Whole-spine MRI Research Articles

Prevalence of and factors associated with stenotic thoracic ligamentum flavum hypertrophy

IntroductionStenotic thoracic ligamentum flavum hypertrophy can cause leg and/or low back pain similar to that caused by lumbar spinal stenosis. However, the thoracic spine may occasionally be overlooked in patients...

Deep learning-based k-space-to-image reconstruction and super resolution for diffusion-weighted imaging in whole-spine MRI

PurposeTo assess the feasibility of deep learning (DL)-based k-space-to-image reconstruction and super resolution for whole-spine diffusion-weighted imaging (DWI). MethodThis retrospective study included 97 consecutive patients with hematologic and/or oncologic diseases who underwent DL-processed whole-spine MRI from July 2022 to March 2023. For each patient, conventional (CONV) axial single-shot echo-planar DWI (b = 50, 800 s/mm2) was performed, followed by DL reconstruction and super resolution processing. The presence of malignant lesions and qualitative (overall image quality and diagnostic confidence) and quantitative (nonuniformity [NU], lesion contrast, signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR], and ADC values) parameters were assessed for DL and CONV DWI. ResultsUltimately, 67 patients (mean age, 63.0 years; 35 females) were analyzed. The proportions of vertebrae with malignant lesions for both protocols were not significantly different (P: [0.55–0.99]). The overall image quality and diagnostic confidence scores were higher for DL DWI (all P ≤ 0.002) than CONV DWI. The NU, lesion contrast, SNR, and CNR of each vertebral segment (P ≤ 0.04) but not the NU of the sacral segment (P = 0.51) showed significant differences between protocols. For DL DWI, the NU was lower, and lesion contrast, SNR, and CNR were higher than those of CONV DWI (median values of all segments; 19.8 vs. 22.2, 5.4 vs. 4.3, 7.3 vs. 5.5, and 0.8 vs. 0.7). Mean ADC values of the lesions did not significantly differ between the protocols (P: [0.16–0.89]). ConclusionsDL reconstruction can improve the image quality of whole-spine diffusion imaging.

Whole-Spine MRI in Children With Suspected Abusive Head Trauma.

BACKGROUND. Abusive head trauma (AHT) in children has recently been associated with findings on cervical spine MRI. OBJECTIVE. The purpose of this study was to evaluate whether whole-spine MRI in children with suspected AHT shows additional abnormalities not identified on cervical spine MRI. METHODS. This retrospective study included 256 children younger than 3 years old (170 boys, 86 girls; mean age, 5.9 months) who underwent skeletal survey and head MRI for suspected child abuse from January 2019 to December 2020. Per institutional protocol, children with suspected AHT also underwent whole-spine MRI. AHT diagnoses were established by a combination of clinical information from medical record review and injuries described in reports from skeletal survey, head MRI, and head CT (if performed). Two pediatric neuroradiologists independently reviewed whole-spine MRI examinations for presence and level of intraspinal hemorrhage (classified as subarachnoid, subdural, or epidural), ligamentous injury, spinal cord edema, and vertebral fractures; subdural hematoma, epidural hematoma, ligamentous injury, and fracture unidentified by skeletal survey were considered major findings. Interobserver agreement was assessed; a third radiologist resolved discrepancies. Findings were summarized with attention to injuries isolated to the thoracolumbar spine. RESULTS. A total of 148 of 256 (57.8%) children underwent whole-spine MRI. AHT was diagnosed in 79 of 148 (53.4%) children who underwent whole-spine MRI versus in 2 of 108 (1.9%) who did not undergo whole-spine MRI (p < .001). Interobserver agreement, expressed as kappa coefficient, was 0.90 for intraspinal hemorrhage, 0.69 for ligamentous injury, 0.66 for spinal cord edema, and 0.95 for fracture. A total of 57 of 148 (38.5%) whole-spine MRI examinations showed injuries, and 34 of 148 (23.0%) showed injuries localized to the thoracolumbar spine. A total of 47 of 148 (31.8%) whole-spine MRI examinations showed major findings, of which 24 (51.1%) were localized to the thoracolumbar spine. Isolated thoracolumbar injuries included 23 of 34 spinal subdural hematomas, 2 of 3 spinal epidural hematomas, and 9 of 11 vertebral fractures, including five fractures not identified by skeletal survey. Diagnosis of AHT was more common in children with positive, versus negative, whole-spine MRI examinations (76.8% vs 39.1%; p < .001). CONCLUSION. In children with suspected AHT, whole-spine MRI commonly shows isolated thoracolumbar injuries. CLINICAL IMPACT. The results support performing whole-spine MRI rather than cervical spine MRI in children with suspected AHT.

Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report

Background and aim: Spinal tuberculosis (STB) is a hazardous type of bone tuberculosis that could affect the entire spine, with predilection towards the lower thoracic level. Upper cervical spondylitis occurred only at 0.3 – 1% of all STB cases, but this rare type leads to severe consequences, including tetraplegia, autonomic dysfunction, and respiratory impairment. This case reported long CTLSO rigid external stabilisation reasoning to boost protection whilst recovering tuberculosis despite stable internal stabilisation. Methods: A 34-year-old male came with one year of worsening low-back pain, unintentional weight loss, and gradual loss of power and sensation of both feet within a month. Physical examination showed kyphotic deformity, tenderness, key-muscle-strength 3, and sensory impairment for lower extremities, with no autonomic disturbances. Laboratory works showed chronic ongoing infection. Whole-spine MRI showed multiple spondylodiscitis with multi-focal paravertebral abscesses at C3 – C5, C7 – T3, T9 – T12, L1, severe canal stenosis and anterior segment destruction of T12. Results: The patient was diagnosed with SCI AIS D with a neurological level of L3 secondary to T12 vertebra destruction from STB. He underwent abscess evacuation, debridement, and posterior stabilisation at T10 – L3 and debridement of abscess at C3 – C5 without the need for stabilisation. After procedures, the spine was further stabilised by a CTSLO brace with flexion, extension, lateral flexion, rotation stop. Inward rehabilitation includes incremental mobilisation, upper-limb-extensor-group-strengthening-programme, balance-exercise with ambulation training. Patient discharged with status: ambulate independently with a walker. To date, the patient has returned to work with independent ambulation. Conclusion: Type-III STB was indicated for surgical procedures. Instability of upper cervical prevented patient to performed loadbearing activity thus lowering patient functional outcomes. CTLSO supplementation was given to compensate for 3 lesion sites, the upper cervical, mid-thoracic, and lower-thoracic. For the C3 – C5 lesion, there was no internal stabilisation, so a proper external mode of stabilisation should be given. However, for the thoracic level, CTLSO was given due to (1) incomplete SCI lesion in the absence of deteriorating neurological deficit,c(2) porous nature of STB, and (3) good prognostic recovery of STB with anti-TB medication leading to the reversible neurological deficit.

Comparative analysis and differentiation between SAPHO syndrome and spondyloarthropathies using whole-spine MRI

To determine the imaging characteristics of SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome and seronegative spondyloarthropathies (SpAs) on whole-spine magnetic resonance imaging (WS-MRI) and evaluate the role of WS-MRI in the diagnosis and differentiation of the two diseases. Twenty-eight patients with SAPHO and 44 with SpAs were included. All patients were symptomatic and clinically diagnosed with SAPHO or SpAs, and all underwent WS-MRI for comparison of imaging characteristics. The mean age of the SAPHO patients was 48.7±12.7 years, while that of the SpA patients was 34.7±12.3 years (p<0.001). WS-MRI showed that the frequency of cervical, thoracic, and lumbar spine involvement was 53.6% versus 52.3%, 75% versus 88.6%, and 60.7% versus 63.6%, respectively (p=0.70, 0.13, and 0.80). The frequency of sacroiliac joint involvement was 7.1% and 100% (p<0.001). Continuous spinal involvement accounted for 50% versus 43.2%, 60.7% versus 84.1%, and 39.3% versus 40.9% in the cervical, thoracic, and lumbar vertebrae, respectively (p=0.03). WS-MRI showed that bone marrow oedema of spinal anterior corner was observed in 50% versus 75% (p=0.03). Vertebral body and posterior attachment involvement accounted for 85.7% versus 93.2% and 14.3% versus 34.1% (p=0.3, 0.06). The frequency of bone erosion in mobile spine was 75% and 36.4%, respectively (p=0.02). The frequency of intervertebral disc, endplate, anterior thoracic wall, and paraspinal soft-tissue swelling was 42.9% versus 18.2%, 53.6% versus 22.7%, 85.7% versus 42.2%, and 50% versus 11.4% (p=0.02, 0.00). Factors differentiating the two groups at WS-MRI were bone marrow oedema of the spinal anterior corner, bone erosion, and swelling of the intervertebral disc, endplate, anterior thoracic wall, and paraspinal soft-tissue.

