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INTRODUCTION: While selective dorsal rhizotomy (SDR) was originally described as a multilevel approach, single-level approaches are now popularized. Conus localization is beneficial for operative planning in single-level selective dorsal rhizotomy. Our approach to SDR involves minimal exposure for a single-level laminoplasty, preserving one attached interspinous ligament. Pre-operative conus localization is required for this tailored approach to determine the laminoplasty level and dictate rostral or caudal division of the superior spinus ligament. While rapid MRI sequences have been popularized for pediatric cranial imaging, its utility for spinal imagining is less well-described, and specific application for conus localization has not been reported. OBJECTIVE: Illustrate that rapid MRI without sedation is sufficient to identify conus level for tailored single-level laminoplasty SDR. MATERIAL AND METHODS: Patients undergoing SDR from 2014 to 2022 at one institution were reviewed for type of pre-operative MRI (rapid vs full), conus level, procedural time for MRI, and radiology report. The typical rapid MRI has four sequences utilizing single-shot technique (scout, sagittal T2, axial T2, and axial T1) that typically take less than 1 min each of acquisition time, with non-single-shot sequences added periodically in cooperative patients. To include time for patient positioning, pre-scan shimming, procedural incidentals, and other patient-specific variations, MRI procedure length was recorded as documented in the electronic medical record. RESULTS: N = 100 patients had documentation of an MRI for pre-operative imaging. Seventy-nine of these had a rapid MRI, and 21 required a full MRI with anesthesia for their treatment plan. Mean total procedure time for rapid MRI was 21.5 min (median 17). Mean procedure time for MRI under general anesthesia was 91.2 min (median 94). Of patients with rapid MRI imaging, 2/79 had an ambiguous conus level (1 from motion artifact, 1 from spinal hardware) vs 1/21 with a full MRI under anesthesia (due to spinal hardware). CONCLUSION: Rapid spinal MRI without sedation can be used for conus localization in a pediatric population. This may be routinely used as pre-operative imaging for a single-level approach to selective dorsal rhizotomy, without sedation or intubation procedures.

Introduction: While selective dorsal rhizotomy (SDR) was originally described as a multilevel approach, single-level approaches are now popularized. Conus localization is beneficial for operative planning in single-level selective dorsal rhizotomy. Our approach to SDR involves minimal exposure for a single-level laminoplasty, preserving one attached interspinous ligament. Pre-operative conus localization is required for this tailored approach to determine the laminoplasty level and dictate rostral or caudal division of the superior spinus ligament. While rapid MRI sequences have been popularized for pediatric cranial imaging, its utility for spinal imagining is less well-described, and specific application for conus localization has not been reported. Objective: Illustrate that rapid MRI without sedation is sufficient to identify conus level for tailored single-level laminoplasty SDR. Material and methods: Patients undergoing SDR from 2014 to 2022 at one institution were reviewed for type of pre-operative MRI (rapid vs full), conus level, procedural time for MRI, and radiology report. The typical rapid MRI has four sequences utilizing single-shot technique (scout, sagittal T2, axial T2, and axial T1) that typically take less than 1 min each of acquisition time, with non-single-shot sequences added periodically in cooperative patients. To include time for patient positioning, pre-scan shimming, procedural incidentals, and other patient-specific variations, MRI procedure length was recorded as documented in the electronic medical record. Results: N = 100 patients had documentation of an MRI for pre-operative imaging. Seventy-nine of these had a rapid MRI, and 21 required a full MRI with anesthesia for their treatment plan. Mean total procedure time for rapid MRI was 21.5 min (median 17). Mean procedure time for MRI under general anesthesia was 91.2 min (median 94). Of patients with rapid MRI imaging, 2/79 had an ambiguous conus level (1 from motion artifact, 1 from spinal hardware) vs 1/21 with a full MRI under anesthesia (due to spinal hardware). Conclusion: Rapid spinal MRI without sedation can be used for conus localization in a pediatric population. This may be routinely used as pre-operative imaging for a single-level approach to selective dorsal rhizotomy, without sedation or intubation procedures. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hyperuricemia is a common metabolic disease, and the main clinical manifestation of patients with hyperuricemia is the formation of uric acid crystals leading to gout. Previous studies have only reported that uric acid crystals lead to intervertebral disc degeneration, but there are fewer studies on the correlation between hyperuricemia and intervertebral disc degeneration. OBJECTIVE: To retrospectively analyze the characteristics of intervertebral disc degeneration in patients with hyperuricemia and the correlation between serum uric acid level and intervertebral disc degeneration. METHODS: A retrospective analysis was performed in all patients diagnosed with intervertebral disc degeneration admitted at the Department of Orthopedics, the Affiliated Hospital of Southwest Medical University from January 2021 to December 2022. There were 97 hyperuricemia patients in the hyperuricemia group and 194 non-hyperuricemia patients in the control group according to sex and age in a ratio of 1: 2. Blood uric acid test results were collected, and Pfirrmann scoring was performed for the degree of disc degeneration in patients based on the whole spinal MRI images. The difference in the degree of disc degeneration between the two groups was compared, and the correlation between the serum uric acid level and the degree of intervertebral disc degeneration was analyzed. RESULTS AND CONCLUSION: The Pfirrmann score in the hyperuricemia group was higher than that in the control group, and the total number of disc degeneration in the hyperuricemia group was also significantly higher than that in the control group (P＜0. 05). Spearman correlation analysis showed that the degree of disc degeneration in male patients was positively correlated with serum uric acid level at many spinal segments in the hyperuricemia group (C3/4: r=0. 317, C4/5: r=0. 333, C5/6: r=0. 309, L2/3: r=0. 443, P＜0. 05);the degree of disc degeneration in female patients was also positively correlated with serum uric acid level (C3/4: r=0. 354, C4/5: r=0. 388, C6/7: r=0. 312, T7/8: r=0. 282, T9/10: r=0. 305, T11/12: r=0. 277, L4/5: r=0. 319, L5-S1: r=0. 367, P＜0. 05). In the control group, there was no significant correlation between the degree of disc degeneration and serum uric acid level in male and female patients (P＞0. 05). To conclude, in patients with hyperuricemia, the higher serum uric acid level indicates the more serious intervertebral disc degeneration. Therefore, hyperuricemia is one of the risk factors for intervertebral disc degeneration. [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hypotension (SIH), which generally presents as orthostatic headache, is increasingly being identified due to improved imaging technologies and heightened awareness. Many prior studies have reported the characteristic brain MRI findings of SIH. However, recently, focus has shifted to spinal MRI, as SIH is believed to be caused by leakage of cerebrospinal fluid from the spinal dural sac. Advanced techniques such as ultrafast CT myelography and digital subtraction myelography have emerged as useful technique to identify the site of cerebrospinal fluid leakage. In this review, we discuss the diagnosis, spinal MRI findings, imaging techniques, and treatment of SIH.

