Total Spine Magnetic Resonance Imaging Research Articles

The "Crossing Collection Sign": A Diagnostic Tool on Spine Magnetic Resonance Imaging For Localizing Cerebrospinal Fluid Leak.

The aim of the study is to determine whether the site of "cross" between ventral and dorsal spinal longitudinal extradural CSF collections (SLECs) seen on magnetic resonance imaging during initial workup of patients with suspected CSF leaks can predict the subsequently confirmed leakage site on computed tomography myelography or surgical repair. This was an institutional review board-approved, retrospective study performed from 2006 to 2021. Patients with SLECs who underwent total spine magnetic resonance imaging at our institution, followed by myelography and/or surgical repair for CSF leak, were included. Patients with incomplete workup including lack of computed tomography myelography and/or surgical repair and patients severely motion degraded imaging were excluded from our study. The site of cross between ventral and dorsal SLECs was defined as the "crossing collection sign" and was compared with the anatomically confirmed site of leak on myelography and/or at surgical repair. Thirthy-eight patients met inclusion criteria with 18 females and 11 males ranging in age from 27 to 60 years (median, 40 years; interquartile range, 14 years). The crossing collection sign was seen in 76% of patients (n = 29). The distributions of confirmed CSF leak were as follows: cervical (n = 9), thoracic (n = 17), and lumbar spine (n = 3). The crossing collection sign predicted the site of CSF leak in 14 of 29 patients (48%) and was within 3-vertebral segments in 26 of 29 cases (90%). The crossing collection sign can help prospectively identify spinal regions with highest likelihood for CSF leak in patients with SLECs. This can potentially help optimize the more invasive subsequent steps in the workup for these patients, including dynamic myelography and surgical exploration for repair.

Dermatomal somatosensory evoked potentials and cortical somatosensory evoked potentials assessment in congenital scoliosis

BackgroundThe aim of this study was to assess the value of dermatomal somatosensory evoked potentials (DSEPs) and cortical somatosensory evoked potentials (SSEPs) in monitoring spinal cord function for patients with congenital scoliosis (CS).MethodsThis retrospective study reviewed the medical records of patients (n = 102) who underwent DSEP (T2-S1 dermatome), of whom 60 were normal subjects and 62 with congenital scoliosis. The study analyzed the latencies and peaks of N1-L, N1-R, P1-L and P1-R recorded by DSEPs of patients’ thoracolumbar dermatomes. To observe the incidence of abnormal DSEPs and SSEPs in CS patients and to analyze the difference in sensitivity and reliability between the two in the examination of scoliosis patients. SPSS 22.0 statistical software package was used to analyze the data, and χ2 test and correlation analysis were used to indicate that the difference was statistically significant, p < 0.05.ResultsSixty two patients with CS were evaluated with total spine magnetic resonance imaging (MRI). Only 23 patients (37.09%) showed spinal cord malformations in the MRI findings. The DSEP recordings showed a relatively high sensitivity (97.8%) compared to the abnormality rate of SSEPs recordings, and the rates of waveform, latency and amplitude abnormalities were much higher in DSEPs recordings (36.6, 36.3, 24.8%) than in SSEPs recordings (3.2, 22.5, 14.5%). The abnormality rate of DSEP records with and without neurological symptoms was higher than the abnormality rate of SSEP records (100% vs 20, 96.2% vs 44.2%, p<0.05). And in 62 patients with CS, the rate of positive MRI (37.1%) was lower than that recorded by DSEP (79.6% / 57.9%). p < 0.05.ConclusionDSEPs are more sensitive to microscopic posterior column dysfunction in patients with CS that cannot be detected by either radiology or routine clinical examination. Preoperative DSEPs assessment is recommended as a baseline examination for intraoperative monitoring and comparison with the postoperative situation. DSEPs recording complements the information obtained from routine clinical and radiological evaluation.