Cerebellar Hemangioblastoma: Diagnostic Yield of Contrast-Enhanced Abdominal CT and Whole-Spine MRI as Initial Screening Imaging.

OBJECTIVE. The existing literature lacks research into the benefits of initial screening imaging for patients with cerebellar hemangioblastoma. We aimed to evaluate the diagnostic yield of initial screening imaging using abdominal CT and whole-spine MRI in patients with cerebellar hemangioblastoma. MATERIALS AND METHODS. This retrospective study included 117 consecutive patients with histopathologically confirmed, newly diagnosed cerebellar hemangioblastomas at a single tertiary hospital between January 2006 and October 2018. Patients underwent contrast-enhanced abdominal CT, whole-spine MRI, or both to detect abdominal and spinal lesions of von Hippel-Lindau disease. Diagnostic yields and false referral rates for initial screening imaging were determined. RESULTS. After exclusion of six patients who forewent any initial imaging, 111 patients were included (53 men [mean age ± SD, 51 ± 13 years] and 58 women [mean age, 43 ± 16 years]). The diagnostic yield of abdominal CT was 3.8% (4 of 105; 95% CI, 1.1-9.3%), whereas the false referral rate was 1.0% (1 of 105; 95% CI, 0.0-5.2%). For whole-spine MRI, the corresponding values were 5.6% (4 of 71; 95% CI, 1.6-13.8%) and 2.8% (2 of 71; 95% CI, 0.3-9.8%), respectively. The respective diagnostic yields in patients with a single cerebellar hemangioblastoma were both 0% (0 of 98 and 66, respectively). CONCLUSION. For patients with a single cerebellar hemangioblastoma, screening examinations with abdominal CT and whole-spine MRI are unnecessary before the results of genetic testing are available.

An analysis of clinical risk factors for adolescent scoliosis caused by spinal cord abnormalities in China: proposal for a selective whole-spine MRI examination scheme

BackgroundApproximately 80% of adolescent scoliosis cases are idiopathic, and some non-idiopathic scoliosis cases caused by spinal cord abnormalities are misdiagnosed as idiopathic scoliosis. This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities, explored the feasibility of whole-spine MRI, and provided a theoretical basis for the routine diagnosis and treatment of adolescent idiopathic scoliosis.MethodThe clinical data of adolescent scoliosis patients who were admitted to Shanghai Tongren Hospital and Shanghai Changhai Hospital between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. Sex, age, main curvature angle, main curvature direction, kyphosis angle, scoliosis type, coronal plane balance, sagittal plane balance, abdominal wall reflex, sensory abnormality, ankle clonus and tendon reflexes were compared between the two groups. Student’s t test was used to evaluate the differences in the continuous variables, and the chi-square test was used to evaluate the differences in the categorical variables. Fisher’s exact test was applied to detect the difference in the rate of intraspinal anomalies between the groups. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities.ResultA total of 714 adolescent scoliosis patients with a mean age of 13.5 (10–18 years) were included in the study, and intramedullary abnormalities were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P < 0.01). Logistic regression showed that the ratios for sex, scoliosis direction, scoliosis type, abdominal wall reflex and ankle clonus were 2.987, 3.493, 4.823, 3.94 and 8.083, respectively. The ROC curve showed a sensitivity of 66.18% and a specificity of 89.01%, and the Youden index corresponding to the optimal critical point was 0.5519.ConclusionRisk factors associated with adolescent scoliosis caused by abnormal intramedullary abnormalities included male sex, thoracic scoliosis on the left side, sharp curvature of the spine, abnormal abdominal wall reflex and ankle clonus. In adolescent scoliosis patients, the incidence of scoliosis caused by intramedullary abnormalities was approximately 9.5%. These clinical indicators suggest that there is a high-risk adolescent scoliosis population who should undergo whole-spinal MRI preoperatively to rule out intramedullary abnormalities.

