Spinal Magnetic Resonance Imaging Research Articles

Retrospective, descriptive study of acute myelitis in French Guyana.

Acute myelitis is a neurological entity, often posing the problem of etiology. The two main causes are infectious or autoimmune. French Guyana is a region of the world where infectious etiologies are multiple, in particular human immunodeficiency virus infection, and autoimmune diseases appear to be emerging. The aim of our study was firstly to determine the proportion of each etiology of acute myelitis in French Guyana, and secondly to describe the clinical, paraclinical and epidemiological characteristics of autoimmune myelitis in French Guyana, with particular reference to neuromyelitis optica spectrum disorder (NMOSD). This retrospective, observational study included all patients who presented with acute myelitis between January 2015 and August 2023 at Cayenne Hospital Center. Each patient's chart was reviewed and patients were classified according to etiology. Demographic and clinical data were collected, as well as blood, lumbar puncture, and cerebral and spinal cord magnetic resonance imaging results. Of the 40 patients included, immune etiology was found in 74%, including 49% with NMOSD (37% with positive anti-aquaporin-4 antibodies) compared with three patients with infectious etiology. There was no statistically significant difference in complementary examinations between immune and infectious etiologies. The prevalence of NMOSD in French Guyana was estimated at 8/100,000 (6/100,000 for patients with positive anti-aquaporin-4 antibodies). No significant difference in the geographic distribution of patients with NMOSD in French Guyana was demonstrated. Our results show a high proportion of autoimmune etiology of acute myelitis in French Guyana, and more particularly of NMOSD. There is a high prevalence of NMOSD, the second highest in the world after the French West Indies. Given this high proportion of autoimmune myelitis, several hypotheses can be put forward, with genetic and environmental factors in the foreground. For patients with acute myelitis in French Guyana, an immune cause is the most likely. It is therefore important to think about this and look for NMOSD in particular, without ignoring an infectious etiology.

Spinal meningitis and abscess associated with dermal sinus tract: a case report

This case report discusses an 11-month-old male with a dermal sinus tract (DST) complicated by spinal meningitis and a long-segment intramedullary abscess. DSTs are rare congenital malformations that may remain asymptomatic until complicated by infections or neurological deficits. The patient was presented with prolonged fever and motor weakness in the extremities, leading to the discovery of a lumbosacral DST and associated abscess via cerebrospinal fluid (CSF) analysis and contrast-enhanced spinal Magnetic Resonance Imaging (MRI). Prompt surgical excision of the DST, drainage of the abscess, and prolonged antibiotic therapy resulted in significant clinical improvement. This case underscores the importance of early recognition, advanced imaging, and aggressive management to mitigate the severe neurological consequences of DST-associated infections.

P-904. Spinal Arachnoiditis and Syringomyelia in Coccidioidomycosis: A Case Series of 53 Adult Patients

Abstract Background Central nervous system (CNS) involvement with coccidioidomycosis (cocci) is a serious infection that is universally fatal if not treated. Prior to the advent of magnetic resonance imaging (MRI), very few reports describe spinal cord involvement and autopsies often omitted spinal cord examination. Accurate and anatomic localization of areas affected by CNS cocci can be challenging due to mental status changes and the presence of brain abnormalities. Here, we describe radiologic and clinical characteristics of 53 cases of CNS cocci who had spinal MRI imaging performed. Methods This retrospective case series reviewed 53 adult patients at the Valley Fever Institute in Bakersfield, California. Patients had confirmed CNS cocci and MRI of at least one segment of the spinal image with and without contrast. A waiver of consent was submitted, and approval was obtained by Kern Medical’s Institutional Review Board. ICD 9 and ICD 10 codes were used to query electronic health record and cross referenced with imaging. Each record reviewed required inclusion criteria of age above 18 years, cerebrospinal fluid (CSF) abnormalities compatible with chronic meningitis and one of the following: positive CSF IgG antibody, CSF complement fixation (CF) or growth of Coccidioides on CSF culture. MRI Imaging with and without contrast of at least one of the following: cervical, thoracic or lumbar spine. Results 77% of the patients were Latinx, 13% African American, 4% Asian and 6% Caucasian. Males make up the majority at 72%. 37% had intrathecal (IT) amphotericin (ABD) injections. Spinal cord abnormalities can be asymptomatic with the most common symptom of back pain followed by radiculopathy. Abnormal findings included leptomeningeal enhancement, arachnoid cysts, masses or adhesions, syringomyelia, myelitis, cord edema, myelomalcia, flattened cord, nerve root "clumping" or solid cauda equina. Conclusion This study suggests the benefit of obtaining neuro axis imaging with and without contrast on all new cases of Coccidioidal meningitis. Spinal cord involvement with CNS cocci is common and contributes to significant morbidity. Contrary to common belief, our study shows that spinal arachnoiditis occurs in patients who were never treated with IT ABD. This may suggest that IT ABD may not cause arachnoiditis. Disclosures All Authors: No reported disclosures

