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Objective: To evaluate the accuracy in determining the degree of lumbar spinal stenosis in patients utilizing lumbar spine magnetic resonance imaging (MRI) with axial loading as compared to conventional lumbar spine MRI with clinical correlation. To assess the difference in the dural cross sectional area (DCSA) between lumbar spine MRI with axial loading and conventional lumbar spine MRI. Materials and Methods: Thirteen patients with clinically diagnosed lumbar spinal stenosis, which comprised of three males and ten females, aged 20 to 80 years, and that had the severity of their stenosis clinically and radiologically graded by history taking, physical examination, and by performing both conventional and axial loaded MRI were included in this study. Results: The present study found a statistically significant difference (p<0.05) after applying load at all lumbar levels. The L4-L5 level showed the greatest reduction at 12.8%, followed by L3-L4 and L2-L3, in which the DCSA was reduced by 11.2% and 9.0%, respectively. Comparing the clinical severity and degree of each lumbar spinotic level and the maximum severity per person, the results showed that the most accuracy was at the L3-L4 level followed by L5-S1 and L2-L3 levels. No accuracy between clinical severity and the degree of lumbar spinal stenosis at L1-L2 and L4-L5 levels were shown, suggesting that more than the DCSA change influence the clinical severity. To gain further insights, following up patients and a study with more patients are needed. The maximum severity by D CSA measurement, both pre- and post-loading, of individual patients compared with clinical severity showed concordance for three patients. No significant difference in accuracy was found between pre- and post-loading. Conclusion: Changes in the DCSA of lumbar spinal stenosis after loading MRI was statistically significant especially at the moderate and severe stenotic levels particularly at the L3-4 level and L5-S1 level. [ABSTRACT FROM AUTHOR]

Metal artifacts often appear in the images of computed tomography (CT) imaging. In the case of lumbar spine CT images, artifacts disturb the images of critical organs. These artifacts can affect the diagnosis, treatment, and follow up care of the patient. One approach to metal artifact reduction is the sinogram completion method. A mixed-variable thresholding (MixVT) technique to identify the suitable metal sinogram is proposed. This technique consists of four steps: 1) identify the metal objects in the image by using k-mean clustering with the soft cluster assignment, 2) transform the image by separating it into two sinograms, one of which is the sinogram of the metal object, with the surrounding tissue shown in the second sinogram. The boundary of the metal sinogram is then found by the MixVT technique, 3) estimate the new value of the missing data in the metal sinogram by linear interpolation from the surrounding tissue sinogram, 4) reconstruct a modified sinogram by using filtered back-projection and complete the image by adding back the image of the metal object into the reconstructed image to form the complete image. The quantitative and clinical image quality evaluation of our proposed technique demonstrated a significant improvement in image clarity and detail, which enhances the effectiveness of diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to determine the distribution of intracranial atherosclerotic calcification, its association with risk factors, and cerebrovascular events in patients with major ischemic stroke., Material and Method: In this retrospective study, 327 patients who underwent CT scan of brain were included and the clinical parameters were recorded. Two neuroradiologists evaluated the non-contrast axial CT images for any of intracranial arteries, based on a standard CT scoring system for extent (0-4) and thickness (0-4). The composite CT score for extent and thickness of these vascular segments or vessels were recorded on all patients., Results: Based on of MDCT features, 155 major ischemic stroke and 172 non-ischemic stroke were enrolled The highest prevalence of calcification was seen in intracranial internal carotid artery (IICA) (73%), and less commonly in the vertebral artery (8%). There were higher prevalence of intracranial artery calcification in ischemic stroke patients than non-ischemic stroke patients (82% vs. 52%, p < 0.0001). Hypertension (OR = 1.903, 95% CI: 1.019-3.552, p < 0.05), intracranial artery calcification (OR = 2.147, 95% CI: 1.143-4.033, p < 0.05), moderate degree of calcification (OR = 2.631, 95% CI: 1.299-5.260, p < 0.05), and severe degree of calcification (OR = 3.479, 95% CI: 1.500-8.068, p < 0.05) were found to be independently associated with ischemic stroke., Conclusion: Significant intracranial atherosclerosis as determined by severe CT calcification had higher incidence in ischemic stroke patients. Intracranial artery calcification with moderate and severe degree of calcification and hypertension were independently significant associated with ischemic stroke. CT calcification score might serve as an indicator of intracranial atherosclerotic disease and might be useful in predicting ischemic stroke.

