intraventricular or both), meningeal or cranial nerve involvement and an increased LDH level (HRfor100unit=1.11, p=0.006) were found to be associated with shorter OS.Restricted analysis, including patients receiving anthracycline-based / high-dose MTX regimen only , found paravertebral mass (HR=38.265, p=0.011) and meningeal disease (HR=10.463, p=0.059) to be associated with an increased risk of relapse. Of note, brain involvement (HR=0.08, p=0.036) was associated with a decrease risk of relapse.Conclusion: Combination therapy with RCHOP-HD MTX provides encouraging outcome in DLBCL patients presenting with systemic and CNS disease, with half remain free of disease at 2 years post diagnosis. Patients presenting with brain involvement had better survival than patients diagnosed with paravertebral involvement. Our study did not demonstrate clear survival benefit for patients undergoing ASCT, and given the relatively good outcome of our cohort, the benefit of ASCT in this group of patients needs to be further validated in prospective studies. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Thoracic paravertebral involvement in patients withIgG4-related disease: CT and MR imaging findings.

To retrospectively evaluate CT and magnetic resonance (MR) imaging thoracic paravertebral findings at baseline and follow-up in patients with IgG4-related disease. The study consisted of 36 patients with IgG4-related disease involving thoracic paravertebral regions (32 men and four women; mean age, 58 years; range, 25-78 years). A total of 36 patients underwent CT or MR imaging at baseline; 20 patients underwent follow-up. CT and MR images were reviewed and analysed in consensus by two radiologists for the various features of thoracic paravertebral lesions. All lesions were located around two or more thoracic vertebrae, particularly the lower thoracic vertebrae (n = 36). The right side of vertebrae was predominantly affected in all cases (n = 36). Radiologically, IgG4-related thoracic paravertebral lesions were categorized into three types: solitary or multiple saddle-like masses type (32 patients); multiple nodules type (three patients); and invasively irregular mass type (three patients). All the types showed soft-tissue density on CT images, isointense on T1- and T2-weighted images, and homogeneous enhancement with penetration of small arteries in the lesions on contrast-enhanced CT and MR images. Steroid therapy administered to 20 patients dramatically diminished the mean maximum thickness in 18 patients. One patient with T7-12 vertebrae involved improved after steroid therapy. IgG4-related paravertebral lesions occur mainly around the right side of the lower thoracic vertebrae and manifest as three major patterns of CT and MR imaging findings. Recognition of these diagnostic features will assist in the diagnosis and treatment of IgG4-related disease.

Evaluation of non-traumatic myelopathy using magnetic resonance imaging

Background: Prompt and concise diagnosis of etiologic agent behind Non-Traumatic Myelopathy (NTM) and localization of the site of lesion are essential for prediction of neurological and functional outcomes. Magnetic Resonance Imaging (MRI) plays a key role in evaluation of myelopathy. Objectives: The objective of the present study was to characterize the spinal cord lesions in Non-traumatic Myelopathy and to evaluate the etiological factors leading to NTM. Materials and Methods: A hospital based cross-sectional study was done from November 2017 to May 2019 in a tertiary care centre of South India, where 85 patients with clinical suspicion of NTM were evaluated with MRI of spine. The MRI data collected was analyzed and described. Results: Out of 85 patients in our study group, 44 (51.8%) were males and 41 (48.2%) were females, without any significant gender predilection. The age group ranged from 5 to 83 years, with majority of patients in the 7th decade (25.9%). Degenerative myelopathy was the most common etiology accounting for 57.6% of the patients, followed by infective (28.2%), primary neoplastic (9.4%), congenital (1.1%), demyelinating (1.1%), metastatic (1.1%) and nutritional (1.1%) etiologies. Conclusion: MRI characteristics of the most common lesions were sufficiently distinct to allow them to be differentiated from each other and from most other entities. Other characteristics such as extradural versus intradural, intramedullary versus extramedullary, nature of enhancement on Post Gadolinium study, the presence of epidural, prevertebral and paravertebral involvement permit further differentiation among the various other abnormalities. MRI is a very sensitive, specific, non-invasive radiation-free modality for evaluation of NTM.

Cerebrospinal Fluid Flow Cytometry Analysis in Newly Diagnosed Aggressive Non-Hodgkin Lymphomas at High Risk for Leptomeningeal Disease: Result of a Multicentric Prospective Italian Study.