The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis

BackgroundThe relationship between spinal alignment and skeletal muscle mass (SMM) has attracted attention in recent years. Sagittal alignment is known to deteriorate with age, but it is not known whether this is related to paraspinal muscles. Therefore, the purpose of this study is to elucidate the role of the multifidus (MF) and psoas major (PS) muscles in maintaining global spinal alignment in patients with lumbar spinal stenosis (LSS) and/or degenerative spondylolisthesis (DS), and to analyze whether each muscles’ cross-sectional area (CSA) correlates with whole-body SMM using bioimpedance analysis (BIA).MethodsWe retrospectively evaluated 140 patients who were hospitalized for surgery to treat LSS and/or DS. Spinal alignment, CSA of spinal muscles, and body composition parameters were measured from full-length standing whole-spine radiography, MRI, and BIA before surgery. The following standard measurements were obtained from radiographs: sagittal balance (C7-SVA), cervical lordosis (CL; C2–C7), lumbar lordosis (LL; L1–S1), thoracic kyphosis (TK; T5–T12), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS).ResultsThe average PS CSA (AveCSA) was highest at L4-L5, whereas MF AveCSA was highest at L5-S1. Paraspinal muscle CSAs were greater in males than in females. There was no statistically significant difference between the left and right CSA for either MF or PS. Correlation coefficient showed strong correlations between the PS AveCSA (L4-L5) and whole body SMM (r = 0.739). Correlation coefficient analysis also showed weak correlation between SMM and PT (r = − 0.184). Furthermore, PS AveCSA (L4-L5) correlated with the PT (r = − 0.183) and age (r = − 0.156), while PT correlated with the whole body SMM (r = − 0.184) but not with age.ConclusionsWhole body SMM showed correlation with PS AvCSA (L4-L5) and with PT among the spinal parameters, which was the same result in MF AvCSA (L4-L5). These findings suggest that the posterior inclination of the pelvis may be correlated with paraspinal muscle area rather than age.

The utility of whole spine survey MRI in blunt trauma patients sustaining single level or contiguous spinal fractures

To determine the utility of obtaining whole-spine survey MRI after a whole-spine CT diagnoses single level or contiguous fractures. A retrospective search from 2015 to 2017 was performed using an institutional PACS database for consecutive patients who sustained spinal fractures from blunt injury. Only patients who received whole-spine CT followed by whole-spine MRI were included in the study. All cases had sagittal T2-weighted and Short TI (Tau) inversion recovery (STIR) imaging of the entire spine with additional T1 and T2-weighted axial imaging covering the known injury. Reports from the whole-spine CTs were compared to the reports of the whole-spine MRI to determine if additional bony and soft tissue injury were identified on subsequent MRI. A total of 156 patients met the inclusion criteria, with an average age of 59.5 ± 20.6years. Twenty-nine patients (18.5%) had a whole-spine MRI that demonstrated an additional bony ± soft tissue injury. A 95.1% of the additional injuries were osseous contusions or vertebral body compression fractures without significant loss of height. The distance between the original injury on CT and the additional injury on MR ranged from 1 to 13 vertebrae. A 82.8% of the additional injuries occurred within 1 to 8 vertebrae levels of the primary injury and most commonly in the thoracic spine. Most additional bony injuries detected on MRI are bone contusions and mild compression fractures, which are unlikely to alter management. However, if screening MRI is performed for additional bony injuries, we posit that a targeted regional spinal MRI is adequate.

Apparent Diffusion Coefficient as an Imaging Biomarker for Spinal Disease Activity in Axial Spondyloarthritis.