Objective: Retrospectively comparing 18F-FDG PET/CT and CT findings at the same anatomic locations in patients with lymphoma by using a combined PET/CT scanner and to analyze the lesions on both metabolic and anatomic bases to evaluate their sensitivity specificity positive predictive value (PPV), negative predictive value (NPV), and accuracy. We analyzed all studies, all patients, common cell type in this study such as diffuse large B cell lymphoma (DLBCL) and Hodgkin's lymphoma and indication of the study such as restaging for recurrence post-therapy and evaluate residual disease within two months after chemotherapy., Material and Method: Sixty-seven lymphoma patients were studied PET/CT between January 2007 and December 2012 in Siriraj Hospital. We excluded six patients due to no medial report in our hospital. Sixty-one patients (29 male, 32 female, mean age 46.6 +/- 17.7 years, range 8-75) with NHL and with HL) were analyzed for the result of dual-modality PET/CT They underwent 77 18F-FDG PET/CT studies for restaging, for recurrence post-therapy based on 41 studies and evaluation of residual disease within two months after chemotherapy in 36 studies., Results: The statistical parameters of 18F-FDG PET/CT imaging of lymphoma patients after treatment show significantly better specificity than CT and insignificant high accuracy for all studies, all patients, histology of DLBCL, indication of evaluation of active lymphoma within two months after chemotherapy. The 18F-FDG PET/CT parameters of accuracy and PPV are higher than CT without statistical significance. The 18F-FDG PET/CT is not significantly better than CT for histology of Hodgkin's lymphoma and indication of restaging for recurrence post-therapy Nevertheless, the 18F-FDG PET/CT shows slightly improved specificity PPV and accuracy than CT The sensitivity of CT in this study is high and may be from most of our cases selected post-treatment lymphoma that had a residual mass after treatment. Therefore, the sensitivity of PET scan is not significantly higher when compared with CT scan., Conclusion: The PET/CT is better than CT for post-treatment lymphoma patient particularly for cell type of DLBCL and indication for evaluation of active lymphoma within two months after chemotherapy.

Objective: To evaluate diagnostic performance of 18F-FDG PET/CT in assessment of recurrence colorectal cancer after treatment in Siriraj Hospital., Material and Method: The authors retrospectively studied 48 treated colorectal cancer patients with suspected recurrence who underwent 18F-FDG PET/CT and contrast-enhanced CT (CECT). Clinical information, image follow-up for at least one year, and pathological reports of the patients were reviewed for gold standard, Results: Recurrent or metastatic disease was found in 36 of 48 patients. Calculated sensitivity, specificity and accuracy of 18F-FDG PET/CT were 94.4%, 66.7%, and 87.5%. 18F-FDG PET/CT can reduce false positive results of CECT in six patients, thus specificity of 18F-FDG PET/CT was statistically significantly better than that of CECT. Using lesion-based analysis with 65 recurrent sites and 26 non-recurrent lesion, 18F-FDG PET/CT showed better sensitivity 87.7%, specificity 61.5%, and accuracy 80.2 than CECT without statistical significance., Conclusion: 18F-FDG PET/CT overall showed higher sensitivity, specificity, and accuracy than CECT.

