Magnetic resonance imaging of the cervical, thoracic, and lumbar spine in children: spinal incidental findings in pediatric patients.
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SUBMITTER: Ramadorai UE
PROVIDER: S-EPMC4229374 | biostudies-other | 2014 Dec
REPOSITORIES: biostudies-other
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Project description:Study Design?Systematic review. Clinical Question?What is the prevalence of incidental magnetic resonance imaging (MRI) findings of the spine in asymptomatic pediatric patients? Methods?Electronic databases and reference lists of key articles were searched up to December 15, 2013, to identify studies reporting the incidence or prevalence of incidental findings on MRI in asymptomatic pediatric patients. Athletes or children with a known history of trauma, infection, or congenital abnormalities were excluded. Results?Seven publications, one prospective cohort, and six cross-sectional studies met the inclusion criteria. The most commonly reported findings on MRI were disc-related and included degenerative disc disease (seven studies, prevalence 19.6%), disc herniation/protrusion (four studies, 2.9%), disc height/narrowed disc space (two studies, 33.7%), and endplate changes (two studies, 5.3%). Other disc-related findings, reported by one study each, included bulging disc, abnormal nucleus shape, annular tear, high intensity zone, and nerve root compression, with prevalences ranging from 4.5 to 51.6%. Spondylolisthesis and spondylolysis were reported by one study each with a prevalence of 2.3 and 0%, respectively. Other findings reported included tumors and infections (one study, 0% for both) and Scheuermann-type changes (one study, 7.7%). Conclusions?The prevalence of positive MRI findings in the asymptomatic pediatric population is higher than previously assumed, particularly in regard to disc morphology, highlighting the importance of correlating the history and physical examination to the MRI findings to avoid misdiagnosis or over-treatment in the pediatric population.
| S-EPMC4174226 | biostudies-literature
Project description:CONTEXT:Currently, there is a national focus on establishing and disseminating standardized guidelines for return to play for athletes at all levels of competition. As more data become available, protocols and guidelines are being refined and implemented to assist physicians, coaches, trainers, players, and parents in making decisions about return to play. To date, no standardized criteria for returning to play exist for injuries to the spine. EVIDENCE ACQUISITION:Electronic databases including PubMed and MEDLINE and professional orthopaedic, neurosurgical, and spine organizational websites were reviewed between 1980 and 2015. STUDY DESIGN:Clinical review. LEVEL OF EVIDENCE:Level 4. RESULTS:Although clinical guidelines have been published for return to play after spine injury, they are almost exclusively derived from expert opinion and clinical experience rather than from well-designed studies. Furthermore, recommendations differ and vary depending on anatomic location, type of sport, and surgery performed. CONCLUSION:Despite a lack of consensus and specific recommendations, there is universal agreement that athletes should be pain free, completely neurologically intact, and have full strength and range of motion before returning to play after spinal injury.
| S-EPMC4702157 | biostudies-literature
Project description:BackgroundDetection of nerve involvement originating in the spine is a primary concern in the assessment of spine symptoms. Magnetic resonance imaging (MRI) has become the diagnostic method of choice for this detection. However, the agreement between MRI and other diagnostic methods for detecting nerve involvement has not been fully evaluated. The aim of this diagnostic study was to evaluate the agreement between nerve involvement visible in MRI and findings of nerve involvement detected in a structured physical examination and a simplified pain drawing.MethodsSixty-one consecutive patients referred for MRI of the lumbar spine were - without knowledge of MRI findings - assessed for nerve involvement with a simplified pain drawing and a structured physical examination. Agreement between findings was calculated as overall agreement, the p value for McNemar's exact test, specificity, sensitivity, and positive and negative predictive values.ResultsMRI-visible nerve involvement was significantly less common than, and showed weak agreement with, physical examination and pain drawing findings of nerve involvement in corresponding body segments. In spine segment L4-5, where most findings of nerve involvement were detected, the mean sensitivity of MRI-visible nerve involvement to a positive neurological test in the physical examination ranged from 16-37%. The mean specificity of MRI-visible nerve involvement in the same segment ranged from 61-77%. Positive and negative predictive values of MRI-visible nerve involvement in segment L4-5 ranged from 22-78% and 28-56% respectively.ConclusionIn patients with long-standing nerve root symptoms referred for lumbar MRI, MRI-visible nerve involvement significantly underestimates the presence of nerve involvement detected by a physical examination and a pain drawing. A structured physical examination and a simplified pain drawing may reveal that many patients with "MRI-invisible" lumbar symptoms need treatment aimed at nerve involvement. Factors other than present MRI-visible nerve involvement may be responsible for findings of nerve involvement in the physical examination and the pain drawing.