Background A quantifiable imaging measure to gauge the intensity of individual inflammatory lesions in axial spondyloarthritis (SpA) has not been well established. Previous studies have shown that diffusion-weighted (DW) MRI reflects disease activity in axial SpA. Purpose To determine the association between apparent diffusion coefficient (ADC) at MRI of discovertebral lesions and disease activity in individuals with axial SpA. Materials and Methods In this prospective study, 243 study participants (mean age ± standard deviation, 43.2 years ± 13.5) with back pain who fulfilled the Assessment of SpondyloArthritis International Society criteria for SpA were recruited from four rheumatology centers between April 2014 and March 2018. There were 132 men (mean age, 41.4 years ± 13.3) and 111 women (mean age, 45.3 years ± 13.4). Clinical, biochemical, and radiologic parameters were collected. All participants underwent whole-spine MRI by using a short inversion time inversion-recovery sequence and DW imaging. Two independent readers identified the presence of discovertebral lesions. ADCs were measured and normalized with normal bone marrow. Regression analysis was performed to determine association between the mean, maximum, and normalized mean and maximum ADCs of the discovertebral lesions and disease activity and functional parameters (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Bath Ankylosing Spondylitis Global Index [BASGI]). Results Ninety-one discovertebral lesions (five cervical, 61 thoracic, 25 lumbar) were present in 55 of the 243 study participants (22.6%). After adjusting for confounding factors, increased maximum ADC was independently associated with increased BASFI (regression coefficient [β] = 1.94 [×10-3 mm2/sec], P = .04). Increased normalized maximum ADC was independently associated with BASDAI question 2 (ie, back pain score) (β = 0.45, P = .01), mean stiffness score (β = 0.41, P = .04), and BASGI (β = 0.43, P = .04). Increased normalized mean ADC was independently associated with BASDAI question 2 (β = 0.61, P = .04). Conclusion Apparent diffusion coefficients at MRI of discovertebral lesions were associated with disease activity, functional impairment, and patient global assessment in axial spondyloarthritis. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Guermazi and Roemer in this issue.

C2 neurofibromas in neurofibromatosis type 1: genetic and imaging characteristics.

OBJECTIVEC2 nerve root neurofibromas have been reported frequently in patients with neurofibromatosis type 1 (NF1), although their genetic and imaging characteristics are unexplored. The aim of this study was to characterize genetic and spinal imaging findings in a large cohort of NF1 patients with C2 neurofibromas.METHODSThe authors performed a review of national NF1 referrals between 2009 and 2016. Inclusion criteria were at least 1 C2 root neurofibroma and cervical-spine or whole-spine MRI scans available for analysis. Blinded imaging review was performed by a neuroradiologist with an interest in NF1.RESULTSFifty-four patients with 106 C2 neurofibromas were included. The median age was 32.5 years (range 15-61 years), and there were slightly more male patients (33 vs 21 female patients). Splice-site (30%) and missense (20%) variants were frequent. Spinal neurofibromas were distributed in all spine regions (65%) or in the cervical spine alone (22%). Most (93%) C2 neurofibromas were visible on MRI scans of the head. Intradural invasion and cord compression in the cervical spine included the C2 level in 95% and 80% of patients, respectively. Compared with all other cervical spine neurofibromas in these patients, C2 neurofibromas had higher rates of intraspinal extension (75% vs 32%; OR 6.20, 95% CI 3.85-9.97; p < 0.001), intradural invasion (53% vs 26%; OR 3.20, 95% CI 2.08-4.92; p < 0.001), and cord compression (25% vs 13%; OR 2.26, 95% CI 1.35-3.79; p = 0.002). However, C2 neurofibromas had lower rates of extraforaminal growth beyond the transverse process (12% vs 62%; OR 0.09, 95% CI 0.05-0.16; p < 0.001).CONCLUSIONSC2 neurofibromas are associated with an aggressive intraspinal phenotype, limited growth outside the spinal canal, and an uncommon genetic profile. These observations require future study.

Balanced Steady-State Free Precession Sequence (CISS/FIESTA/3D Driven Equilibrium Radiofrequency Reset Pulse) Increases the Diagnostic Yield for Spinal Drop Metastases in Children with Brain Tumors