Background: The Canadian Neurological Scale (CNS) is one of the most reliable stroke severity assessment scales. There is a strong need for a simple and well validated stroke severity assessment scale among Thais., Objective: To translate and perform a reliability and validity study of the Canadian Neurological Scale, Thai version (CNS-T)., Material and Method: Forward and backward translations of the original CNS version were independently performed. The final version of the CNS-T was prospectively tested for reliability and validity in acute ischemic stroke setting. Consecutive series of acute stroke patients were assessed by one of the six raters from three different types of healthcare providers: 2 stroke nurses, 2 internal medicine residents and 2 stroke fellows. Each patient was independently assessed twice at 3 weeks interval using video tape by all raters. Extent of infarction was measured by MRI lesion volume. Clinical outcome at 3 months was measured using modified Rankin Score (mRS). Correlation among the CNS-T and 3-mo mRS and MRI lesion volume were assessed. Inter and intra-observer reliabilities were evaluated., Results: A total of 38 patients were enrolled. Median CNS-T was 8.5. Intra-observer reliability demonstrated a high agreement with an intraclass correlation (ICC) of 0.99, 0.97, 0.98, 0.96, 0.93 and 0.98 for 2 stroke fellows, 2 internal medicine residents and 2 stroke nurses respectively. Inter-observer reliability between the 6 raters was excellent: ICC 0.87 (95% CI; 0.81-0.92). The Spearman rank correlation coefficient was -0.55 (p = 0.001) between the initial CNS-T score versus initial MRI lesion volume and -0.61 (p < 0.001) between the initial CNS-T score versus 3-mo mRS., Conclusion: The CNS-T can be performed by trained nurses, internists and neurologists with an excellent reliability. The CNS-T is a valid and simple clinical tool for stroke severity assessment among Thais.

Objective: To describe clinical manifestations, neuroimaging findings, and clinical outcomes in children with acute disseminated encephalomyelitis (ADEM)., Material and Method: Children with a diagnosis of ADEM who were less than 15 years of age at Siriraj Hospital between January 2002 and December 2008 were retrospectively reviewed. Clinical symptoms and signs as well as cerebrospinal fluid analysis, neuroimaging findings and clinical outcomes were extracted from medical records using a standard form., Results: During the present study period, 14 children were diagnosed with ADEM. Median age was 7.2 years (range, 1.25-13 years). The most common presenting symptoms were decreased mental status (93%), weakness (71%), and fever (50%). Cranial MRI was abnormal in all patients. All but one patient received high dose intravenous methylprednisolone and a course of tapered oral prednisolone. After a mean follow-up period of 28.6 +/- 19.8 months, 13 patients were classified as monophasic ADEM and one progressed to have multiple sclerosis. Eleven patients recovered completely while one was left with mild hemiparesis and the other two (one with final diagnosis of MS) with severe psycho-neurological disturbances., Conclusion: There are no specific symptoms and signs in children with ADEM. Multifocal neurological deficits along with encephalopathy and abnormal MRI findings lead to correct diagnosis. Treatment with corticosteroid may improve clinical outcomes. Some children may progress to MS. Long-term clinical and neuroimaging studies in these children are needed.

Objective: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) value in discriminating benign from malignant vertebral compression fracture., Material and Method: 22 symptomatic patients with compression fracture of vertebra referred for conventional MRI spines during January 2009-March 2010 underwent additional diffusion weighted MR techniques. Evaluation of diffusion weighted MR imaging and quantified ADC value from reconstructed ADC map were performed. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of apparent diffusion coefficient (ADC) value were calculated., Results: A total of 39 vertebral fractures; 7 malignant compression fractures and 32 benign compression fractures were evaluated. The difference between ADC values of malignant, benign compression fracture and normal vertebrae were statistically significant (p < 0.0001). The accuracy, sensitivity and specificity were 89.7%, 85.7% and 90.6% respectively with the ADC threshold of 0.89 to discriminate malignancy., Conclusion: The ADC promises to be an effective implement for characterization of vertebral body compression fracture in differentiating benign and malignant compression fractures.