| S-EPMC2944219 | biostudies-literature
Project description:ObjectiveWe describe the prevalence and range of incidental intracranial abnormalities identified through MRI of the brain in a large group of children screened for a clinical trial.MethodsWe included 953 children between 5 and 14 years of age who were screened with MRI of the brain for the Silent Infarct Transfusion Trial. All had sickle cell anemia or sickle beta-null thalassemia. MRI scans were interpreted by 3 neuroradiologists. MRI scans reported to have any abnormality were reviewed by 2 study neuroradiologists. Incidental findings were classified into 4 categories, that is, no, routine, urgent, or immediate referral recommended. Cerebral infarctions and vascular lesions were not considered incidental and were excluded.ResultsWe identified 63 children (6.6% [95% confidence interval: 5.1%-8.4%]) with 68 incidental intracranial MRI findings. Findings were classified as urgent in 6 cases (0.6%), routine in 25 cases (2.6%), and no referral required in 32 cases (3.4%). No children required immediate referral. Two children with urgent findings underwent surgery in the subsequent 6 months.ConclusionIn this large cohort of children, incidental intracranial findings were identified for 6.6%, with potentially serious or urgent findings for 0.6%.
| S-EPMC3153884 | biostudies-literature
Project description:BackgroundRevised diagnostic criteria for pseudotumor cerebri syndrome require three of four neuroimaging findings in the absence of papilledema. We examined the sensitivity and specificity of three or more of four of these magnetic resonance imaging (MRI) findings for pseudotumor cerebri syndrome in children.MethodsAs part of clinical care, patients in whom there was suspicion for pseudotumor cerebri syndrome underwent neurological and fundoscopic examinations, lumbar puncture, MRI, or magnetic resonance venogram. For this retrospective study, we used this information to classify 119 subjects into definite (n = 66) or probable pseudotumor cerebri syndrome (n = 12), elevated opening pressure without papilledema (n = 23), or controls who had normal opening pressure without papilledema (n = 24). A neuroradiologist, unaware of the clinical findings or original MRI report, reviewed MRIs for pituitary gland flattening, flattening of the posterior sclera, optic nerve sheath distention, and transverse venous sinus stenosis.ResultsThe presence of three or more MRI findings has a sensitivity of 62% (95% confidence interval: 47% to 75%) and a specificity of 95% (95% confidence interval: 77% to 100%), compared with controls. Two of three (transverse venous sinus stenosis, pituitary gland flattening, flattening of the posterior sclera) had a similar sensitivity and specificity. Transverse venous sinus stenosis alone had a slightly higher sensitivity (74%, 95% confidence interval: 60% to 85%) and specificity (100%, 95% confidence interval: 80% to 100%).ConclusionsIn children, three of four of the proposed neuroimaging criteria and transverse venous sinus stenosis alone have a moderate sensitivity and robust specificity for pseudotumor cerebri syndrome. MRIs should be reviewed for these criteria, and their presence should raise suspicion for pseudotumor cerebri syndrome in children, particularly if the presence of papilledema is uncertain.