Spontaneous intracranial hypotension (SIH), which generally presents as orthostatic headache, is increasingly being identified due to improved imaging technologies and heightened awareness. Many prior studies have reported the characteristic brain MRI findings of SIH. However, recently, focus has shifted to spinal MRI, as SIH is believed to be caused by leakage of cerebrospinal fluid from the spinal dural sac. Advanced techniques such as ultrafast CT myelography and digital subtraction myelography have emerged as useful technique to identify the site of cerebrospinal fluid leakage. In this review, we discuss the diagnosis, spinal MRI findings, imaging techniques, and treatment of SIH. [ABSTRACT FROM AUTHOR]

Pyogenic spinal infections are potentially life-threatening diseases that can impair the patient's neurological status, physical abilities, and quality of life. They can be considered a single disease or group of diseases and include spondylitis, discitis, facet arthritis, epidural phlegmon/abscesses, peri/paraspinal soft tissue infection/abscesses, pachymeningitis and/or leptomeningitis, and myelitis/spinal cord abscess. This group of diseases is distinct from degenerative diseases, metabolic and inflammatory disorders, and neoplasms and mimickers. Delays in the diagnosis and treatment can cause significant morbidity and mortality. Imaging is important in preparing diagnoses, planning minimally invasive treatment, and monitoring patient progress. This review explains the adult spinal infections' radiological imaging features and their values in differential diagnoses. [ABSTRACT FROM AUTHOR]

Campylobacter jejuni ( C. jejuni ) is a gram-negative bacterium known to cause gastroenteritis with fever, abdominal pain, and bloody diarrhea. Although Campylobacter bacteremia is reported in patients with gastroenteritis, localized abscess formation, particularly spinal epidural abscess (SEA), is extremely rare and can easily be missed. Herein, we report a case of a 54-year-old immunocompromised female presenting with severe back pain without gastrointestinal symptoms, who was ultimately diagnosed with an L5/S1 SEA due to C.jejuni , requiring laminectomy and drainage. As far as we know, this is the second reported case of SEA due to C. jejuni without any preceding gastrointestinal symptoms. This case highlights the critical importance of performing a contrasted MRI for the early and accurate diagnosis of SEA., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yabe et al.)

Introduction: Leptomeningeal metastasis (LM) is known to demonstrate a very poor prognosis. The purpose of this study was to evaluate the prognostic factors in LM cases diagnosed by spinal magnetic resonance imaging (MRI). Methods: We retrospectively analyzed 19 patients with LM detected by spinal MRI between 2010 and 2017. Results: The primary tumors were breast carcinoma (n = 7), lung carcinoma (n = 6), lymphoma (n = 3), colorectal carcinoma (n = 2), and gastric carcinoma (n = 1). Thirteen patients exhibited preceding brain metastasis, and 11 of these exhibited metastasis in the posterior fossa. Ten patients exhibited limb paralysis. Performance status at diagnosis was 0-1 in 6 patients, 2 in 9 patients, and 3-4 in 4 patients. Testing of cerebrospinal fluid revealed malignant cells in 9 patients. On MRI, 11 patients demonstrated disseminated tumor lesions at the cervical cord level, 15 patients at the thoracic cord level, and 11 patients below the conus level. Eleven patients received radiation therapy, while intrathecal chemotherapy was performed in 9 patients. Univariate analysis revealed cervical cord level lesions, intrathecal chemotherapy, paralysis, and performance status as prognostic factors. Multivariate analysis identified existence of a cervical cord lesion as associated with a poor prognosis (hazards ratio (HR) 3.46, 95% confidence interval (CI) 1.12-12.2), while administration of intrathecal chemotherapy was associated with a good prognosis (HR 0.15, 95% CI 0.026-0.67). Conclusions: In LM patients, cervical cord level lesions are a negative factor for prognosis, and performance of intrathecal chemotherapy is a positive factor for prognosis.

Superficial siderosis of the central nervous system (SS-CNS) is a rare condition characterized by a hemosiderin accumulation along the subpial surfaces and arises from an intermittent chronic bleeding in the subarachnoid space usually as a result of a chronic subarachnoid hemorrhage by trauma, vascular malformations, CNS tumors, or cerebral amyloid angiopathy (CAA). We present a 61-year-old male with a 12-year history of limb weakness, muscle wasting, cramps, clumsiness, progressive unsteady gait, and fine motor impairments. His medical history included the resection of a left parietal meningioma and a myxopapillary ependymoma near the conus terminalis (L3/4) at the age of 51 years. The clinical examination revealed a motor neuron syndrome with a clear bilateral wasting of the hand muscles, a diffuse atrophy of the shoulder and calf muscles, and a weakness of the arms, fingers, hips, and feet. Deep tendon reflexes were symmetrically briskly hyperactive. Standing and walking were only possible with a support. Magnetic resonance imaging of the entire neuroaxis showed progressive severe cerebral, brainstem, and spinal superficial siderosis in form of extensive hypointensities on T2-weighted gradient-echo images and susceptibility-weighted sequences. Despite a successful neurosurgical removal of the tumors and delaed medical treatment with an iron chelator for one year, we observed no clinical recovery or stability in our patient, making this case unique, and suggesting an irreversible neurodegenerative process. This case reinforces the need of including SS-CNS in the list of amyotrophic lateral sclerosis (ALS)-mimics and demonstrates the fundamental use of a complete neuraxial MRI investigation on evaluating possible ALS cases.