Total spine magnetic resonance imaging for detection of multifocal infection in pyogenic spondylodiscitis: a retrospective observational study

BackgroundDue to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. However, controversially discussed is the need for magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD.MethodsWe retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 2016 and 2018. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. Surgical therapy was evaluated in patients with mSpD.ResultsuSpD was detected by MRI in 69 of 79 patients (87%). Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. All patients with uSpD were treated operatively. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure; one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. One patient died before a planned two-stage procedure was performed.ConclusionsDue to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen.

Diagnostic performance of sacroiliac joint MRI and added value of spine MRI to detect active spondyloarthritis

PurposeTo investigate the diagnostic performance of sacroiliac joint (SIJ) magnetic resonance imaging (MRI) and the incremental value of spine MRI to “predict” clinical disease activity in patients with axial spondyloarthritis (axSpA). Materials and methodsThis cross-sectional study included adult patients with known axSpA according to the SpondyloArthritis International Society (ASAS) classification criteria, radiological arm. MRI disease activity was scored semi-quantitatively for SIJ and total spine MRI in each patient. Two cut-off levels (≥ 1.3 and ≥ 2.1) for ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP) were considered for clinical disease activity categorization. MRI scores were first evaluated individually. Then, SIJ score was combined with the score from a spine segment (lumbar, cervical, thoracic or total spine) to build a bi-parametric model using a classification tree. Receiver operating characteristic (ROC) curves were constructed to evaluate the classification performance according to disease activity category of these models. ResultsForty-four patients (30 men, 14 women; mean age, 37 years±10 [SD] [range: 17–64 years]) with a mean disease duration of 5 years±8 (SD) (range: 0–35 years) were included. Thirty-six patients (36/44; 82%) had ASDAS-CRP≥1.3 and 27 patients (27/44; 61%) had ASDAS-CRP≥2.1. The most frequently involved spinal segment was mid-thoracic (T7-T8). The SIJ MRI score was an informative model to identify active axSpA (AUC≥0.7, regardless of the cut-off level on ASDAS-CRP). Performance of bi-parametric models based on “SIJ+thoracic spine” (for detecting patients with ASDAS-CRP≥1.3) or “SIJ+total spine” (for detecting patients with ASDAS-CRP≥2.1) outperformed that of the individual SIJ score (P<0.05). ConclusionThe combination of MRI of the SIJ and spine allows to accurately discriminate between active and inactive axSpA, outperforming SIJ MRI alone.

Magnetic resonance tomography for the early detection of occult fractures of the spinal column in patients with ankylosing spondylitis

PurposeThe purpose of this study was to determine the extent to which magnetic resonance imaging (MRI) performed in patients with ankylosing spondylitis (AS) after low- and no-energy trauma leads to an improved diagnosis and, as a result, to a change in the therapeutic strategy.MethodsAll patients with AS, who underwent surgery after minor traumas (low-energy traumas, LETs) and patients without trauma history (NET: no-energy trauma), were retrospectively analysed. The diagnostic and planned surgical procedure was examined initially and again after total spine MRI in patients with persistent and/or new complaints.ResultsOne hundred and thirty-six patients with AS after trauma were surgically treated. A total of 92 patients with LETs and 12 patients with NETs were included. After initial diagnostics (CT and X-ray) were performed in 15.4% of the patients with LET or NET (n = 16), we found occult fractures on MRI scans. In ten of these patients (6 LET, 4 NET) in which a previous decision was made to follow conservative therapy, no fracture indication was found on CT or X-ray. Two fracture heights were observed in six patients who experienced LET. However, on X-ray and CT, the fractures were only visible at one height. All fractures were treated surgically with stabilization and decompression if indicated.ConclusionConsidering the high percentage of our patient population with occult fractures, we recommend supplementing the basic diagnostic procedures with an MRI of the entire spinal column in patients with painful spinal column findings after minor trauma and for those with persistent pain without trauma.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.