| S-EPMC6890473 | biostudies-literature
Project description:PurposeTo characterize the inter- and intraobserver variability of qualitative, non-disk contour degenerative findings of the lumbar spine at magnetic resonance (MR) imaging.Materials and methodsThe case accrual method used to perform this institutional review board-approved, HIPAA-compliant retrospective study was the random selection of 111 interpretable MR examination cases of subjects from the Spine Patient Outcomes Research Trial. The subjects were aged 18-87 years (mean, 53 years +/- 16 [standard deviation]). Four independent readers rated the cases according to defined criteria. A subsample of 40 MR examination cases was selected for reevaluation at least 1 month later. The following findings were assessed: spondylolisthesis, disk degeneration, marrow endplate abnormality (Modic changes), posterior anular hyperintense zone (HIZ), and facet arthropathy. Inter- and intraobserver agreement in rating the data was summarized by using weighted kappa statistics.ResultsInterobserver agreement was good (kappa = 0.66) in rating disk degeneration and moderate in rating spondylolisthesis (kappa = 0.55), Modic changes (kappa = 0.59), facet arthropathy (kappa = 0.54), and posterior HIZ (kappa = 0.44). Interobserver agreement in rating the extent of Modic changes was moderate: kappa Values were 0.43 for determining superior anteroposterior extent, 0.47 for determining superior craniocaudal extent, 0.57 for determining inferior anteroposterior extent, and 0.48 for determining inferior craniocaudal extent. Intraobserver agreement was good in rating spondylolisthesis (kappa = 0.66), disk degeneration (kappa = 0.74), Modic changes (kappa = 0.64), facet arthropathy (kappa = 0.69), and posterior HIZ (kappa = 0.67). Intraobserver agreement in rating the extent of Modic changes was moderate, with kappa values of 0.54 for superior anteroposterior, 0.60 for inferior anteroposterior, 0.50 for superior craniocaudal, and 0.60 for inferior craniocaudal extent determinations.ConclusionThe interpretation of general lumbar spine MR characteristics has sufficient reliability to warrant the further evaluation of these features as potential prognostic indicators.
| S-EPMC2657480 | biostudies-literature
Project description:Study designCase-control study.PurposeIn this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with lumbar spinal stenosis (LSS) who were treated by minimally invasive surgery (MIS) unilateral laminectomy for bilateral decompression (ULBD) using a tubular retractor.Overview of literatureNumerous methods using imaging have been attempted to describe the severity of spinal stenosis. But the relationship between clinical symptoms and radiological features remains debatable.ObjectiveIn this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with LSS who were treated by MIS-ULBD.MethodsWe methodically assessed 85 consecutive patients aged >65 years who were treated for LSS. The patients were retrospectively analyzed in two age groups: 66-75 years (group 1) and >75 years (group 2). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria. Outcome parameters were compared between the groups at the 1-year follow-up. Core radiologic parameters for central and lateral stenosis were analyzed and clinical findings of the groups were compared.ResultsAt the 1-year follow-up, patients in both groups 1 and 2 demonstrated significant improvement in their VAS and ODI scores. All clinical outcomes, except postoperative ODI, were not significantly difference between the groups. In addition, no significant difference was noted in the preoperative radiological parameters between the groups. There was no statistically significant correlation between radiological parameters and clinical symptoms or their outcomes. Moreover, no differences were noted in perioperative adverse events and in the need for repeat surgery at follow-ups between the groups.ConclusionsMIS-ULBD by tubular approach is a safe and effective treatment option for elderly patients with LSS. Clinical outcomes in patients with LSS and aged >75 years were comparable with those in patients with LSS and aged 66-75 years. Moreover, we did not find any correlation between radiological parameters and clinical outcomes in either of the two patient groups.
| S-EPMC5913020 | biostudies-literature
Project description:Development of a dual-tuned proton/sodium radiofrequency (RF) coil for magnetic resonance imaging (MRI) of the rabbit spine and quantification of sodium concentration in intervertebral discs.To develop the dual-tuned proton/sodium MRI of rabbit lumbar spine to investigate proteoglycan matrix content and intervertebral disc degeneration (IDD).IDD is a common chronic condition that may lead to back pain, limited activity, and disability. Early-stage IDD involves the loss of proteoglycan matrix and water content in the disc. Sodium MRI is a promising noninvasive technique for quantitative measurement of proteoglycan changes associated with IDD. The combined structural (proton) and biochemical (sodium) MRI facilitates the investigation of morphological and molecular changes associated with degeneration of discs.Multichannel dual-tuned proton/sodium transceiver RF coil of the rabbit spine was developed and optimized at 3T human scanner-8 channels allocated for the sodium coil and 4 channels for the proton coil. High-resolution anatomy proton images of the discs were acquired using turbo spin echo and dual echo steady state sequence. Sodium concentration of the discs was quantified from sodium magnetic resonance (MR) images that were calibrated for signal attenuation because of RF field inhomogeneity, sodium MR relaxation times, and disc thickness. Twelve rabbits (~1-yr old, female, 5.2 ± 0.4 kg) were used for measuring disc sodium concentration.High-resolution in vivo proton and sodium MR images of rabbit discs (?2-mm thickness) were successfully obtained using an in-house dual-tuned proton/sodium RF coil at 3T. The total acquisition time for each set of images was approximately 40 minutes. Sodium concentration of normal rabbit lumbar discs was measured at 269.7 ± 6.3 mM, and this measurement was highly reproducible, with 5.3% of coefficient of variation.Sodium concentrations of rabbit lumbar discs were reliably measured using our newly developed dual-tuned multichannel proton/sodium RF coil at 3T.