Objective: Establish the predictive value of magnetic resonance imaging (MRI) for cervical spondylotic myelopathy as being a good operative outcome., Material and Method: A retrospective study of the 52 consecutive patients with cervical spondylotic myelopathy underwent both magnetic resonance imaging (MRI) cervical spines examination at Siriraj Hospital between January 2005 and June 2007. Surgery was divided into two groups: "Good" operative outcome (35 patients) and "No improvement group" (17 patients). Two neuroradiologists independently identified the MR images data that showed the maximum stenosis on sagittal and axial sections and recorded predictive MRL parameters: T2-weighted signal change of the spinal cord, cross-sectional area of the spinal cord, anteroposterior (AP) diameter of the spinal canal and the spinal cord and AP-compression ratio (AP diameter/transverse diameter of the spinal cord)., Results: There were no statistically significant differences between both groups in all parameters., Conclusion: The AP-diameter of the spinal canal and spinal cord, AP-compression ratio and signal change of the spinal cord are not useful in predicting prognosis outcome in patients with cervical spondylotic myelopathy. In addition, cross-sectional area of the spinal cord cannot confidentially be used as predictive factor in CSM patients due to many influent factors of surgical outcome. A further prospective study without patient selective bias may offer more definite results to confirm these findings.

Objective: Determine the value of PET/CT in unknown primary cancer patient with high tumor marker and negative study for clinical and conventional imaging., Material and Method: A retrospective database review of 417 patients who received PET/CT between July 2006 and August 2007 in National cyclotron and PET center at Chulabhorn cancer center was done. Patients were included in this study if the diagnosis were unknown primary cancer and rising tumor marker. Twelve patients were included in this study. Data included age, gender, tumor marker rising, anatomical imaging finding (CT and MRI), PET finding and clinical follow-up., Results: Nine cases had normal PET/CT. This showed that PET/CT does not get more information than conventional imaging. The PET scan showed positive in three cases, #5, #6 and #10. Two cases were false positive, #5 and #6. Case #5 had clinical follow-up for one year and revealed to be normal. Case #6 PET showed markedly glucose avid lesion at tumor thrombus but contrast CT confirm blood clot and the patient was treat with wafarin and claxane. The follow-up clinical showed improvement. The high serum CA 125 explained by lung infarction caused the false positive. In case #10, the PET/CT suggested lung cancer at basal segment of LLL., Conclusion: Screening 18F FDG PET/CT is not appropriate in unknown primary with rising tumor marker and normal conventional imaging is required.

Objective: To evaluate the relationship between the degree of midline shift by Computed Tomography (CT) finding and Glasglow Coma Score (GCS) as a predictive of clinical outcome in patients after head injury. METHOD AND METHOD: The present study was performed by retrospectively reviewing 216 consecutive cases of traumatic head injury admitted to the trauma center in Siriraj Hospital from 1999 until 2004. All patients were evaluated for level of consciousness by a neurosurgeon determining by GCS and underwent CT brain for evaluation of intracranial hemorrhage and midline shift. The final clinical outcome was also divided into two groups; good outcome for the patients who recovered well with moderate disability and the poor outcome for the patients who suffered severe disability, vegetative status and death. Then, the authors compared midline shift vs. GCS and midline shift vs. clinical outcomes., Results: Total of 216 cases, the three most common types of head injury were motorcycle accident, fall or assault and car accident. 96 of 216 patients had midline shifting, 53 of 96 patients had CT scan of midline shifting less than 10 mm whereas 37 of 96 patients had a CT scan of greater than 10 mm of midline shifting. 63.3% with midline shifting up to 10 mm had severe head injury and up to 81% with brain shifting greater than 10 mm had severe head injury. The clinical outcome also showed that poor clinical outcomes correlated to midline shifting greater than 10 mm., Conclusion: The increased degree of midline shift in patients with head injuries by CT scan was related to the severity of head injury (GCS = 3-12) and was significantly related to poor final clinical outcome.