Hip-spine syndrome from the perspective of radiology: correlations between hip joint disease and lumbar spine MRI findings.

Hip joint (HJ) pain, which may be caused by lumbar disease, is a common complaint. To investigate the prevalence and specific correlations between various HJ diseases and lumbar spine magnetic resonance imaging (MRI) findings in patients with HJ pain. Patients with the chief complaint of HJ pain who had both HJ MRI and lumbar MRI were retrospectively included. According to the existence of HJ disease, patients were divided into the following groups: non-HJ disease; osteoarthritis (OA); femoroacetabular impingement (FAI); ischiofemoral impingement (IFI); greater trochanter pain syndrome (GTPS); and other diseases. The prevalence of major lumbar MRI findings was compared. Correlations between HJ disease and major lumbar MR findings were explored. A total of 585 patients were included, of which 566 (96.8%) had major findings on lumbar MRI. The HJ disease group was more likely to be female and had more spondylolisthesis, while the non-HJ disease group had more low back or leg pain. The OA group was older and correlated with lumbar spinal stenosis (contingency coefficient = 0.164) and spondylolisthesis (contingency coefficient = 0.095). The FAI group was younger, had more male patients, and correlated with lumbosacral transitional vertebrae (contingency coefficient = 0.122). The IFI group was older, had more female patients, and correlated with facet joint osteoarthritis (contingency coefficient = 0.168). The GTPS group was older, had more female patients, and correlated with spondylolisthesis (contingency coefficient = 0.097). Major lumbar MRI findings were frequently observed in patients with hip pain, even in patients without HJ disease. Specific lumbar MRI finding correlated with different HJ disease.

Data-driven denoising in spinal cord fMRI with principal component analysis.

Numerous approaches have been used to denoise spinal cord functional magnetic resonance imaging (fMRI) data. Principal component analysis (PCA)-based techniques, which derive regressors from a noise region of interest (ROI), have been used in both brain (e.g., CompCor) and spinal cord fMRI. However, spinal cord fMRI denoising methods have yet to be systematically evaluated. Here, we formalize and evaluate a PCA-based technique for deriving nuisance regressors for spinal cord fMRI analysis (SpinalCompCor). In this method, regressors are derived with PCA from a noise ROI, an area defined outside of the spinal cord and cerebrospinal fluid. A parallel analysis is used to systematically determine how many components to retain as regressors for modeling; this designated a median of 11 regressors across three fMRI datasets: motor task (n=26), breathing task (n=27), and resting state (n=10). First-level fMRI modeling demonstrated that principal component regressors did fit noise (e.g., physiological noise from blood vessels), particularly in the resting state fMRI dataset. However, group-level motor task activation maps themselves did not show a clear benefit from including SpinalCompCor regressors over our original denoising model. The potential for collinearity of principal component regressors with the task may be a concern, and this should be considered in future implementations for which task-correlated noise is anticipated.

Tuberculous longitudinal extensive transverse myelitis: 2 cases and literature review