Neurologic complications are being recognized as important outcomes of coronavirus disease 2019 (COVID-19). Pathogenesis is varied and incompletely understood, and may include neuroinvasion, indirect post-infectious neuroinflammation, and cerebrovascular pathologies. We present a case of COVID-19-related encephalomyeloradiculitis with clinical and magnetic resonance imaging characteristics of neuromyelitis optica spectrum disorders that was associated with anti-aquaporin-4 antibodies. Our case suggests post-infectious autoimmunity as a mechanism in at least a subset of patients with COVID-19-related neurologic disease. [ABSTRACT FROM AUTHOR]

Development of back pain is multifactorial, and it is not well understood which factors are the main drivers of the disease. We therefore applied a machine-learning approach to an existing large cohort study data set and sought to identify and rank the most important contributors to the presence of back pain amongst the documented parameters of the cohort. Data from 399 participants in the KORA-MRI (Cooperative health research in the region Augsburg-magnetic resonance imaging) (Cooperative Health Research in the Region Augsburg) study was analyzed. The data set included MRI images of the whole body, including the spine, metabolic, sociodemographic, anthropometric, and cardiovascular data. The presence of back pain was one of the documented items in this data set. Applying a machine-learning approach to this preexisting data set, we sought to identify the variables that were most strongly associated with back pain. Mediation analysis was performed to evaluate the underlying mechanisms of the identified associations. We found that depression and anxiety were the 2 most selected predictors for back pain in our model. Additionally, body mass index, spinal canal width and disc generation, medium and heavy physical work as well as cardiovascular factors were among the top 10 most selected predictors. Using mediation analysis, we found that the effects of anxiety and depression on the presence of back pain were mainly direct effects that were not mediated by spinal imaging. In summary, we found that psychological factors were the most important predictors of back pain in our cohort. This supports the notion that back pain should be treated in a personalized multidimensional framework. PERSPECTIVE: This article presents a wholistic approach to the problem of back pain. We found that depression and anxiety were the top predictors of back pain in our cohort. This strengthens the case for a multidimensional treatment approach to back pain, possibly with a special emphasis on psychological factors., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Background The imaging of the lumbar canal is an important aspect of low back pain (LBP) management. Magnetic resonance imaging (MRI) has gained widespread acceptance for the evaluation of spine anatomy. Objective The objective of the study is to compare the MRI findings of the anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal in symptomatic low back pain patients to that of patients without low back pain. Methods The cross-sectional study included 200 subjects of which 100 subjects (49 males and 51 females) were symptomatic cases of low back pain and 100 subjects (53 males and 47 females) had no symptoms of low back pain and were enrolled as controls. The MRI scans were studied for the anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal. Results In our study, the anteroposterior diameter of the lumbar vertebral canal among cases was found to have a mean of 14.42, 14.09, 13.44, 13.63, and 13.79 with a standard deviation (SD) of 1.25, 1.32, 1.75, 1.75, and 2.65 at L1, L2, L3, L4, and L5 levels, respectively. The anteroposterior diameter of the lumbar vertebral canal among controls was found to have a mean of 15.26, 15.16, 14.71, 14.68, and 15.28 with an SD of 1.60, 1.67, 1.30, 1.36, and 1.97 at L1, L2, L3, L4, and L5 levels, respectively. The difference in anteroposterior diameters of the lumbar vertebral canal was found to be statistically significant at each level, between cases and controls. The transverse diameter of the vertebral canal was found to be smaller in cases as compared to controls with a statistically significant difference at each of the levels studied. The thecal sac area of the vertebral canal was found to be less in subjects with low back pain at each of the vertebral levels studied. Conclusion The study results provide insight into the lumbar vertebral parameters in the study population and give comparative data among the symptomatic low back pain patients and control subjects without low back pain. The MRI reflected decreased anteroposterior diameter, transverse diameter, and thecal sac area of the lumbar vertebral canal among symptomatic low back pain patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Badaam et al.)

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Background: Intramedullary spinal cord abscesses (ISCA) are a rare pathological entity with very few cases reported in the world and may be confused with an intramedullary tumor. Cervical location is the least frequently affected, except for cryptogenic spread, mostly seen in adult patients. Meticulous study of contrast-enhanced MRI pictures has a key role in the diagnosis.Method and results: We present a case of a spontaneous cervical ISCA, mimicking a spinal cord tumor, in a pediatric patient with good outcome. A review of the literature shows that this is a life-threatening condition with high chances of rupture and subsequent meningitis.Conclusions: We point out that if a solitary cervical spinal cord lesion is surrounded by significant medullar edema associated with fast onset of symptoms, fever, and elevation of WBC, the possibility of a spinal cord abscess should be considered prior to surgery. [ABSTRACT FROM AUTHOR]

A broad spectrum of spinal pathologies can affect the pediatric population. Ultrasound (US) is the primary modality for pediatric spine assessment due to its widespread availability, non-requirement of sedation, and absence of ionizing radiation. Supplementing this, MRI offers an in-depth exploration of these conditions, aiding in preoperative strategizing. In this review, we examine the clinical indications, methodologies, and protocols for US and MRI scans of the pediatric spine. Additionally, we illustrate normal pediatric spinal anatomy, highlighting several examples of normal variants that are often misinterpreted. Through a series of case-based illustrations, we offer a comprehensive overview of various pathological conditions such as tethered cord, spinal dysraphism, spinal lipoma, diastematomyelia, and dermal sinus tract, among others. Furthermore, we explore the correlation between US and MRI findings for these lesions, employing real-world cases to enhance our understanding of this topic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hunsaker et al.)