Objective: To determine the role of Magnetic Resonance (MR) imaging for the investigation ofpatients with suspected metastasis to the spine by bone scintigraphy., Material and Method: Retrospectively reviewed with comparison was made between Technetium-99m Methylene Diphosphonate (99(m)Tc-MDP) bone scintigraphy and corresponding spine MR images in 48 cases of vertebral metastasis at Siriraj Hospital. The intervals between bone scintigraphy and MR images did not exceed 1 month. The authors studied between January 2005 and December 2006 Bone scintigraphy were performed with planar imaging of the entire body and MR imaging was performed with the 1.5 tesla and 3.0 tesla scanner using standard techniques with T1-, T2-weighted images and fat-suppressed T1-weighted images with intravenous administration of gadopentetate dimeglumine. The MR imaging findings were studied: location (cervical or thoracic or lumbar or sacrum spine), number of lesions (solitary or multiple lesions), pattern of enhancement (homogeneous or inhomogeneous), involvement of spinal canal, compression of spinal cord, extradural extension, other incidental findings such as pulmonary metastasis, pleural effusion, lymphadenopathy The final diagnosis was confirmed clinically and followed-up for further management (radiation or surgery) or followed-up by MR imaging (1 month-16 months) and bone scintigraphy (5 months-12 months)., Results: Forty-eight cases (80 lesions) of vertebral metastasis were identified (25 men and 23 women; mean age 61 years and range 8-84 years). Primary neoplasms include breast cancer (n=11), colorectal cancer (n=7), lung cancer (n=6), prostate cancer (n=5), nasopharyngeal cancer (n=5), head and neck cancer (n=3), thyroid cancer (n=2), liver cancer (n=2), esophagus cancer (n=1), bladder cancer (n=1), retroperitoneum cancer (n=1), medulloblastoma (n=1), cervical cancer (n=1), ovarian cancer (n=1), malignant melanoma (n=1). The result of bone scintigraphy and MR imaging is used to evaluate vertebral metastasis: in 44 lesions of bone scintigraphy positive for vertebral metastasis, 40/44 lesions (91%) which MR imaging reveal vertebral metastasis. This group may not benefit for further investigation by MR imaging. In 24 lesions of negative of bone scintigraphy for vertebral metastasis, the authors found that 14/24 lesions (58%) showed positive of vertebral metastasis from MR imaging. In this group, the authors recommended a further investigation because 58% of negative bone scintigraphy lesions are depicted by only MR imaging. MR imaging demonstrated metastatic cord compression in 16 cases. Extradural extension causes spinal canal narrowing in 30 cases., Conclusion: The authors conclude that the MR imaging is more efficient than the bone scintigraphy in detecting vertebral metastasis, especially in the cases that bone scintigraphy are equivocal or negative for vertebral metastasis in high clinical suspicion. Furthermore, MR imaging is important for the further treatment planning such as radiation therapy or systemic chemotherapy. Although MR imaging is useful in the detection of early metastasis that are localized completely in the bone marrow cavity routinely bone scintigraphy remains that most cost-effective method for examination of the entire skeleton.

Objective: To determine the lowest miliampere-second (mAs) of a cranial computed tomography (CT) scan that can maintain acceptable image quality on cranial CT scan which might help reducing the risk of cataract formation., Material and Method: The present study was performed on the 148 patients in routine daily practice sent for diagnosis of intracranial conditions by a cranial CT scan. During the cranial CT scanning, each lens's radiation dose on patient's eyes was measured by a thermoluminescent dosimeter Clinical image quality, particularly in analysis of gray and white matter differentiation, was evaluated independently using a 5 point scale by two radiologists., Results: During standard cranial CT scan protocol with 250 miliampere-second (mAs), the total dose of left and right lens's dose were about 50.93 miligray (mGy) and 51.66 mGy, respectively. When applying low dose cranial CT scan protocols by decreasing mAs to 200, 150 and 100 mAs, the total dose ofright and left lens were of 45.68 mGy and 46.04 mGy for 200 mAs, 34.65 mGy and 34.77 mGy for 150 mAs, 28.73 mGy and 29.25 mGy for 100 mAs respectively., Conclusion: A low dose cranial CT scan at 100 miliampere-second provides not only an acceptable clinical image quality, but also decreases the lens's radiation dose by 43%.