Context This study aimed to investigate the characteristics, diagnosis, and management of tuberculous longitudinally extensive transverse myelitis (TB-LETM), a rare manifestation of tuberculosis. Findings We analyzed two rare cases of TB-LETM and discussed their clinical manifestations and imaging findings in the context of the relevant literature. Patient 1, a 23-year-old female, presented with quadriplegia and dysuria, and spinal magnetic resonance imaging (MRI) revealed lesions extending from C1 to T3. Patient 2, an 18-year-old female, reported acute-onset numbness and weakness in both lower limbs, with MRI showing lesions from T1 to T4, along with multiple intracranial leptomeningeal enhancements. Both patients had elevated cerebrospinal fluid (CSF) cell counts and protein levels, and positive blood T-cell spot test (T-SPOT.TB), but no microbiological evidence of Mycobacterium tuberculosis was found. Diagnosis was based on clinical presentation, medical history, chest computed tomography (CT) findings, and CSF analysis. Over the past decade, 14 cases of TB-LETM have been reported. Common symptoms include fever, acute paralysis, sensory deficits in the lower limbs, and dysuria. Elevated CSF protein, lymphocytosis, and decreased glucose levels are essential for differentiating TB-LETM from autoimmune disorders. Conclusion Longitudinally extensive transverse myelitis (LETM), especially when involving the cervical and thoracic cords, should be considered a potential manifestation of tuberculosis infection. Analysis of cerebrospinal fluid, MRI findings, and T-SPOT testing can provide crucial diagnostic insights. A combination of anti-tuberculosis therapy and corticosteroids has proven clinically effective in managing this condition.

Diagnosis of Leptomeningeal Disease in Diffuse Midline Gliomas by Detection of H3F3A K27M Mutation in Circulating Tumor DNA of Cerebrospinal Fluid.

Leptomeningeal disease (LMD) in diffuse midline gliomas (DMGs) can lead to devastating symptoms such as severe pain, urinary incontinence, and tetraparesis, with limited treatment options. We determined whether detecting H3F3A K27M-mutant droplets in cerebrospinal fluid (CSF) circulating tumor deoxyribonucleic acid (ctDNA) could be a biomarker for detecting LMD in DMGs. Twenty-five CSF samples were obtained from 22 DMG patients. Histological confirmation of H3F3A K27M mutation was obtained in 10 (45.5%) cases. ctDNA was extracted from CSF, and H3F3A K27M-mutant and wildtype droplets were detected using digital droplet polymerase chain reaction (ddPCR). LMD was diagnosed by CSF cytology and pre- and post-contrast head and spine magnetic resonance (MR) imaging. The number of H3F3A K27M-mutant droplets (median 27 [range: 1-379] vs. median 0 [range: 0-1]; p<0.0001) and variant allele frequency (VAF) (median 48.9% [range: 7.5%-87.5%] vs. median 0.0% [range: 0.0%-50.0%]; p<0.0001) were significantly higher in the LMD/early-LMD group compared to no-LMD group. In two cases (Cases 4 and 11) without clinical evidence of LMD, multiple H3F3A K27M-mutant droplets were detected in CSF ctDNA. In those cases, extensive spinal dissemination was detected 6months after the initial liquid biopsy. One case (Case 15) with high Schlafen11 (SLFN11) expression responded well to treatment for LMD and survived for 532days after the diagnosis of LMD. This study provides evidence that detecting H3F3A K27M-mutant droplets in CSF ctDNA is diagnostic for LMD and is more sensitive than traditional methods such as CSF cytology and MR imaging.

Comparison of sagittal measurements of cervical spine in spondylosis patients between Magnetic Resonance Imaging and Radiograph

Background Cervical spondylosis is the common degenerative disease of the vertebrae in adults which can lead to change in sagittal alignment of cervical spine. Radiograph and Magnetic resonance imaging (MRI) are widely used imaging modalities for measuring the sagittal parameters. However sagittal parameters measured using radiograph and MRI can be influence by patient positioning and imaging technique. The study aims to compare sagittal parameters measured using MRI (Magnetic Resonance Imaging) and radiograph in cervical spondylosis patients. Methods The study was done retrospectively. 77 patients who underwent both MRI and radiograph were included in the study. The sagittal parameters such as Neck Tilt (NT), T1 slope (T1S), thoracic inlet angle (TIA), C2-C7 angle (C2-C7A) and C2-C7 sagittal vertical axis (C2-C7 SVA) were measured on sagittal MRI and lateral cervical spine radiograph. Paired t-test was used to compare cervical sagittal measurements between MRI and radiography. Results The cervical sagittal parameters such as NT, T1S, TIA and C2-7 SVA showed significant difference between MRI and radiograph (p &lt; 0.05). But C2-C7A did not show significant difference (p &gt; 0.05) Conclusion The study concludes that MRI cannot be used as an alternative to cervical spine radiograph in spondylosis patient for measuring the sagittal balance as there was significant difference between sagittal parameters except C2-C7 A.