The objective of this work is to automatically produce radiological gradings of spinal lumbar MRIs and also localize the predicted pathologies. We show that this can be achieved via a Convolutional Neural Network (CNN) framework that takes intervertebral disc volumes as inputs and is trained only on disc-specific class labels. Our contributions are: (i) a CNN architecture that predicts multiple gradings at once, and we propose variants of the architecture including using 3D convolutions; (ii) showing that this architecture can be trained using a multi-task loss function without requiring segmentation level annotation; and (iii) a localization method that clearly shows pathological regions in the disc volumes. We compare three visualization methods for the localization. The network is applied to a large corpus of MRI T2 sagittal spinal MRIs (using a standard clinical scan protocol) acquired from multiple machines, and is used to automatically compute disk and vertebra gradings for each MRI. These are: Pfirrmann grading, disc narrowing, upper/lower endplate defects, upper/lower marrow changes, spondylolisthesis, and central canal stenosis. We report near human performances across the eight gradings, and also visualize the evidence for these gradings localized on the original scans. [ABSTRACT FROM AUTHOR]

We report three cases of Vitamin B12 deficiency with symmetrical posterior spinal cord lesions and discuss the differential diagnosis, some of which are not well known. Because the degree of resolution of the clinical symptoms in subacute combined degeneration depends on early detection, MRI findings should not be missed.

Spontaneous intracranial hypotension is an important cause of new daily persistent headaches in young and middle-aged individuals. The diagnosis is made based on low cerebrospinal fluid pressure with characteristic findings upon brain and spinal magnetic resonance imaging (MRI). We present the case of a 15-year-old boy with spontaneous intracranial hypotension. Although his brain MRI was normal, his lumbar spinal MRI showed clustering of the nerve roots characteristic of arachnoiditis. Radionuclide cisternography revealed an epidural leak, which was treated with an epidural blood patch. The patient reached a near-full recovery within 24 h, and the lumbar spinal MRI findings mimicking arachnoiditis disappeared.

Sacral dimples are common physical examination findings among newborns and are rarely associated with spinal dysraphism. Screening ultrasonography for simple sacral dimples in the absence of other physical findings leads to unnecessary health care costs and undue stress on families. This study was a retrospective chart review of infants with a sacral dimple on examination who underwent spinal ultrasonography in the first week of life. The documented indication for ultrasonography was compared to standard guidelines. Among 151 infants in the study, 80% had a normal spinal ultrasound. Of infants with abnormal ultrasonography, 7 (5%) had abnormal spinal magnetic resonance imaging and 2 infants (1%) required neurosurgical intervention. Our study revealed that nearly one-third of infants who underwent spinal ultrasonography had a simple sacral dimple and low likelihood of spinal dysraphism according to existing guidelines. Among patients who underwent spinal ultrasonography in accordance with guidelines, only a small percentage required neurosurgical intervention indicating that guidelines may need to be revised. Larger studies involving multiple centers are necessary to assess this need. [ABSTRACT FROM AUTHOR]

Abstract Orthostatic headache is the leading clinical manifestation of CSF leakage. Anatomic changes due to low CSF pressure can be detected by cranial and spinal magnetic resonance imaging (MRI). We report improved spinal MRI findings in a pediatric case of post-dural puncture headache treated by epidural blood patch administration. In this case, a 7-year-old girl with a history of recurrent lumbar punctures and orthostatic headache for three months is presented. Cerebrospinal fluid (CSF) leak was reported at the level of T5-L1 by magnetic resonance imaging (MRI). An autologous epidural blood patch was performed under sedation with a blood volume of 6 ml. Five days after the procedure MRI showed no CSF signal in the extradural space and dural infolding was found to be disappeared. On the seventh day of the procedure, headache recurred and the procedure was repeated using same amount of blood. After seven months of follow-up, the patient reported no recurrence of headache. To the best of our knowledge, this is the first pediatric case report that presents improved spinal MRI findings following an epidural blood patch. Although MR findings show improvement, it is not a definitive proof of the adequacy of the treatment. [ABSTRACT FROM AUTHOR]

To characterize spinal abnormalities in patients with neurofibromatosis type 1 (NF1) using magnetic resonance imaging (MRI). NF1 patients with at least one spine MRI were selected from participants prospectively enrolled in the National Cancer Institute NF1 Natural History Study. Data were analyzed retrospectively. Ninety-seven patients (38 females, median age 14.2 years, standard deviation [SD] 7.6) had baseline imaging of the spine, and 26 patients (27 %) had one follow-up spine MRI (follow up time 2.5 years, SD 1.1, range 0.7-4.7). Seventy-eight patients (80 %) had spinal neurofibromas, with rising frequency from 70 % in patients younger than 10 years to 80 % in patients aged 10-18 years to 89 % in individuals older than 18 years of age. At baseline, 33/97 patients (34 %) had MRI changes consistent with spinal cord compression that was most prevalent at the cervical (43 %) and lumbar spine region (40 %). Seven of nine patients with progression of their spinal neurofibromas developed cord compression. Paraspinal plexiform neurofibromas (PNs) were present in 77/97 patients (79 %), of which 68 patients (88 %) had concomitant spinal neurofibromas. Spinal curvature abnormality was present in 50/97 patients (51 %, 20 females, median age 14.6 years, SD 7.6). Patients with paraspinal PNs had six-fold higher odds of developing spinal curvature abnormalities compared to patients without PN (OR = 5.9, 95 % CI 1.81 to 19.44, p = 0.0033). A total of 58/97 patients (60 %, median age 16.1 years, SD 7.8, range 4.8-48.2 years) presented with neurologic abnormalities that progressed in 12/26 patients (46 %). Substantial spinal neurofibroma and paraspinal PN burden was observed in our study population, which represents a selective group of patients with specifically more severe tumor involvement than the general NF1 population. Occurrence and progression of spinal neurofibromas on repeat evaluations highlight the need for longitudinal clinical monitoring in patients with known spinal disease. [ABSTRACT FROM AUTHOR]