Identification of spinal drop metastases is important in the staging and management of pediatric patients with primary brain tumors. Our aim was to assess the diagnostic utility of the balanced steady-state free precession (bSSFP) sequence (CISS/FIESTA/3D driven equilibrium radiofrequency reset pulse) for the detection of spinal drop metastases in pediatric patients with primary intracranial tumors. This was a retrospective study of 44 pediatric patients with primary intracranial tumors undergoing MR imaging spine evaluation for drop metastases before radiation treatment. All patients underwent a whole-spine MRI with both bSSFP and postcontrast T1WI sequences. Two neuroradiologists independently reviewed only the bSSFP sequence, then 1 week later only the postcontrast T1WI sequence. Patients ranged from 1 to 18 years of age (mean, 7.1 ± 4.2 years) with 27 males and 17 females. The number of lesions per patient ranged from 1 to 13 and from 2 to 11 mm in size. Lesions suspicious for drop metastases were seen in 8 patients on the postcontrast T1WI (18%) compared with 10 patients on the bSSFP sequence (23%). Twenty-two drop metastases seen on the bSSFP sequence were not visible on the postcontrast T1WI, including nonenhancing drop metastases and multiple nodules of <3 mm. Interrater agreement was excellent for the bSSFP sequence (0.91) and the postcontrast T1 sequence (0.90). The bSSFP sequence increased the diagnostic yield for the detection of drop metastases in pediatric patients with primary intracranial tumors and was particularly advantageous for small drop metastases (<3 mm) and nonenhancing metastases, and it decreased the number of false-positives. The bSSFP sequence may be an important adjunct to postcontrast T1WI for the evaluation of drop metastases.

The prevalence of tandem spinal stenosis and its characteristics in a population-based MRI study: The Wakayama Spine Study.

Tandem spinal stenosis (TSS) is a condition of combined spinal stenosis in the cervical and lumbar regions. The purpose of this study was to determine the prevalence of radiographic TSS and its association with developmental canal stenosis (DCS). The second purpose was to investigate the extent to which radiographic TSS is associated with cervical myelopathy and symptomatic LSS. We recruited 1011 (336 men and 675 women) participants in this population-based study. After excluding those with a pacemaker, a history of cervical or lumbar surgery, disqualification, the MRI data of whole spine was analysed in 931 (mean, 67.3years) participants. Cervical cord compression (CCC) and radiographic lumbar spinal stenosis (LSS) were evaluated by MRI. The canal-to-body ratio was also measured by plain X-ray. DCS was diagnosed as canal-to-body ratio <0.75. The diagnosis of cervical myelopathy and symptomatic LSS was made by presentation of both symptoms and radiographic compression using MRI. The prevalence of CCC was 24.7%, that of radiographic LSS was 30.2%, and that of radiographic TSS was 11.0% (men, 14.1%; women, 9.4%). The prevalence of TSS was significantly higher in the DCS group than in the non-DCS group (p<0.001). Among the participants with radiographic TSS, the prevalence of cervical myelopathy and symptomatic LSS was 9.8 and 18.6%, respectively. The coexisting cervical myelopathy and symptomatic LSS was 6.1% in the participants with LSS. The present study is the first population-based study to clarify TSS characteristic using whole-spine MRI.

Incidence of numerical variants and transitional lumbosacral vertebrae on whole-spine MRI.

ObjectivesThis study sets out to prospectively investigate the incidence of transitional vertebrae and numerical variants of the spine.Materials and methodsOver a period of 28 months, MRIs of the whole spine were prospectively evaluated for the presence of transitional lumbosacral vertebrae and numerical variants of the spine.ResultsMRI of the whole spine was evaluated in 420 patients, comprising 211 female and 209 male subjects. Two patients had more complex anomalies. Lumbosacral transitional vertebrae were seen in 12 patients: eight sacralised L5 (3 male, 5 female) and four lumbarised S1 (3 male, 1 female). The incidence of transitional vertebrae was approximately 3.3. % (14/418). Thirty-two (7.7 %) of 418 patients had numerical variants of mobile vertebrae of the spine without transitional vertebrae. The number of mobile vertebrae was increased by one in 18 patients (12 male, 6 female), and the number was decreased by one in 14 patients (4 male, 10 female).ConclusionsNumerical variants of the spine are common, and were found to be almost 2.5 times as frequent as transitional lumbosacral vertebrae in the study population. Only whole-spine imaging can identify numerical variants and the anatomical nature of transitional vertebrae. The tendency is toward an increased number of mobile vertebrae in men and a decreased number in women.Main messages• Numerical variants of the spine are more common than transitional vertebrae.• Spinal numerical variants can be reliably identified only with whole-spine imaging.• Increased numbers of vertebrae are more common in men than women.• Transitional lumbosacral vertebrae occurred in about 3.3 % of the study population.• The incidence of numerical variants of the spine was about 7.7 %.