MRI to digital medicine diagnosis: integrating deep learning into clinical decision-making for lumbar degenerative diseases.

To develop an intelligent system based on artificial intelligence (AI) deep learning algorithms using deep learning tools, aiming to assist in the diagnosis of lumbar degenerative diseases by identifying lumbar spine magnetic resonance images (MRI) and improve the clinical efficiency of physicians. The PP-YOLOv2 algorithm, a deep learning technique, was used to design a deep learning program capable of automatically identifying the spinal diseases (lumbar disc herniation or lumbar spondylolisthesis) based on the lumbar spine MR images. A retrospective analysis was conducted on lumbar spine MR images of patients who visited our hospital from January 2017 to January 2022. The collected images were divided into a training set and a testing set. The training set images were used to establish and validate the deep learning program's algorithm. The testing set images were annotated, and the experimental results were recorded by three spinal specialists. The training set images were also validated using the deep learning program, and the experimental results were recorded. Finally, a comparison of the accuracy of the deep learning algorithm and that of spinal surgeons was performed to determine the clinical usability of deep learning technology based on the PP-YOLOv2 algorithm. A total of 654 patients were included in the final study, with 604 cases in the training set and 50 cases in the testing set. The mean average precision (mAP) value of the deep learning algorithm reached 90.08% based on the PP-YOLOv2 algorithm. Through classification of the testing set, the deep learning algorithm showed higher sensitivity, specificity, and accuracy in diagnosing lumbar spine MR images compared to manual identification. Additionally, the testing time of the deep learning program was significantly shorter than that of manual identification, and the differences were statistically significant (P < 0.05). Deep learning technology based on the PP-YOLOv2 algorithm can be used to identify normal intervertebral discs, lumbar disc herniation, and lumbar spondylolisthesis from lumbar MRI images. Its diagnostic performance is significantly higher than that of most spinal surgeons and can be practically applied in clinical settings.

Intelligent Medical System for Diagnosis of Intervertebral Disc Deformation

The article examines the application of semi-supervised learning and computer vision methods for segmentation of spine MR images and diagnosis of deformation of intervertebral discs. Existing neural network architectures for spine MR image segmentation and semi-supervised learning methods used in medical image segmentation are reviewed. A system for diagnosis deformation of intervertebral discs is proposed, which consists of two modules: a segmentation module and a diagnostic module. The implementation of the proposed system using two convolutional neural networks is presented: U-Net for segmentation of spine MR images and ResNet for classification of the degree of deformation of each intervertebral disc based on the Pfirrmann classification of degenerative changes. The software implementation of the medical diagnosis system was developed in the Python programming language using the PyTorch library. Neural networks were trained on an open dataset of spine MR images using a variant of the Mean Teacher semi-supervised learning method. As a result of the verification, it was found that the system is capable of performing segmentation with high accuracy. It was found that the exact prediction of the grade of degenerative changes according to Pfirrmann remains a difficult task, but the introduction of another classification made it possible to increase the accuracy of diagnosis of deformation of intervertebral discs. The proposed medical system involves the addition of new diagnostic modules, which makes it possible to use it for the comprehensive analysis of various spine diseases

Correlation Between MRI Findings, ODI, and VAS Score in Lumbar Disc Herniation

Introduction. Magnetic resonance imaging (MRI) is the preferred method for diagnosing the causes of lumboischialgia, as it offers the highest sensitivity and specificity compared to other imaging techniques. In clinical practice, there is often a notable discrepancy between patients’ clinical symptoms and the radiological findings. While there are various clinical tests for lumboischialgia, the Oswestry Disability Index (ODI) and the Visual Analogue Score (VAS) are the most commonly used and reliable. This article aims to explore the correlation between patients’ subjective pain experiences and their level of disability due to lumboischialgia and disc herniation as detected by MRI. Methods. In this prospective clinical study, a total of 100 patients of both genders, aged 18 to 65 years, were included. These patients were referred for magnetic resonance imaging of the lumbar spine due to complaints of lumboischialgia. MRI of the lumbar spine was performed, and the extent of degenerative changes was evaluated. Participants completed a questionnaire regarding their subjective pain experience and functional status, and the Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) were calculated. Results. The statistical analysis revealed a significant correlation between the severity of disc herniation (classification) and the intensity of spinal pain (p = 0.010), as well as with the disability index (p = 0.003). Conclusion. A statistically significant relationship was confirmed between the levels of pain and disability and the degree of intervertebral disc herniation observed on MRI images of the lumbar spine. Keywords: lumbal disk herniation, lumboischialgia, pain.