We report three cases of Vitamin B12 deficiency with symmetrical posterior spinal cord lesions and discuss the differential diagnosis, some of which are not well known. Because the degree of resolution of the clinical symptoms in subacute combined degeneration depends on early detection, MRI findings should not be missed. [ABSTRACT FROM AUTHOR]

SUMMARY Magnetic resonance imaging provides very good contrast between different soft tissues; however, in some cases, this technique is not so suitable to image calcified structures like bones. The quality of images is often degraded by blur edges or noises, which makes it difficult to accurately identify bone structures. In this paper, we proposed a new curvelet preprocessing method for local image enhancement to especially improve the quality of spinal MRI. Our objective is to both sharpen boundaries and smoothen the intensity variation of the vertebra. In the first phase, we extract features through curvelet coefficients and the gradient of the original image, then we utilize fuzzy cluster method to classify the whole image scope into the 'edge' region and the 'nonedge' region. In the second phase, we locally sharpen or smoothen the image by adaptive adjustment of curvelet coefficients and Gaussian smoothing method in different subregions. To evaluate the effect of the preprocessing method, we examine the gradient of the image and its segmentation results as the assessments. The experiment results show that the feature extraction method is effective for classification and the vertebra performs higher contrast on boundaries and less noises after the enhancement, which indeed helps increase the accuracy of further segmentation. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The introduction of magnetic resonance imaging in spondyloarthritis constitutes the main improvement in imaging over the past two decades. X-rays remains the cornerstone of diagnosis, although magnetic resonance imaging is more sensitive in early stages of the disease. The primary advantage of magnetic resonance imagingI is its ability to visualize soft tissue inflammation and inflammatory lesions within bone in three dimensions. Studies continue to appear describing its diagnostic utility, its sensitivity in early disease, its reliability, its predictive value for the detection of damage progression and its value in the assessment of certain complications. In this paper we review the characteristics of this imaging technique and the advantages and limitations of magnetic resonance imaging in spondyloarthritis. [ABSTRACT FROM AUTHOR]

Spontaneous intracranial hypotension is an important cause of new daily persistent headaches in young and middle-aged individuals. The diagnosis is made based on low cerebrospinal fluid pressure with characteristic findings upon brain and spinal magnetic resonance imaging (MRI). We present the case of a 15-year-old boy with spontaneous intracranial hypotension. Although his brain MRI was normal, his lumbar spinal MRI showed clustering of the nerve roots characteristic of arachnoiditis. Radionuclide cisternography revealed an epidural leak, which was treated with an epidural blood patch. The patient reached a near-full recovery within 24 h, and the lumbar spinal MRI findings mimicking arachnoiditis disappeared. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To look for cerebral white matter MRI changes in patients with long-standing and disabling MS. Methods: We analyzed retrospectively brain MRIs (performed 10 or more years after symptom onset) of patients with MS diagnosis and expanded disability status scale of 6 or more. The following parameters were analyzed: total number of brain T2 hyperintensities; number of brainstem, cerebellar, corpus callosum, basal ganglia, and juxtacortical T2 hyperintensities; diffuse leukoencephalopathy score; total number of T1 hypointensities. Results: Eighty-four patients were included. The mean time between symptom onset and MRI was 20.2 years. Eight percent had less than 9 cerebral T2 hyperintensities. Posterior fossa, juxtacortical, and corpus callosum T2 hyperintensities, and T1 hypointensities lacked in respectively 19%, 12%, 47%, and 8%. Overall, normal MRI was not seen, 6% had abnormal MRI but did not meet Barkhof''s criteria, and the remaining 94% had MRI abnormalities fulfilling Barkhof''s criteria. Moderate or severe diffuse leukoencephalopathy was seen in 69%. Extensive diffuse leukoencephalopathy predominant to nodular lesions was seen in 5%. Conclusions: Despite long-standing and disabling MS, typical MRI abnormalities lacked in a minority of patients, and 6% did not fulfil Barkhof''s criteria. The majority showed moderate or severe diffuse leukoencephalopathy. [Copyright &y& Elsevier]

Intramedullary metastases are rare, accounting for 0.9-5% of spinal metastases. Radiation myelopathy is considered one of the most distressing complications of radiotherapy. In both cases symptoms are aspecific, and there are no characteristic neuroradiologic findings. We describe a case of single intramedullary metastasis from lung microcytoma in a 55-year-old man with a history of malignancy, treated by radiotherapy five years previously. The patient returned to our observation complaining of pain and paraesthesia in the left C7 area. Spinal MRI and rachicentesis findings were aspecific. Ten days later a new MRI showed that the lesion size had increased, and neoplastic cells were found in CSF. Intramedullary metastases are extremely rare, accounting for 0.1-0.4% of all CNS tumors. The risk of developing delayed radionecrosis varies with the total dose administered. In both cases diagnosis is histological, while contrast-enhanced MRI is highly sensitive and specific in identifying and characterizing the lesion. In case of metastatic lesions the prognosis is unfavorable. Differential diagnosis is important because it has a strong effect on patient management. [ABSTRACT FROM AUTHOR]