Teaching Neuro Images : Multiple epidural abscesses after acupuncture

An 80-year-old woman presented with 2 days of progressive quadriparesis, difficulty voiding, and fever. She had received acupuncture in the cervical and lumbar regions for 5 days beginning a week before. Whole-spine MRI showed multiple epidural abscesses at levels C3-C7, L3-L5, and L5-S1 (figure). Broad-spectrum antibiotics were administered, and the abscesses were surgically drained. Strains of Staphylococcus aureus were isolated. Single epidural abscesses after acupuncture have been reported, but multiple abscesses due to acupuncture are extremely rare.1,2

Vertebral body corner oedemavsgadolinium enhancement as biomarkers of active spinal inflammation in ankylosing spondylitis

To investigate the relative performance of T(2) weighted short tau inversion-recovery (STIR) and fat-suppressed T(1) weighted gadolinium contrast-enhanced sequences in depicting active inflammatory lesions in ankylosing spondylitis (AS). Whole-spine MRI was performed on 32 patients with AS, who participated in a clinical trial of infliximab treatment, by STIR and contrast-enhanced sequences at baseline and after 30 weeks. The AS spine MRI-activity (ASspiMRI-a) scoring method was used. The images from these two imaging techniques were evaluated separately by two independent readers. For the pre-treatment lesion status, the intraclass correlation coefficients comparing STIR readings and contrast-enhanced readings were 0.69±0.23 for Reader 1 and 0.65±0.21 for Reader 2. At baseline, the mean ASspiMRI-a score was 15.4% and 17.7% higher for contrast-enhanced images than for STIR images for Reader 1 and Reader 2, respectively. After infliximab treatment, Reader 1 rated an ASspiMRI-a score reduction of 50.8±33.6% and 25.3±35.3% for STIR images and contrast-enhanced images, respectively, whereas Reader 2 rated an ASspiMRI-a score reduction of 42.4±50.4% and 32.9±35.6% for STIR images and contrast-enhanced images, respectively. While both contrast-enhanced and STIR sequences showed sensitivity to change over a short period of time after infliximab treatment, these two sequences may reflect different disease mechanisms.

Peripheral Nerve Involvement (Neurolymphomatosis) as a Manifestation of Intravascular Large B-Cell Lymphoma

AbstractAbstract 4128 Background;Intravascular large B-cell lymphoma (IVL) is characterised by proliferation of lymphoma cells only in the lumina of small vessels in various organs, a high incidence of neurological symptoms associated with central nervous system (CNS) involvement has been reported, but its association with peripheral nerve involvement (neurolymphomatosis, NL) has rarely described previously. We recently encountered 2 patients with IVL who relapsed as a NL shortly after the completion of chemotherapy. Because both NL and IVL is extremely rare clinical condition, its occurrence led us to explore the predilection of NL in patients with IVL. Method;We reviewed the medical records of patients with diagnosis of IVL over the past 4 years. Diagnosis of IVL was made by the definition of WHO classification of hematopoietic tumours. The diagnosis of NL required: 1) clinical symptoms and neurological findings related to the peripheral neuropathy of cranial or spinal nerves; and 2) histological confirmation of lymphoma cells within the peripheral nerve, nerve root/plexus, or cranial nerve; or 3) CT/MRI demonstration of nerve enhancement and/or enlargement of peripheral nerve(s) that were also demonstrated by accumulation of FDG by FDG-PET/CT. Results;We identified 5 patients of NL among 12 IVL patients. NL occurred as an initial manifestation in one patient and relapse disease in the remaining 4 patients. All 5 patients had neurologic symptoms corresponding to the NL of cranial and/or peripheral nerve. Comparison of clinical and laboratory features could not disclose the difference in IVL patients with or without NL in terms of presence or absence of haemophagocytosis, bone marrow infiltration, neurological symptoms, cytopenia, soluble interleukin 2 receptor level, and skin lesions. All of the 4 patients with NL as a relapse disease occurred during or shortly after R-CHOP chemotherapy. Brain MRI and whole-spine MRI with thin sliced coronal image could reveal the nerve infiltration by gadolinium enhancement and enlargement of nerve structure, it might not always sensitive enough for its detection because of patchy distribution and small lesion. In contrast, FDG-PET/CT successfully revealed the involved lesions as a linear or nodular FDG-uptake which was anatomically correlated with cranial nerves, nerve plexus, spinal nerve root, or peripheral nerves in all of the 5 cases. In addition FDG-PET/CT was useful for evaluating the therapeutic responses. Treatment with high-dose methotrexate with or without systemic chemotherapy appeared beneficial, however one of the 5 patient needed additional localized irradiation for relapse disease. Conclusion;Considering the extreme rarity of both IVL and NL, there may be a strong predilection of NL in patients with IVL. As IVL has a high frequency of CNS involvement, it may also have a high frequency of peripheral nerve involvement. Early recognition and familiarity of the disease and prompt institution of aggressive chemotherapy incorporating high-dose MTX with or without involved field radiation might be useful, although further studies are still warranted. Disclosures:No relevant conflicts of interest to declare.