| S-EPMC3421064 | biostudies-literature
Project description:In vivo three-dimensional (3D) kinematics of the lumbar spine has not been well evaluated by the conventional methods because of their methodological limitations, while 3D intervertebral motions have been quantitatively determined by cadaver studies. We thus developed a novel 3D analyzing system for the relative motions of individual vertebrae using 3D magnetic resonance imaging (MRI) and analyzed in vivo 3D intervertebral motions of the lumbar spine during trunk rotation. Ten healthy volunteers underwent 3D MRI of the lumbar spine in nine positions with 15 degrees increments during trunk rotation (0 degrees , 15 degrees , 30 degrees , 45 degrees , and maximum). Relative motions of the lumbar spine were calculated by automatically superimposing a segmented 3D MRI of the vertebra in the neutral position over images of each position using the voxel-based registration method. These 3D motions were represented with 6 degrees of freedom by Euler angles and translations on the coordinate system. The mean axial rotation of ten healthy volunteers of each lumbar spinal segment in 45 degrees trunk rotation to each side ranged from 1.2 degrees to 1.7 degrees . Coupled flexion with axial rotation was observed at the segments from L1/2 to L5/S1. Coupled lateral bending of the segments from L1/2 to L4/5 was in the opposite direction of the trunk rotation, while that of T12/L1 and L5/S1 was in the same direction. The direction of the coupled lateral bending in the present study was different from that in the previous cadaver study only at L4/5. This difference might result from the non-load state of the supine position in the current study and/or the non-physiological state in the cadaver study. Our system has two limitations: (1) the study was conducted with each volunteer in the supine position, and (2) because the rotation device regulated trunk rotation, trunk rotation might not have been physiological. In vivo 3D intervertebral motions of the lumbar spine during trunk rotation were evaluated using our novel motion analysis system. These data may be useful for the optimal orthopaedic management of lumbar spinal disorders.
| S-EPMC2223353 | biostudies-literature
Project description:(1) Background: Although radiography performed on the subject in an upright position is considered the standard method for assessing sagittal cervical alignment, it is frequently determined, or reported, based on MRI performed on the subject in a supine position. (2) Methods: Cervical alignment observed in both imaging modalities was assessed using four methods: the C2-7 Cobb angle, the absolute rotation angle (ARA), Borden's method, and the sagittal vertical axis (SVA). Cervical alignment was determined (lordosis, kyphosis, and straight) based on radiography. Then, the diagnostic cut-off values for the MRI images and their corresponding diagnostic accuracies were assessed. (3) Results: The analysis included 142 outpatients. The determined diagnostic cut-off values for lordosis, using three measurements (Cobb angle, ARA, and Borden's method), were -8.5°, -12.5°, and 3.5 mm, respectively, and the cut-off values for kyphosis were -4.5°, 0.5°, and -1.5 mm, respectively. The cut-off value for SVA > 40 mm was 19.5 mm. The Cobb angle, ARA, and Borden's method, on MRI, showed high negative predictive values for determining kyphosis. The SVA on MRI measurements also showed high negative predictive values for determining >40 mm. (4) Conclusions: MRI measurements may be predictive of cervical alignment, especially for the exclusion of kyphosis and SVA > 40 mm. However, caution is needed in the other determinations using MRI, as their accuracies are limited.
| S-EPMC8702200 | biostudies-literature