Abstract: Anorectal malformations (ARMs) are associated with a variety of spinal dysraphisms, of which clinical impact is often underestimated. A 6-year-old girl, with a history of rectovaginal fistula, presented with gait disturbance, asthenia, and worsening of fecal incontinence. The spinal magnetic resonance imaging (MRI) at 12 months of age had revealed a tethered cord and a little intradural lipoma. Within the lipoma, a small cystic lesion, interpreted as a cerebrospinal fluid (CSF)-filled loculation, was also described. A consecutive MRI showed a marked increase in size of the CSF-like cyst that was clearly hyperintense on diffusion-weighted imaging (DWI) and presented reduced apparent diffusion coefficient values (855 ± 109 s/mm2), not compatible with CSF values. This lesion, interpreted as an (epi)dermoid cyst, was removed and histologically confirmed; the spinal cord was untethered. The child''s lower limb motor deficit resolved rapidly after surgery, and the fecal incontinence slowly returned to the previous bowel habit. There is a growing interest in recognizing and defining spinal dysraphism in ARM patients because some abnormalities may carry severe clinical consequences. For this purpose, a standardized MR protocol is required, in which DWI plays a pivotal role to disclose associated dysembriogenetic lesions, in particular when a CSF loculation is detected. [Copyright &y& Elsevier]

The authors aimed to evaluate the magnetic resonance (MR) imaging features characterizing spontaneous intracranial hypotension (SIH) in comparison with radionucleotide cisternography (RNC) findings in this condition. Five patients with postural headache and idiopathic low cerebrospinal fluid (CSF) pressure presented to our institution from October 2000 to July 2002. RNC demonstrated early filling of the bladder in five cases, and CSF leak was detected on the left side of the cervicothoracic junction in four cases. In two cases, intracranial MR imaging failed to demonstrate typical diffuse pachymeningeal enhancement; however, spinal MR imaging showed intense epidural or meningeal enhancement in those cases. Post-contrast spinal MR imaging was performed in four patients, revealing intense epidural or meningeal enhancement, mainly at the ventral cervical level and dorsal thoracic level of the spine. Among the four patients with obvious CSF leaks detected on the RNC, three patients demonstrated slight dilatation of the perineural root sleeve, without epidural fluid collection or spinal hygroma. In SIH, spinal MR imaging was very helpful in establishing the diagnosis when intracranial MR imaging failed to demonstrate typical findings. However, identification of the level of a CSF leak using MRI alone remains difficult, since the variety of imaging results is considerable and typical findings do not necessarily appear. [Copyright &y& Elsevier]

Invasive central nervous system aspergillosis is being seen with an increased frequency, particularly due to the increased number of immunosuppressed patients. The major cause of invasive central nervous system aspergillosis is bone marrow transplantation. In most cases, aspergillosis develops in the paranasal sinuses and in the lungs, and secondarily spreads to the brain. Imaging of cerebral aspergillosis may present different patterns depending on the lesion's age and the immunologic status of the patient. Lesions of the spinal cord are far less common but has been encountered in our series. In this article we review the clinical and radiologic features of aspergillosis affecting the central nervous system in patients who underwent bone marrow transplantation. Different CT and MR patterns are presented, including pertinent clinical and pathologic material. Significant morbidity and mortality can be associated with this fungal infection, and it is therefore incumbent upon the radiologist to identify intracranial aspergillosis as early as possible so that appropriate therapy can be administered. [ABSTRACT FROM AUTHOR]

Objectives: To report the elevation of the 14-3-3 protein and the complete denervation of hand muscles in idiopathic acute transverse myelitis (IATM) of the cervical cord. Case description: In a 29-year-old woman with a 2-week history of neck pain and repeated attenuated flus, subacute quadriplegia, hypaesthesia of both arms, a T3 sensory level, and urinary dysfunction occurred. Based upon the clinical findings, the cervical MRIs, and an elevated 14-3-3 protein in the CSF, IATM C4–C7 was diagnosed. Ten, 17, 28 and 61 days after onset, nerve conduction studies revealed complete denervation of the right abductor pollicis brevis and abductor digiti minimi muscles but gradual improvement of the compound muscle action potential of the left abductor pollicis brevis muscle. F-waves of the right median nerve were absent. Tibial somatosensory evoked potentials showed a prolonged central conduction time. Transcranial magnetic stimulation evoked a response in the left but not the right abductor digiti minimi muscle. Conclusion: IATM may cause elevation of the 14-3-3 protein and loss of motor axons originating from affected anterior horn cells. [Copyright &y& Elsevier]

Purpose: To assess the effect of prescription parameters on the dose received by the spine during palliative radiotherapy.Methods and Materials: In a survey, members of the Canadian Association of Radiation Oncologists were asked to define their prescription parameters for vertebral metastases. The depth of the spinal canal and vertebral body at 8 spinal levels was measured in 20 magnetic resonance imaging studies (MRIs). Survey results were applied to the measurements to assess the dose received at depth. The depth of spinal structures assessed at simulation and by diagnostic imaging was compared.Results: Prescriptions were most commonly to Dmax 3 cm or 5 cm using 60Co-6MV photons delivering 8–30 Gy in 1–10 fractions. Mean depths from MRI were: posterior spinal canal, 5.5 cm; anterior spinal canal, 6.9 cm; and anterior vertebral body, 9.6 cm. Application of the prescription parameters from the survey to these measurements showed a wide range in the dose at depth with variation in technique. Depths measured at simulation correlated well with diagnostic imaging.Conclusion: The spinal canal and vertebral body lie >5 cm beneath the skin, and the dose received varies by up to 50% with changes in prescription depth. We suggest a suitable prescription point for vertebral metastases and a method for determining this at simulation. [Copyright &y& Elsevier]

The MR monitoring of a patient with acute spontaneous intracranial hypotension successfully treated by epidural blood patch revealed strikingly different time course of the initially concomitant cranial and spinal subdural fluid collections. This undescribed feature suggested different pathophysiological mechanisms for the disorder in the two locations and should be kept in mind when imaging patients with the condition. [ABSTRACT FROM AUTHOR]

The case is a 65 years old man. He noticed muscle weakness of lower limbs from 3 years ago. Dysesthesia was developed, He came in our hospital in X year. He was detected muscle weakness, sensory disturbance in distal lower limbs predominance and detected radicular significant swelling in spinal cord MRI and diagnosed it with chronic inflammatory demyelinating polyneuritis (CIDP). In the follow-up purpose of other diseases regularly, it was confirmed that nerve root was gradually swelling from around 7 years before the onset. The radicular swelling is one of the characteristics in CIDP, supports the diagnosis. This case was the valuable case that was able to chase image progress before the onset.

