Page 1. Degenerative Disc Disease 127 Degenerative Disc Disease 6 Paul M. Parizel, Johan WM Van Goethem, Luc Van den Hauwe, and Maurits Voormolen PM Parizel, MD, PhD; JWM Van Goethem, MD, PhD; L. Van den ...
Spondylitis or infection of the spine is a spectrum of diseases involving the bone, disks, and/or ligaments. Because of a significant increase in the immunocompromised patient population, spinal infections are a growing and changing group...
moreSpondylitis or infection of the spine is a spectrum of diseases involving the bone, disks, and/or ligaments. Because of a significant increase in the immunocompromised patient population, spinal infections are a growing and changing group of conditions, making the diagnosis based on imaging more challenging. Most cases of spinal infections are pyogenic and occur after hematogeneous spread of an infection located elsewhere in the body. A prompt diagnosis remains crucial and MR imaging remains the cornerstone in the diagnosis. This article provides a pictorial overview of the complications and sequelae in spinal infections in general. Discussed are postoperative infections, extraspinal spread of infection, fractures and malformations, and neurologic complications.
Interpreting MR images of the lumbar spine remains a formidable diagnostic challenge, especially in patients with degenerative changes. What are the pertinent findings? Which abnormalities are clinically relevant? Which changes should be...
moreInterpreting MR images of the lumbar spine remains a formidable diagnostic challenge, especially in patients with degenerative changes. What are the pertinent findings? Which abnormalities are clinically relevant? Which changes should be viewed as normal aging? The purpose of this presentation is to present a standardized 7-step approach towards interpreting MR images of the degenerative lumbar spine.
Neuroradiology plays an essential part in the clinical management of patients with brain tumors [1]. Magnetic resonance imaging (MRI) and, to a lesser extent, computed tomography (CT) are the cornerstones for the diagnosis, definition of...
moreNeuroradiology plays an essential part in the clinical management of patients with brain tumors [1]. Magnetic resonance imaging (MRI) and, to a lesser extent, computed tomography (CT) are the cornerstones for the diagnosis, definition of extent, detection of spread and follow-up of residual or recurrent tumor [2]. The purpose of this presentation is to discuss basic and advanced neuroradiological techniques that have been developed in the examination and management of patients with brain tumors. Until recently, neuroradiological techniques were used to characterize cerebral neoplasms by: • Definition of the exact tumor location (intra-or extra-axial, supra-or infratentorial) [3,4,5]; • Demonstration of anatomy in various planes; • Display of differences in tissue density (MDCT); • Display of differences in MRI signal intensity between normal and abnormal brain tissue; • Use of contrast media to demonstrate tumor vascularity (cerebral arteriography) or to detect breakdown of the bloo...
A critical review of the potential applications, clinical usefulness and shortcomings of low field MR imaging with a view to cost control is provided.
We describe the clinical and neuroradiological findings in a 63-year-old man with Parinaud's syndrome. Magnetic resonance (MR) imaging showed a mass lesion within the quadrigeminal plate. Additional MR findings included a right...
moreWe describe the clinical and neuroradiological findings in a 63-year-old man with Parinaud's syndrome. Magnetic resonance (MR) imaging showed a mass lesion within the quadrigeminal plate. Additional MR findings included a right frontoparietal subcortical lesion as well as periventricular white matter edema due to acute deterioration of hydrocephalus. On MR, the diagnosis of multifocal glioma was proposed. Neuropathological examination after resection of the supratentorial lesion revealed an oligodendroglioma, grade II.
A woman with systemic lupus erythematosus (SLE) presented with a zoster eruption. Transverse myelitis developed at the site of the dermatomal distribution of the rash. SLE and varicella zoster virus (VZV) can both cause myelitis, and are...
moreA woman with systemic lupus erythematosus (SLE) presented with a zoster eruption. Transverse myelitis developed at the site of the dermatomal distribution of the rash. SLE and varicella zoster virus (VZV) can both cause myelitis, and are difficult to differentiate. The topographic association between the cutaneous and the neurological involvement suggesting VZV myelitis was confirmed by polymerase chain reaction (PCR) for VZV in the cerebrospinal fluid. This case illustrates the potential role of the selective amplification of VZV DNA in cerebrospinal fluid to diagnose central neurological complications associated with VZV. The value of magnetic resonance imaging of the spinal cord in the evaluation of patients with myelitis is emphasized.