Abstract 2919Poster Board II-895 Background:Flow cytometry (FCM) assessment of cerebrospinal fluid (CSF) has recently been known to increase the rate of positivity of occult leptomeningeal disease (LD) in comparison to conventional cytologic examination (CC). However it's still unknown its prognostic value. Patients and methods: The aim of this study was to compare CC vs FCM in a large cohort of patients with newly diagnosed aggressive NHL at high risk for LD (diffuse large B-cell lymphoma (DLBCL) IPI 2-3 and elevated LDH with at least two extranodal sites or with bone marrow, testis, paranasal sinuses, orbit or paravertebral involvement; Burkitt lymphoma (BL); blastoid variant of mantle cell lymphoma (B-MCL); B-cell precursor lymphoblastic lymphoma (B-LL); HIV+ aggressive lymphoma patients). All patients were required to have no evidence or signs of neurological disease. All patients received intrathecal standard prophylactic therapy with 12 mg of methothrexate except for BL that were given prophylaxis with 50 mg of liposomial aracytin for a total of 4 doses. CFS samples were analysed both with CC and FCM. The incidence of positive test for occult LD with FCM and CC was compared using the McNemar test for paired data. Results:Between August 2004 and June 2008, a total of 159 consecutive patients were enrolled in 11 Italian centres and underwent evaluation of CSF. Out of these, 128 patients (80%) were considered at high risk of occult LD. Clinical characteristics were: median age 53 years (IQR:43-62); DLBCL 96 patients (75%); BL 21 pts (16%); B-MCL 6 pts (5%); B-LL 5 pts (4%); 26 pts (20%) were HIV positive. FCM was able to detect a clonal population in 17 out of 128 patients (13%) whereas CC detected abnormal cells only among 7 pts (5%)(p= 0.0002). Therefore, 10 patients (8%) were discordant: FCM+/CC-. Among the 128 patients, there was no association between the CFS total protein, glucose level and the presence of positive analysis of FCM, whereas the difference between the number of WBC cells in CSF was significantly higher in patients with positive versus negative FCM with a median value of 12 cells/ul (IQR: 3.5;40) versus 1.0 cells/ul (IQR: 0.0;3.0) (p=0.0120). Univariate and multivariate analyses, using logistic models, showed that abnormal LDH (OR 3.98, 95%CI: 1-15.92)(p=0.05) and number of WBC cells in CSF ≥5 (OR 4.57, 95%CI:1.37-15.33)(p=0.014) were the only predictive factors of a positive test performed by FCM. From date of diagnosis, overall median follow up of survivors was 14 months (IQR:8-22). We observed 39 (30%) systemic progressions, 6 (5%) CNS progressions (in 5 cases an isolated CNS progression whereas 1 pts experienced a CNS along with systemic progression). Thirty-two (25%) patients died and causes of deaths were as follows: 27 progressive disease, 1 infection, 1 treatment related toxicity, 1 hepatitis, 2 unknown. PFS at 1 year was 71% (95%CI:62-78) in the whole group of patients. The progression risk was significantly higher in patients both FCM+/CC+ compared with patients both FCM-/CC- (1-yr PFS 43% vs 74%) (HR 3.8 95%CI:1.6-9.0) (p=0.003). An higher but not significant risk of progression was found in pts discordant (FCM+/CC-) with respect to patients both FCM-/CC- (1-yr PFS 65% vs 74%) (HR 1.61, 95%CI:0.63-4.11) (p=0.315). In the univariate and multivariate analyses performed with Cox models, we found that the presence of ECOG PS≥2 (HR 2.14, 95%CI: 1.14-4)(p=0.018) and level of protein in CSF >40/ul (HR 1.83 95%CI: 1.01-3.29)(p=0.045) were prognostic factor of PFS. Conclusion:FCM assessment of CSF increase the rate of positivity of occult LD compare with CC but it's clinical relevance is still to be clearly defined. Our preliminary data suggest that patients both FCM+/CC+ have an higher risk of progression compared with those both negative, whereas discordant cases may have an intermediate prognosis. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Long-term result of treatment for paraspinal and extradural hydatid cyst: a case report

Hydatid cyst is a zoonosis affecting any part of the body and presenting difficulty in diagnosis and treatment. Primary bone involvement seen in about 2% of the cases is accompanied by spinal involvement in 50%. A 41-year-old female presented with low back pain radiating to the left leg. After physical examination, radiologic and laboratory investigations, a diagnosis of spinal hydatid cyst was made with intraspinal extradural, vertebral, and paravertebral involvement. The patient was treated with two-staged posterior and anterior surgical resections with addition of pre- and postoperative antihelminthic therapy. No recurrences developed within a follow-up of 5.5 years. Recurrences can be reduced by initiation of antihelminthic therapy preoperatively, perioperative injection of scolicidal agents into the cyst, and careful excision of the cyst without spread to neighboring tissues.

MRI of extradural spinal tumours at 0.3 T.

Ninety-one patients with extradural spinal tumours were examined by magnetic resonance imaging. There were 76 metastases (6 from unknown primary tumours). Seven patients had primary spinal tumours and 8 had multiple myeloma. Sixteen had bulging, diseased vertebral bodies compressing the subarachnoid space and 67 had extradural tumour compressing the spinal cord. Sixty patients had paravertebral involvement. Intraspinal involvement did not correlate with the extent of spinal lesions. All patients had vertebral destruction, with hypointense or combined hypo- and isointense signal relative to bone marrow on T1-weighted images. In most of the 22 patients with T2-weighted images the tumours were isointense or slightly hyperintense. It was usually impossible to differentiate the various tumours on the basis of signal intensity and morphology. However, metastases from carcinoma of the prostate were often more hypointense than other tumours on T1- and T2-weighted images. An inhomogeneous pattern in which diffusely low signal is combined with focal lower signal on T1-weighted images may suggest myeloma. In the 22 patients examined with both T1- and T2-weighted images, T1-weighted images gave the best information in 18; in 3 they were equivalent and in 1 inferior to T2-weighted images; they are therefore recommended for routine imaging of epidural spinal tumours.