Objective: To analyze CT findings in hemorrhagic stroke patients correlation with clinical outcome and assess the interobserver agreement of hemorrhagic stroke identification on CT imaging., Material and Method: CT imaging features of 131 cases and clinical data were verified and collected at Siriraj Hospital from Jan 2004 to Dec 2005 and retrospectively analyzed for type, location, mass effect, size of hemorrhage, intraventricular extension, initial level of consciousness (GCS), hospital length of stay and patient outcome. The percentages, predictive values, kappa were calculated., Results: From all types of hemorrhagic stroke, intracerebral hemorrhage remains a common and devastating clinical problem. The most common site was the thalamus and basal ganglia. In the present study, the authors found that fifty-three cases (53/131 cases, 40.5%) with thalamic-ganglionic hemorrhage, nineteen cases (19/131 cases, 14.5%) in lobar hemorrhage, five cases (5/131 cases, 3.8%) in cerebellum, five cases (5/131 7 cases, 3.8%) in brainstem and eight cases (8/131 cases, 6.1%) occurred in multiple locations. There were twenty-five cases (25/131 cases, 19.1%) of subarachnoid hemorrhage, thirteen cases (13/131 cases, 9.9%) of subdural hemorrhage and three cases (3/131 cases, 2.3%) of intraventricular hemorrhage. Two variables on CT imaging, identified as significant as early mortality predictors, were hematoma volume more than 60 cm3, and presence of intraventricular hemorrhage extension (p < 0.05). The mass effect defined as midline and/or enlargement of contralateral ventricle was not significant (p = 0.067). The present study found concordance between CT brain interpretation by two neuroradiologists for the type of hemorrhagic stroke was very good, Kappa = 0.861 as well as for location was 0.866., Conclusion: CT imaging is an imaging instrument for early identification of hemorrhagic stroke patients and providing imaging evidence of high mortality risk.

Objective: To systemically evaluate MR imaging features of tuberculous spondylitis and to find features that may help differentiating tuberculosis from other spinal diseases., Material and Method: Retrospective review of 65 MR imaging of two groups of patients between January 2002 and December 2005. Thirty-one patients were diagnosed as tuberculosis spondylitis and the rest were a randomly selected group of 34 patients with other spinal diseases. All images were reviewed by two neuroradiologists blinded to clinical data. Sensitivity and specificity of each MR imaging features were calculated., Results: Three most useful MR imaging features with high sensitivity and specificity (> 80%) were endplate disruption (100%, 81.4%), paravertebral soft tissue (96.8%, 85.3%), and high signal intensity of intervertebral disc on T2W (80.6%, 82.4%). High sensitivity but low specificity signs in MRI included bone marrow edema (90.3%, 76.5%), bone marrow enhancement (100%, 42.5%), posterior element involvement (93.5%, 76.5%), canal stenosis (87.1%, 26.5%), and spinal cord or nerve root compression (80.6%, 38.2%). Low sensitivity but high specificity features in MRI were intervertebral disc enhancement (63.3%, 84.2%), vertebral collapse (58.1%, 85.3%), and kyphosis deformity (67.7%, 82.4%). Overall, the sensitivity and specificity of MRI for spinal tuberculosis were 100% and 88.2% respectively., Conclusion: The authors presented three good to excellent sensitivity and specificity MR imaging features for spinal tuberculosis, end plate disruption, paravertebral soft tissue formation, and high signal of intervertebral disc on T2W. In contrast to a previous study, most of the presented cases still presented with classic radiological pictures of "two vertebral disease with the destruction of the intervertebral disc". Only a small portion of the patients revealed sparing intervening disc or isolated single vertebral body involvement, which possibly reflected the early stages of the disease process.