We studied the diagnostic value of MRI in spinal emergency. One hundred patients were analyzed retrospectively and the MR-findings were compared with operative results or autopsy whenever available. The advantages of MRI compared to CT and conventional myelography are discussed. The limitations of MRI are addressed and the important features of appropriate diagnostic procedure are outlined with special attention to neurosurgical requirements. [ABSTRACT FROM AUTHOR]

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Cutaneous stigmata of the midline spine are a common question in pediatrics. They are known to be related to a higher likelihood of underlying dysraphic spinal abnormalities. Clear understanding of different types of cutaneous stigmata and correlating dysraphic findings can aid in appropriate imaging workup and timely management of patient pathology. In this article, the authors review midline spinal cutaneous findings in the pediatric population with occult spinal dysraphism., Competing Interests: Disclosure No disclosure., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Simple Summary: According to the current SLiM-CRAB-criteria, asymptomatic multiple myeloma patients who show >1 focal lesion in MRI are now upstaged to multiple myeloma with treatment indication. While the anatomic coverage of MRI protocols differs from spine over spine plus pelvis to whole-body between different institutions, the cutoff for the number of focal lesions which is currently used for the staging decision is not adapted according to the protocol. We found that usage of different MRI protocols leads to markedly different staging decisions according to current SLiM-CRAB-criteria. Adapting the cutoff for the number of focal lesions according to the MRI protocol enables to select comparable risk groups when using different MRI protocols. The combination of >3FL in spine and pelvis or >4FLs in the whole body came closest to select patients with an 80% probability to develop CRAB-criteria within 2 years, which was the original goal of the IMWG. The purpose of this study was to assess how different MRI protocols (spinal vs. spinal plus pelvic vs. whole-body (wb)-MRI) affect staging in patients with smoldering multiple myeloma (SMM), according to the SLiM-CRAB-criterion '>1 focal lesion (FL) in MRI'. In this retrospective study, a baseline cohort of 147 SMM patients with wb-MRI at initial diagnosis was investigated, including prognostic data regarding development of CRAB-criteria. Fifty-two patients formed a follow-up cohort with a median of three wb-MRIs. The locations of all FLs were determined and it was calculated how staging decisions regarding the criterion '>1 FL in MRI' would have been made if only a limited anatomic area (spine vs. spine plus pelvis) would have been covered by the MRI protocol. Furthermore, subgroups of patients selected by different cutoff-protocol-combinations were compared regarding their prognosis for development of CRAB-criteria. With an MRI protocol limited to spine/spine plus pelvis, only 28%/64% of patients who actually had >1 FL in wb-MRI would have been rated correctly as having '>1 FL in MRI'. Fifty-four percent/36% of patients with exactly 1 FL in spine/spine plus pelvis revealed >1 FL when the entire wb-MRI was analyzed. During follow-up, four more patients developed >1 FL in wb-MRI; both limited MRI protocols would have detected only one of these four patients as having >1 FL at the correct timepoint. Having >1 FL in spine/in spine plus pelvis/in the whole body was associated with a 43%/57%/49% probability of developing CRAB-criteria within 2 years. Patients with >3 FL in spine plus pelvis and patients with >4 FL in the whole body had an 80% probability to develop CRAB-criteria within 2 years. MRI protocols limited to the spine or to spine plus pelvis lead to substantial underdiagnoses of patients who actually have >1 FL in wb-MRI at baseline and during follow-up, which influences staging and treatment decisions according to the current SLiM-CRAB criteria. However, given the spatial distribution of FLs and the analysis on clinical course of patients indicates that the cutoff for the number of FLs should be adopted according to the MRI protocol when using MRI for staging in SMM. [ABSTRACT FROM AUTHOR]

Spinal hydatid cyst is an uncommon but serious condition. Intradural presentation is extremely rare. The case reported herein describes an unusual recurrent hydatidosis with progression of recurrence and spreading into intradural extramedullary field. [ABSTRACT FROM AUTHOR]

Purpose: We sought to identify correlations between working diagnosis, surgeon indication for obtaining spinal MRI and positive MRI findings in paediatric patients presenting with spinal disorders or complaints., Methods: Surgeons recorded their primary indication for ordering a spinal MRI in 385 consecutive patients. We compared radiologist-reported positive MRI findings with surgeon response, indication, working diagnosis and patient demographics., Results: The most common surgeon-stated indications were pain (70) and coronal curve characteristics (63). Radiologists reported 137 (36%) normal and 248 (64%) abnormal MRIs. In total, 58% of abnormal reports (145) did not elicit a therapeutic or investigative response, which we characterized as 'clinically inconsequential'. In all, 42 of 268 (16%) presumed idiopathic scoliosis patients had intradural pathology noted on MRI.Younger age (10.3 years versus 12.0 years) was the only significant demographic difference between patients with or without intradural pathology. Surgeon indication 'curve magnitude at presentation' was associated with intradural abnormality identification. However, average Cobb angles between patients with or without an intradural abnormality was not significantly different (39° versus 37°, respectively). Back pain without neurological signs or symptoms was a negative predictor of intradural pathology., Conclusion: Radiologists reported a high frequency of abnormalities on MRI (64%), but 58% of those were deemed clinically inconsequential. Patients with MRI abnormalities were two years' younger than those with a normal or inconsequential MRI. 'Curve magnitude at presentation' in presumed idiopathic scoliosis patients was the only predictor of intrathecal pathology. 'Pain' was the only indication significantly associated with clinically inconsequential findings on MRI., Level of Evidence: III., (Copyright © 2021, The author(s).)