Congenital paraspinal Ewing sarcoma family of tumors with an epidural extension

Congenital Ewing sarcoma family of tumors (ESFT) is a rare disease, and only 12 patients have been reported. Among those patients, only two had paraspinal tumors with an epidural extension. A 3-week-old infant boy presented with a huge dorsal mass. Whole-spine MRI scans showed a paraspinal mass with an epidural extension from the T11 to L2 levels, causing severe spinal cord compression. An initial operation was performed to confirm the pathological diagnosis. Twenty days after the first operation, the patient showed left lower-extremity weakness. A second operation was performed with a laminectomy from the T11 to L2 levels, and the epidural mass was radically resected. Pathologically, the tumor was confirmed as an ESFT. The patient received adjuvant chemotherapy. His neurological deficit recovered after the second surgery, and there was no tumor recurrence during 17 months of follow-up.

The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy

In the past decade, fat-suppression MRI techniques have been increasingly used for the assessment of axial-SpA. Indeed, newly proposed classification criteria have suggested the inclusion of fat-suppression MRI for the evaluation of the SI joint in inflammatory back pain (IBP) of suspected axial-SpA. However, recent data on the whole spine have identified certain MRI spinal lesions to be highly diagnostic of axial-SpA; that the SI joint can be spared in axial-SpA; and that IBP may originate in the lumbar spine rather than SI joint. Therefore, it is proposed that MRI of the whole spine and not just the SI joint should now become a routine part of the assessment of axial-SpA. Not only is spinal MRI of great diagnostic utility in axial-SpA but there is also increasing evidence to suggest that it can play a significant role in the management, in particular directing anti-TNF therapy in AS, and also it may be prognostically useful in axial-SpA. With the wider availability, improving technology and falling cost of MRI, and the difficulty that clinical assessment of axial-SpA poses, especially in early disease, there is now a strong case for the use of whole-spine MRI in the diagnosis and management of axial-SpA.

Traumatismos raquídeos y lesiones no contiguas. Importancia del cribado con resonancia magnética de columna completa en el esguince cervical

IntroductionIn spinal trauma, the nuclear magnetic resonance (NMR) is directed only to the region concerned. Therefore injuries outside this region can go undetected. This paper aims to investigate the incidence and characteristics of lesions outside the spinal segment that, initially, appeared to be traumatized (non-contiguous injuries; NCI). Material and methodsA total of 48 minor cervical spinal injuries, mostly whiplash, are retrospectively studied. In all of them a NMR screening of the entire spine was performed, by using the “composing system” (Siemens). ResultsThe NCI incidence (pattern III) related to the accident was 16.67%. In the whiplash cases, NCI reaches 24.14%, compared to 5.26% in all the remaining cases (P <0.05). If we add whiplash cases, patterns II to III, the sensitivity in detecting NCI reached 44.83% against 36.84% from the other causes. This means that, in almost 45% of whiplash cases, causal or concausal NCI of interest (patterns II and III), were found. ConclusionsThe occurence of NCI in minor spinal injuries is emphasized. The paper discusses its relevance from a health care and medico-legal perspective and the technical possibility to perform a total spine-MRI study as a complementary study of a spinal region. The study also underlines the usefulness of whole-spine screening MRI in spinal injuries when, for welfare reasons or medico-legal assessment, an MRI is indicated.