Advantages to interspace-level analyses over person-level analyses when studying relationships between lumbar spinal degeneration findings : a cross-sectional study.

To examine associations between lumbar intervertebral disc degeneration (LDD) and type II Modic changes (MC) when retaining information at each interspace ("interspace-level analysis"), as compared to aggregating information across interspaces as is typically done in spine research ("person-level analysis") . The study compared results from (1) interspace-level analyses assuming a common relationship across interspaces (the "interspace-level, common-relationship" approach), (2) interspace-level analyses allowing for interspace-specific associations (an "interspace-level, interspace-specific" approach), and (3) a conventional person-level analytic approach. Adults in primary care (n=147) received lumbar spine magnetic resonance imaging (MRI) and neuroradiologist-evaluated assessments of prevalent disc height narrowing (DHN), type II MC, and other LDD parameters. Analyses examined associations between DHN and type II MC in interspace-level, common-relationship analyses, interspace-level, interspace-specific analyses, and conventional person-level analyses. Cross-sectional, interspace-level, common-relationship analyses found large-magnitude DHN-type II MC associations (adjusted OR [aOR]=6.5, 95% confidence intervals (CIs) 3.3-13; p<0.001). The magnitude of this association was larger and more precise than that yielded by person-level analyses (aOR=2.9 [95% CI 1.2-7]), and substantially more precise than interspace-level, interspace-specific analyses which allowed the association between DHN and type II MC to vary across levels. Across exploratory analyses of disc signal intensity and other MC types, interspace-level, common-relationship analyses produced larger-magnitude and more precise associations than person-level analyses in most situations, and were more precise than interspace-level, interspace-specific analyses. Interspace-level analytic approaches offer some advantages to person-level analyses that may be useful in understanding relationships between spinal degeneration findings.

Modeling of intervertebral discs’ parameters of the lumbar spine base on somatometric data

The relevance of the study arises from the high prevalence of spinal column pathology and the rapid advancement of diagnostic technologies, which necessitate the refinement of criteria for identifying changes in the structural components of the spine, particularly one of its most vulnerable elementsт – the intervertebral discs. The reliance on subjective criteria for assessing intervertebral discs during magnetic resonance imaging (MRI) or computed tomography (CT) highlights the need for more objective, quantitative criteria to evaluate intervertebral disc changes. The aim of the study was to develop an optimal, practical model for calculating the total size index of intervertebral discs based on external body parameters, applicable in clinical practice, and to validate its effectiveness. To achieve this goal, lumbar spine MRI was performed on young women aged 16 to 26 years who were native residents of the Vinnytsia region. The main group consisted of 80 participants, including 52 young women aged 16-20 years and 28 women aged 21-26 years; the validation group included 65 females aged 16-26 years. Anthropometric measurements, including height and body weight, were recorded for all participants. Using data from the main group, mathematical modeling was conducted to determine the total size of lumbar intervertebral discs. The modeling process employed stepwise regression analysis based on somatodisc coefficients of individual intervertebral discs and anthropometric parameters. As a result, a model was developed to calculate somatodisc coefficients using body height and weight. Further algebraic transformations of the somatodisc coefficient yielded a formula for calculating individualized total disc size indicators, integrating vertical, sagittal, and transverse dimensions. The predictive accuracy of the obtained models ranged from 85 % to 91 %. When the actual total size measurements of intervertebral discs in the main group were compared to the mathematically modeled values, deviations did not exceed ±10 %. This mathematical model for calculating the total size of lumbar intervertebral discs based on somatometric data enables the determination of individualized normative metrics and the objective identification of early degenerative disc changes. When comparing clinical visual assessments of intervertebral disc changes using Pfirrmann grading with mathematical evaluations in the validation group, agreement was observed in 91 % of cases. Discrepancies were identified in 9 %, necessitating further analysis to prevent underdiagnosis or overdiagnosis of intervertebral disc changes. Thus, mathematical modeling serves as a tool for determining individualized normative metrics. The proposed mathematical models for calculating the total size of intervertebral discs based on body height and weight represent a powerful supplement to existing criteria for intervertebral disc assessment.