Introduction: Leptomeningeal metastasis (LM) is known to demonstrate a very poor prognosis. The purpose of this study was to evaluate the prognostic factors in LM cases diagnosed by spinal magnetic resonance imaging (MRI)., Methods: We retrospectively analyzed 19 patients with LM detected by spinal MRI between 2010 and 2017., Results: The primary tumors were breast carcinoma (n = 7), lung carcinoma (n = 6), lymphoma (n = 3), colorectal carcinoma (n = 2), and gastric carcinoma (n = 1). Thirteen patients exhibited preceding brain metastasis, and 11 of these exhibited metastasis in the posterior fossa. Ten patients exhibited limb paralysis. Performance status at diagnosis was 0-1 in 6 patients, 2 in 9 patients, and 3-4 in 4 patients. Testing of cerebrospinal fluid revealed malignant cells in 9 patients. On MRI, 11 patients demonstrated disseminated tumor lesions at the cervical cord level, 15 patients at the thoracic cord level, and 11 patients below the conus level. Eleven patients received radiation therapy, while intrathecal chemotherapy was performed in 9 patients. Univariate analysis revealed cervical cord level lesions, intrathecal chemotherapy, paralysis, and performance status as prognostic factors. Multivariate analysis identified existence of a cervical cord lesion as associated with a poor prognosis (hazards ratio (HR) 3.46, 95% confidence interval (CI) 1.12-12.2), while administration of intrathecal chemotherapy was associated with a good prognosis (HR 0.15, 95% CI 0.026-0.67)., Conclusions: In LM patients, cervical cord level lesions are a negative factor for prognosis, and performance of intrathecal chemotherapy is a positive factor for prognosis., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest., (Copyright © 2020 by The Japanese Society for Spine Surgery and Related Research.)

Background The mortality in liver cirrhosis was reported to be greater than that in the five major cancers. Infection further increases the mortality of patients with cirrhosis by four fold. Considering the greatly increased mortality from infection in patients with cirrhosis, early diagnosis and prompt treatments should be compulsory to save patients' lives. However, adherence to such basic principle for patients with cirrhosis is not easy for clinicians engaged in the treatment of pyogenic vertebral osteomyelitis (PVO). Therefore, the mortality rate is expected to be high. However, no reports have described the mortality rate in this patient group. Methods A retrospective study was conducted to investigate the treatment outcome in PVO patients with cirrhosis, and to identify the predictors of their mortality. Mortality was divided into two categories, 30-day and 90-day mortality. A stepwise multivariate logistic regression model was used to identify predictors of mortality. Due to high mortality rate, the clinical outcome was investigated in patients with at least 90-day survival. Results Eighty-five patients were identified after initial exclusion. The patients' mean age was 60.5 years, and 50 patients were male. The early mortality rates within 30 and 90 days were 17.6% and 36.5%, respectively (Table 1). Multivariate analysis revealed that increased age, CTP class C, and bacteremia at the time of PVO diagnosis were predictors of 30-day mortality while higher MELD score, presence of combined infection, and multiple spinal lesions were predictors of 90-day mortality (Figure 1, Table 2). The duration of antibiotic treatment and the length of hospital stay (from the PVO diagnosis) were longer in CTP C patients; however, they were statistically insignificant (Table 3). Recurrence of PVO was more common in CTP C patients (P = 0.028) (Table 3). Conclusion Attention should be paid to the high mortality between 30 and 90 days after PVO diagnosis (18.8%), which was higher than the 30-day mortality. Liver function was consistently strong predictor of mortality in PVO patients with cirrhosis. The high-risk patients should be targeted for an aggressive diagnostic approach using spinal MRI and intensive medicosurgical treatment. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Acute spinal cord compression usually results from trauma, infection, or cancer. Spinal subdural hematoma is an uncommon cause of spinal cord compression that occurs after spine trauma or spinal invasive procedure, especially in context of coagulopathy. In the following reported case, an 82-year-old woman with a history of rapidly progressive paraparesis after a sudden middle back pain, with no previous trauma or coagulopathy, due to an acute spontaneous spinal subdural hematoma. In fact, the main difficulty was to determine, in an emergency situation, the right strategy to identify both the lesion and its cause to adapt therapeutics. This case not only provides an illustrative unusual condition in an emergency department but also a challenging discussion to choose the right treatment for a sudden neurological impairment. According to a literature review of the idiopathic cases of spinal subdural hematomas without coagulopathy, the clinical outcome depends on severity of neurological impairment. MRI is the main examination to perform in an emergency. Thus surgical evacuation should be performed in emergency in patients presenting with severe neurological impairment., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Magnetic resonance imaging (MRI) of the spine is a powerful tool for evaluation, assessment of severity, and follow up of diseases of the spine. It is one of the most sensitive diagnostic tests for detecting anatomic abnormalities of the spine and the adjacent structures., Aim: To determine the pattern of spinal abnormalities on MRI in Kano, Nigeria., Materials and Method: Patients aged between 2 and 95 years who had spinal MRI with AIRIS II TOSHIBA (0.5T) Tesla machine from January to December 2013 were reviewed. Information concerning age, gender, region and findings were recorded., Results: Two hundred and sixty one patients made up of187 males and 74 females were reviewed. Their ages ranged from 2 to 95 years with the mean of 46.43 ± 15.7 years. Lumbo-sacral MRI was the most commonly performed (46.4 %) followed by cervical (44.1%), thoraco-lumbar spine (4.2%), thoracic spine (3.8%) and cervical and lumbar (1.5%). The most common indication of MRI was low back pain in 211 (80.8% ) patients followed by trauma in 36 (17.8% ) patients. About 19.6% of the MRI examinations were normal while spondylosis and moderate disc prolapse was seen in 31.5% and compressive fracture comprised 7.3% of cases., Conclusion: Lumbo-sacral MRI was the commonest MRI in this study and the commonest indications for MRI were low back pain and trauma while the commonest findings were spondylosis, disc prolapse, compressive fracture and spinal metastases.