A population-based study identifies an association of THBS2 with intervertebral disc degeneration

To clarify the genetic mechanisms underlying intervertebral disc degeneration (IDD), we examined the associations between single-nucleotide polymorphisms (SNPs) and indicated as coefficient of interaction term (IDD) in a general population in Japan. This was a cross-sectional study. In 1,605 participants, C2-3 to L5/S1 in the total spine magnetic resonance imaging (MRI) were evaluated using the Pfirrmann's scoring system. Disc scores of 4 and 5 were defined as IDD. Eight SNPs in eight genes associated with IDD were examined at each disc level, considering the non-genetic risk factors of age, sex, and body mass index (BMI). The highest odds ratio was found for rs9406328 in the THBS2 gene at disc level T12-L1 (OR 1.27, 95%CI 1.05 to 1.53), and this association was strengthened after adjustment for age using logistic regression (OR 1.37, 95%CI 1.12 to 1.67). Among participants aged <50 years and 50-59, the average IDD score in those with 2 risk alleles of rs9406328 was markedly higher than in those with 0 or 1 risk allele, and the difference is much wider than the elderly participants. It indicates the genetic effect of rs9406328 is stronger in the younger age groups. Finally, multiple linear regression analyses of the association between rs9406328 and IDD, adjusted for age, sex, and BMI at each disc level, showed a statistical interaction between age and the number of risk alleles at C7-T1, T3-4 and T4-T5 as well as T12-L1. CONCLUSION: The association between rs9406328 in THBS2 and IDD was replicated. The contributions of genetic and environmental factors to IDD differed by disc level.

An MRI Analysis of the Pelvis to Determine the Ideal Method for Ultrasound-Guided Bone Marrow Aspiration from the Iliac Crest.

Use of mesenchymal stem cells from bone marrow has gained significant popularity. The iliac crest has been determined to be an effective site for harvesting mesenchymal stem cells. Review of the literature reveals that multiple techniques are used to harvest bone marrow aspirate from the iliac crest, but the descriptions are based on the experience of various authors as opposed to studied anatomy. A safe, reliable, and reproducible method for aspiration has yet to be studied and described. We hypothesized that there would be an ideal angle and distance for aspiration that would be the safest, most consistent, and most reliable. Using magnetic resonance imaging (MRI), we reviewed 26 total lumbar spine MRI scans (13 males, 13 females) and found that an angle of 24° should be used when entering the most medial aspect of the posterior superior iliac spine (PSIS) and that this angle did not differ between the sexes. The distance that the trocar can advance after entry before hitting the anterior ilium wall varied significantly between males and females, being 7.53 cm in males and 6.74 cm in females. In addition, the size of the PSIS table was significantly different between males and females (1.20 cm and 0.96 cm, respectively). No other significant differences in the measurements gathered were found. Using the data gleaned from this study, we developed an aspiration technique. This method uses ultrasound to determine the location of the PSIS and the entry point on the PSIS. This contrasts with most techniques that use landmark palpation, which is known to be unreliable and inaccurate. The described technique for aspiration from the PSIS is safe, reliable, reproducible, and substantiated by data.

Comparison of somatosensory evoked potentials between adolescent idiopathic scoliosis and congenital scoliosis without neural axis abnormalities