Adjacent Level Canal Area Changes up to 2 years after Lumbar Spinal Stenosis Decompressive Surgery.

A secondary analysis of data from the NORDSTEN-spinal stenosis trial (SST). The aim of the present study was to investigate whether the dural sac cross-sectional area (DSCA) on magnetic resonance imaging (MRI) of adjacent segments decreases after decompressive surgery due to lumbar spinal stenosis (LSS) up to 2 years postoperatively, and to investigate possible associations with baseline variables, including preoperative patient and radiological characteristics, and surgical method used. Decompressive surgery for LSS is currently the most common spinal surgery procedure; however, there is limited knowledge on changes in the DSCA over time adjacent to a decompressed segment. In the NORDSTEN-SST 437 patients were randomized to decompression with one of three minimally invasive surgical methods for LSS. The patients underwent MRI of the lumbar spine (L2-L5) before surgery and at 3 and 24 months postoperatively. Descriptive statistics of adjacent DSCA and changes in adjacent DSCA are presented. Possible prognostic factors (preoperative factors, radiological measures, and surgical method) for changes in the adjacent DSCA were examined using multivariate regression analyses. 322 patients (74%) in the original NORDSTEN-SST had undergone MRI at both 3 and 24 months postoperatively and were included (360 adjacent levels, 263 cranial, and 97 caudal to a decompressed level). Up to 2 years postoperatively, no decrease in adjacent DSCA was observed. No associations were found between the investigated baseline variables, and DSCA change from 0 to 2 years, except for a weak association with baseline adjacent DSCA. Up to 2 years postoperatively, the DSCA did not decrease at adjacent levels after decompressive surgery. None of the investigated baseline variables showed any clinical meaningful prognostic value regarding adjacent DSCA changes 2 years postoperatively. The findings support previous reports that decompression of adjacent levels is not required to prevent subsequent stenosis.

Diagnostic challenges of diffuse leptomeningeal glioneuronal tumor in an adult female: illustrative case

BACKGROUND Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare central nervous system tumor, especially in adult females. Typically, it presents with leptomeningeal enhancements in the basal cisterns and spinal cord. However, varied radiological and pathological features can complicate the diagnosis, as the present case illustrates. OBSERVATIONS An adult female presented with severe headache, blurred vision, and cognitive impairment. Elevated intracranial pressure (ICP) was detected via lumbar puncture. Brain magnetic resonance imaging (MRI) revealed atypical unilateral basal cistern enhancement, differing from the usual symmetrical DLGNT presentation. Despite high ICP, only mild ventricular enlargement was observed. Noncontrast spine MRI failed to demonstrate spinal leptomeningeal enhancement. A stereotactic biopsy of an occipital lesion was inconclusive. These atypical findings led to misdiagnoses of viral encephalitis or inflammation at two hospitals. Significant symptom relief occurred only after ventriculoperitoneal (VP) shunt surgery. Over 2.5 years, intraparenchymal lesions in the parahippocampal gyrus grew, necessitating surgical intervention. Pathological examination finally confirmed DLGNT. Postsurgery, the patient underwent chemotherapy with temozolomide and remains symptom free. LESSONS This case underscores the critical importance of comprehensive initial imaging, strategic biopsy planning, and timely placement of a VP shunt in patients with DLGNT. It contributes to the literature by revealing atypical imaging features and long-term progression patterns of DLGNT. https://thejns.org/doi/10.3171/CASE24701

The Importance of Bright Spotty Lesions on Magnetic Resonance Imaging in Predicting Chronic Neuropathic Pain in Myelitis.