Objective: To assess agreement in detection of lumbar disc herniation (LDH) between limited and full protocol MRI., Material and Method: 123 patients who requested lumbar MRI for diagnosis of disc herniation were assessed The full protocol MRI composed of sagittal T1-wi, sagittal T2-wi and axial T2-wi was performed on each patient. The sagittal T2-wi was selected as the limited protocol MRI. The limited and full protocols MRI of each patient were separately interpreted by three neuroradiologists to assess disc herniation and nerve root compression. The consensus results of limited and full protocol were compared. The diagnostic performance of each protocol was analyzed using surgery as the gold standard., Results: There were 62 females and 61 males enrolled into the study between the age of 21-60 years old (means = 42.91 years). The duration of pain was 1-204 months (mean = 31.20 months). The degree of severity was mild in 23.58%, moderate 45.52% and severe 30.89% of cases. Thirty-three cases were operated on. For detection of LDH, the limited protocol gave the same interpretation results as the full protocol (0 = 1.04, 95%CI = 0.94, 1.14 with accepted range of 0.95-1.05). In nerve root compression, the limited protocol was not accurate as the full protocol (0 = 0.75, 95%CI = 0.87, 0.63). The sensitivity, specificity, accuracy, PPV, NPV, and LR+ in the surgical group of limited protocol in diagnosis of LDH were 82.61%, 80%, 81.82%, 90.48%, 60.67%, 4.13 and in nerve root compression were 54.84%, 100%, 57.58%, 100%, 12.5% respectively. The same statistics of full protocol MRI in diagnosis of LDH were 82.61%, 70.80%, 78.79%, 86.36%, 63.64%, 2.75 and of nerve root compression were 80.65%, 100%, 81.82%, 100%, 25% respectively. The sensitivity and specificity in diagnosis of LDH were not different in both protocols but the sensitivity of nerve root compression was statistically significant different (p < 0.013, 95%CI = -0.33, -0.25)., Conclusion: The authors concluded that limited protocol MRI may replace full protocol MRI in diagnosis of LDH but not in nerve root compression.

Introduction: Sinusitis is a very common disease in childhood. Clinical manifestations in childhood sinusitis are different than in adult. Information in childhood sinusitis in Thailand is limited. We performed a prospective descriptive study to determine clinical characteristics of childhood sinusitis in Thailand, Material and Method: One hundred pediatric patients with clinical diagnosis of sinusitis attending pediatric allergy clinic, pediatric outpatient clinic, and pediatric ENT clinic were recruited. Clinical diagnosis was defined by presence of symptoms indicating upper respiratory infections with exudates at middle meatus by anterior rhinoscopy. Thorough history taking and physical examinations were conducted with findings recording into sinusitis questionnaire. Sinus radiographs were taken in 77 patients and were read blindly a single radiologist who was unaware of clinical conditions of patients. Allergy skin prick tests were performed with a panel of common aeroallergens in Thailand., Results: Age range of the 100 patients were between 1.7 to 12.4 years with a mean (+/- SD) of 6 +/- 2.72 years. History of atopic disease among patients and their families was positive in 49% and 47% respectively. Four most common clinical manifestations were rhinorrhea (95%), nocturnal and productive cough (91%), nasal congestion (74%) and posterior nasal dripping (66%). The three most common signs were obstruction of middle meatus (100%), swelling of turbinates (92%) and granular pharynx (48%). All paranasal sinuses X-rays were abnormal with maxillary sinus being the most commonly involved sinus (99%) followed by ethmoid sinus (91%). The majority of patients had involvement of more than one sinus. Skin prick tests were positive in 53.6%. The two most common sensitizing allergens were dust mites (57.7) and cockroaches (18.6%)., Conclusion: The presence of symptoms of rhinorrhea, cough, nasal congestion and posterior nasal drip should alert physicians for diagnosis of sinusitis in pediatric patients. Maxillary and ethmoid sinus were the most common sinuses involved. Atopic predisposition is present in up to 53.6% in this population.

The term "alien hand syndrome (AHS)" comprises many clinical signs of which the common features are the involuntary motor movement of the affected limb and the denial of limb ownership. It can result from several diseases involving corpus callosum or medial frontal cortex. Two major types of AHS were previously classified, callosal and frontal types. Moreover posterior subtype of which the lesions do not involve corpus callosum have been reported. In the present report, the authors describe a 57-year-old man with AHS, aggressive behavior and hemispatial neglect which are the rare manifestations of callosal damage. Neuroimaging demonstrated subacute infarction of entire corpus callosum from the rostrum to splenium. A review of the literature on these abnormalities is included in the present paper.