Background contextAbnormal somatosensory evoked potentials (SEPs) have been documented in patients with adolescent idiopathic scoliosis (AIS) with different cure severity. However, few studies investigated whether abnormal SEPs were the cause or effect of idiopathic scoliosis. PurposeThe purpose of this study was to investigate the significance of abnormal SEPs in patients with AIS, and to explore its effect on the etiopathogenesis of AIS. Study design/SettingThis study evaluated SEPs in patients with AIS and congenital scoliosis (CS) with similar curve pattern and severity both in coronal and sagittal planes. Patient sampleFemale patients with AIS and CS in our spine surgery center from 2000 to 2009 were recruited for this study. Outcome measuresRate of abnormal SEPs. MethodsPosterior tibial nerve SEPs (PTN-SEPs) were performed on female patients with AIS and CS. The inclusion criteria were patients with AIS with a Lenke type 1 curve and patients with CS with right thoracic curve (apex between T5 and T12) and normal sagittal profile (kyphosis less than 50° measured from T2 to T12). All patients were evaluated with total spine magnetic resonance imaging, and those with neural axis abnormalities were excluded. The patients with neurological deficits on detailed physical examination were also excluded. Absence of SEPs waveforms or prolongation of peak latency or asymmetrical peak latency were defined as pathological change. The incidence of pathological SEPs and clinical characteristics were compared between patients with AIS and patients with CS. ResultsForty-six patients with AIS and 33 patients with CS were included in this study. There was no significant difference in coronal and sagittal Cobb angle between the two groups. The rate of abnormal SEPs was 32.6% (15/46) and 12.1% (4/33) in AIS and CS groups, respectively, and the difference was statistically significant (p<.05). ConclusionSomatosensory pathway dysfunction could be found in both AIS and CS without neural axis abnormalities, and the patients with AIS tended to have higher rates of somatosensory disorders than patients with CS with similar scoliosis curve, which indicates that both scoliosis curve and primary etiopathogenic factor contribute to the sensory deficit in patients with AIS.

Catastrophic Bone Deformities Associated With Primary Hyperparathyroidism in a Middle-Aged Man

In March 2008, a 43-year-old male presented with generalized leg aches and gait disturbances associated with multiple pathological fractures in both upper (Figure 1, left) and lower (Figure 1, right) extremities. His medical records documented that in March 2001, he presented with leg aches to another hospital. With the suspicion of malignancy, total spine magnetic resonance imaging had been performed, and lytic lesions in cervical, thoracic, and lumbar vertebrae were detected. A total-body skeletal scintigraphy had demonstrated widespread lytic lesions. He had had pathological fractures in the right femur, and humerus, and he had been operated for those fractures. The histopathological examination of bone biopsy suggested an increase in both osteoclastic and osteoblastic activities. Thereafter, he had been diagnosed with primary hyperparathyroidism (corrected serum calcium 18.5 [8.4–10.2] mg/dL, PTH 400 [8–76] pg/mL). A right inferior parathyroid adenoma (28 20 mm in diameter), probably unrecognized parathyroid carcinoma, had been excised. Early after the surgery, serum calcium levels were noted as 8.4 mg/dL. The patient was lost in the interval between 2001 and 2008. His serum calcium, creatinine, PTH, and 25-hydroxyvitamin D levels were 15.6 mg/dL, 2.6 mg/dL, 1700 pg/mL, and 24.8 g/L, respectively. Neck ultrasound showed multinodular goiter and multiple hypoechoic lesions adjacent to thyroid. Total parathyroidectomy and thyroidectomy performed. Histopathological and immunohistochemical examinations revealed a parathyroid carcinoma in 3 different loci, with an invasion to the adjacent perineural, vascular, and lymphatic tissues (Figure 2, right sections), and benign nodular goiter. He was discharged from the hospital with serum calcium and PTH levels of 7.6 mg/dL and 430 pg/mL, respectively, and rehospitalization as soon as possible was advised to perform neck dissection. He disappeared and lost his follow-up once again until October 2010, when he presented with malaise, fatigue, gait disturbances, and marked renal insufficiency (calcium 16.5 mg/dL, PTH 1497 pg/mL, and serum creatinine 5.5 mg/dL). Radiography of the right femur demonstrated generalized brown tumors that were huge and incorporated in distal femur giving it the form bent bone, associated with osteitis fibrosa cystica (Figure 2, upper image). Neck ultrasonography showed an irregularly shaped parathyroid lesion (17 14 mm, Figure 2, lower left image), with a surrounding pathological lymph node (14 8 mm, Figure 2, middle image). He died of myocardial infarction when he was being prepared for neck exploration surgery and while he was awaiting for bureaucratic procedures that were started to import cinacalcet from other European countries. Some of the radiologic findings in the last admission were calcifications in Waldeyer’s ring, bilateral cervical lymph nodes 18 to 20 mm in diameter (neck computed tomography), atrophic kidneys with lobulated contours, indistinguishable cortex and medulla within the kidneys, opacities (probably cristaloids) within the collecting tubes of the urinary system (urinary system ultrasonography), mitral valve calcifications, myocardial hypertrophy (echocardiography), and 95% constriction within the left anterior descending artery (coronary angiography). Although the clinical spectrum of primary hyperparathyroidism has changed during the last decades (1), still severe bone deformities may be observed in cases with severe and long-lasting hyperparathyroidism, especially in

Prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis.

Although reports in the literature have demonstrated an approximately 20% prevalence of neural axis abnormalities in patients with juvenile idiopathic scoliosis who have a curve of >20 degrees, the prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis is not well documented. In two previous studies involving a total of only ten patients with infantile idiopathic scoliosis, five patients were noted to have a neural axis abnormality on magnetic resonance images. The records of forty-six consecutive patients who were seen between 1992 and 2000 at three spinal deformity clinics were retrospectively reviewed. The inclusion criteria included presumed idiopathic scoliosis at the time of presentation, an age of three years or less, a curve magnitude of > or = 20 degrees, normal neurological findings, no associated syndromes, and no congenital abnormalities. All patients were evaluated with a total spine magnetic resonance imaging protocol for examination of neural axis abnormalities from the skull to the coccyx. Ten (21.7%) of the forty-six patients were found to have a neural axis abnormality on magnetic resonance imaging. This group included five patients with an Arnold-Chiari malformation and an associated cervicothoracic syrinx, three with syringomyelia, one with a low-lying conus, and one with a brainstem tumor. Eight of these ten patients needed neurosurgical intervention for treatment of the abnormality. The 21.7% prevalence of neural axis abnormalities in this group of patients with infantile idiopathic scoliosis was found to be almost identical to that reported in the literature on patients with juvenile idiopathic scoliosis. Because of the high prevalence of abnormalities and the fact that eight of the ten patients with abnormal findings on magnetic resonance images required neurosurgical intervention, a total spine magnetic resonance imaging evaluation at the time of presentation is recommended for all patients with infantile idiopathic scoliosis who have a curve measuring > or = 20 degrees.

Incidence of neural axis abnormalities in infantile and juvenile patients with spinal deformity. Is a magnetic resonance image screening necessary?

A prospective and retrospective review of patients 10 years and younger with idiopathic scoliosis evaluated with a total spine magnetic resonance imaging (MRI) scan. To determine the incidence of neural axis abnormalities in infantile and juvenile patients with idiopathic scoliosis without neurologic findings on history and examination, to determine the need for a screening MRI in this age group. In previous studies, a 19.2% and 26% incidence of neural axis abnormalities were found in infantile and juvenile patients with "idiopathic" scoliosis, respectively, raising the question of routine MRI screening of the spinal canal in these patients. A prospective study included 34 consecutive patients newborn to 10 years of age treated between 1992 and 1996 at a spinal deformity clinic with idiopathic scoliosis > 20 degrees without neurologic findings. In addition, a retrospective review of 64 patients age newborn to 10 years of age with idiopathic scoliosis was performed. All patients were evaluated by a total spine MRI protocol for examination of neural axis abnormalities. The incidence of neural axis abnormalities in the prospective group of 34 patients was 17.6% (6 of 34); the incidence of neural axis abnormalities was 20.3% (13 of 64) in the retrospective group. Of 6 patients in the infantile age range, 3 (50%) had neural axis abnormalities. A total spine MRI is recommended at presentation in patients with juvenile onset idiopathic scoliosis (> 20 degrees) because of the high incidence of neural axis abnormalities. Further study appears warranted to establish the incidence of neural axis abnormalities in infantile idiopathic scoliosis to determine the need for total spine MRI screening in this age group.