Background/Objectives: Chronic neuropathic pain (CNP) stands as one of the most debilitating complications in patients with myelitis owing to its challenging management. Bright spotty lesions (BSLs) are frequently observed in neuromyelitis optica spectrum disorder (NMOSD), but few reports have discussed CNP in myelitis. We aim to demonstrate that BSLs could be one of the potential prognostic factors for CNP development in myelitis. Methods: We examined 63 patients diagnosed with myelitis. Patients were categorized into CNP and non-CNP groups. We assessed the severity of clinical symptoms and the oral steroid dose administered after pulse therapy. Spine magnetic resonance imaging (MRI) of each patient was reviewed to analyze the characteristics of myelitis. Serological and cerebrospinal fluid (CSF) findings were also examined to confirm the etiology. Results: CNP was observed in 27 patients (42.9%). The mean onset age of patients with CNP was 45.26 ± 14.16 years. The MRI lesions exhibited more enhanced features and bright spotty lesions (BSLs) in the CNP group (χ2 test, p < 0.05). Patients with CNP received a lower oral steroid dose during the first month after symptom onset (χ2 test, p < 0.05). Multivariate logistic regression analysis revealed that patients with CNP exhibited significant BSLs in their myelitis lesions on spine MRI (OR 4.965; 95% CI, 1.282 to 19.235, p = 0.02). Conclusions: Although the exact mechanism remains unknown, the presence of BSLs on spine MRI could serve as an independent prognostic factor for CNP development. Additionally, our study suggests that lower oral steroid doses administered immediately after symptom onset are associated with CNP development. Further investigation with a larger cohort is warranted to validate our findings.

Inter-observer variability in the classification of lumbar foraminal stenosis in magnetic resonance imaging using different evaluation scales.

The evaluation of lumbar spine degeneration on magnetic resonance imaging (MRI) is prone to inter-reader variability, including when assessing foraminal changes. This variability, often due to subjective criteria and inconsistent terminology, may affect clinical correlations. Standardized criteria could help improve agreement among readers. MRI of the lumbar spine of 50 randomly selected patients were evaluated by 12 independent readers. Foraminal stenosis was assessed using four different rating scales for each patient. The first scale classified stenosis as presence/absence of neurologic compromise of the spinal nerve root at the foramen, the second scale classified stenosis as absent/mild/moderate/severe, the third scale as normal/contact of disk or osteophyte with the nerve root/deviation of the nerve root/compression of the nerve root, and the fourth scale utilized the Lee et al. criteria. Agreement analysis was performed using Fleiss' kappa coefficients. Agreement was moderate using the first scale (k = 0.439), and significantly lower using the second, third and fourth scales (k = 0.310, k = 0.311, k = 0.295, respectively). When comparing the agreements obtained between board certified neuroradiologists and between neuroradiology residents, there was statistically significant differences when using the third and fourth scales, where the agreement for board certified neuroradiologists was higher, but still only fair. Individual kappas showed that in the second, third, and fourth scales the levels of agreement were higher in the extremes of the scale, namely, when there was no stenosis or when the stenosis was maximal with nerve compression. Levels of agreement can differ depending on the scale used. Simpler dichotomous scales may return higher levels of agreement compared to more complex ones. For the non-dichotomous scales, using different scales may not result in overall different levels of agreement. Given the overall low inter-rater agreements observed, there is probably significant potential to enhance agreement through more rigorous training and consensus-building.

Comparing the Accuracy and Reliability of Detecting the Intensity of Spinal Inflammation on STIR Sequence with Apparent Diffusion Coefficient Values in Axial Spondyloarthritis

Objective: To compare the accuracy and reliability of detecting the intensity of spinal inflammation on short tau inversion recovery (STIR) with the apparent diffusion coefficient (ADC) values of the active magnetic resonance imaging (MRI) lesions in axial spondyloarthritis (axSpA). Materials and methods: Fifty active lesions in the STIR sequence of spinal MRI were identified. With reference to sites of active lesions in STIR, the corresponding region of interest (ROI) on the ADC map was drawn to determine the maximum ADC (ADC[Formula: see text]), mean ADC (ADC[Formula: see text]), normalized maximum (nADC[Formula: see text]), and mean (nADC[Formula: see text]). Four independent readers scored the identified active lesions as “intense” or “non-intense” according to the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index. They were compared to various ADC parameters for assessment of accuracy and reliability. Regression analyses were used to adjust potential factors that could affect ADC. Results: Significant differences were found in ADC[Formula: see text] between “intense” and “non-intense” lesions scored by three of the four readers (1,405.7 ± 271.4 vs. 1,165.8 ± 223.8, [Formula: see text] = 0.01; 1,420.7 ± 272.1 vs. 1,209.0 ± 248.5, [Formula: see text] = 0.01; 1,438.0 ± 307.2 vs. 1,213.6 ± 231.0, [Formula: see text] = 0.01). Only one reader could differentiate a difference in “intense” and “non-intense” lesions with respect to ADC[Formula: see text] (899.2 ± 248.3 vs. 711.0 ± 222.6, [Formula: see text] = 0.01) and nADC[Formula: see text] (4.4 ± 2.1 vs. 3.4 ± 1.4, [Formula: see text] = 0.05). Inter-reader agreements were slight to moderate (kappa = 0.07–0.45). Reliability substantially improved when only the lowest and highest 25th percentiles of ADC values were included (kappa = 0.17–0.75). Regression analyses showed that the “intense” lesions were associated with higher ADC values after adjustment for confounders. Conclusion: Reading of STIR MRI is limited by the lack of ability in differentiating subtle differences of spinal inflammation. ADC could be an alternative method.

Mild cognitive impairment in spontaneous intracranial hypotension and its rapid reversal by repair of a spinal cerebrospinal fluid leak.

Patients with spontaneous intracranial hypotension (SIH) report difficulties in concentration and memory. To objectify these deficits, we implemented standard cognitive tests into our routine SIH workup. Retrospective, single-center report of cognitive standard tests among patients with SIH consecutively admitted from May to July 2023. Cognitive testing involved the Montreal Cognitive Assessment (MoCA©, alternate versions,0-30 points, 30 points for best performance, ≤26 indicating mild cognitive impairment at age >64 years), and the Trail Making Test, part B (TMT B, z-scores adjusted to age and education) to test for executive function. Both were administered at admission, and within 36-72 h after surgical repair of the spinal cerebrospinal fluid (CSF) leak. A total of 18 patients with an active spinal CSF leak were tested at admission (seven with ventral, three with lateral leak, and eight with CSF-venous fistula). There was no profound brain sagging as described in brain sagging dementia. The mean (standard deviation [SD]) age was 53.6 (11) years. Bern scores ranged between 0 and 9, median 6.5. The mean (SD) MoCA score at admission was 26.5 (2) points, with five patients (28%) scoring <26 points indicative of mild cognitive impairment. Performance in the TMT B was impaired in nine patients (50%, z-score ≥2). Upon targeted treatment of the CSF leak, the mean (SD) MoCA score immediately improved to 28.5 (1), p = 0.001 (n = 14), as did performance on the TMT B (mean [SD] 2.1 [2] vs. 1.1 [1], p = 0.015, n = 13). Spontaneous intracranial hypotension with an active spinal CSF leak is associated with cognitive impairment and surgical closure of the leak led to rapid improvement. We conclude that there may be a causal relationship between cognitive dysfunction and spinal CSF loss. We suggest considering spinal CSF leaks as a treatable cause in patients with mild cognitive impairment and with pre-dementia. This may ultimately necessitate thorough screening of brain and spine magnetic resonance images in patients with mild cognitive impairment.

Advancements in Imaging Techniques for Early Diagnosis and Management of Axial Spondyloarthritis.

We aimed to introduce recent finding of imaging studies used in axial spondyloarthritis (axSpA). Using low-dose whole spine CT (CT syndesmophyte score [CTSS]) improved diagnostic accuracy for evaluating spinal structural progression than previous method (modified Stoke Ankylosing Spondylitis Spinal Score [mSASSS]) in axSpA. The novel definition of positive finding of sacroiliac joint (SIJ) and spine magnetic resonance imaging (MRI) enabled to diagnose axSpA earlier than plain radiography. In addition, novel MRI protocol such as volumetric interpolated breath-hold examination improved detection rate of structural change of axial joints in axSpA, Nuclear medicine imaging showed potential for diagnosis and predicting progression of axSpA. Ultrasonography guided injection is useful for controlling local joint pain of axSpA. AxSpA is characterised by pain and inflammation of axial joints such as the SIJ and spine. Detection of active inflammatory lesions using MRI has expanded the subtypes of axSpA to include non-radiographic axSpA (nr-axSpA). In addition, many other imaging techniques have improved, and can now detect structural and early inflammatory lesions of the axial joints. In addition, a method for quantitative measurement of syndesmophytes by CTSS has been developed; this method is more accurate and sensitive than the mSASSS for detecting spinal structural damage. Here, we discuss the current knowledge and clinical advances in computed tomography, MRI, nuclear medicine imaging, and ultrasonography as imaging methods for axSpA.