Spinal cord injury is the major cause of quadriplegia and disability. Plain radiographs have a low sensitivity for identifying traumatic cervical spine lesions. Therefore trauma victims with plain films negative for cervical injury but...
moreSpinal cord injury is the major cause of quadriplegia and disability. Plain radiographs have a low sensitivity for identifying traumatic cervical spine lesions. Therefore trauma victims with plain films negative for cervical injury but with a high clinical suspicion of injury, or positive for cervical injury should undergo CT or MR for a more definitive evaluation of the cervical spine. Besides the higher sensitivity than plain radiography in detecting fractures, CT is also able to show soft-tissue abnormalities. MR is the definitive modality in assessing cervical soft-tissue injuries, especially in the evaluation of the spinal cord, intervertebral discs, and ligaments. It also allows differentiate spinal cord hemorrhage and edema, which may have a prognostic value. The role of medical imaging in the evaluation of whiplash injuries remains to be determined.
Technical advances in MR angiography (MRA) have improved the sensitivity and the accuracy of this technique in the evaluation of vascular stenoocclusive disease of the brain. In many centers, due to its non-invasive and non-ionizing...
moreTechnical advances in MR angiography (MRA) have improved the sensitivity and the accuracy of this technique in the evaluation of vascular stenoocclusive disease of the brain. In many centers, due to its non-invasive and non-ionizing character, MR angiography has already replaced conventional angiography for the screening of intracranial vascular disease. Several MRA techniques have been developed for imaging the intracranial vascular system, such as time-of-flight MRA (TOF-MRA), phased-contrast MRA (PC-MRA), and more recently contrast-enhanced MRA (CE-MRA).
Injuries to the facial bones, orbits and adjacent soft tissue structures are common. Despite the increasing safety precautions in modern cars, facial injury is very often caused by motor vehicle accidents. Severe trauma to the face is a...
moreInjuries to the facial bones, orbits and adjacent soft tissue structures are common. Despite the increasing safety precautions in modern cars, facial injury is very often caused by motor vehicle accidents. Severe trauma to the face is a strong indication for radiological investigation. In the patient with maxillo-facial trauma, the radiological exploration of should answer two major questions: do the fractures involve areas that may alter the physiologic function of the sinuses, mouth, nasal vault or orbit?, and will the fracture result in any cosmetically detectable abnormality? The goal of the radiological work-up is to define the number and exact location of the fractures, to determine if there is any depression, elevation, or distraction of the fracture fragments, and to assess concomitant soft tissue complications. In this article, we review the role of clinical evaluation, plain X-rays, computed tomography (CT) and magnetic resonance imaging (MRI). Imaging findings are correla...
The incidence of low back pain and leg pain related to the spine is very high in the Western population. As a result of conservative treatment failure there are roughly 200,000 lumbar disk operations performed annually. Unsuccessful...
moreThe incidence of low back pain and leg pain related to the spine is very high in the Western population. As a result of conservative treatment failure there are roughly 200,000 lumbar disk operations performed annually. Unsuccessful surgical outcome is known as the failed back surgery syndrome (FBSS). FBSS is a complex and poorly understood syndrome, with as many different imaging findings as different possible etiologic mechanisms. Still we believe some imaging aspects deserve special attention. Firstly it is of particular importance to correctly differentiate residual disk herniation from epidural scar tissue since disk herniation can be an indication for repeat intervention. Secondly when residual disk herniation is present, one should keep in mind that it is not necessarily responsible for the patients complaints. Thirdly, late nerve root enhancement should be considered as pathological. Finally one should be aware of the mechanical back stress that may develop as a result of di...
This study discusses the influence of user-defined parameters on fiber tracking results obtained from a standard deterministic streamline tractography algorithm. Diffusion tensor imaging with fiber tractography was performed in five...
moreThis study discusses the influence of user-defined parameters on fiber tracking results obtained from a standard deterministic streamline tractography algorithm. Diffusion tensor imaging with fiber tractography was performed in five healthy volunteers. A region of interest was highlighted in the ventral part of the pons at the level of the middle cerebellar peduncle. The parameters studied were angle threshold, fractional anisotropy threshold, step length and number of seed samples per voxel. Changes in fiber tracts were described for increasing values per parameter. Increasing the angle threshold resulted in more and longer fibers. A higher fractional anisotropy threshold resulted in decreased length and fiber tracts that were not representative. Increasing the step length decreased the fiber continuity and altered its position. A higher number of seed samples per voxel resulted in a higher fiber tract density. When interpreting diffusion tensor images, the reader should understand...
Efficient communication between the radiologist and the referring clinician is an essential feature of high quality radiology practice. The written report, the only result of the radiological investigation most clinicians will see, should...
moreEfficient communication between the radiologist and the referring clinician is an essential feature of high quality radiology practice. The written report, the only result of the radiological investigation most clinicians will see, should therefore comply with a number of quality criteria. As far as reporting in Dutch is concerned, these criteria have not been clearly defined. Articles on the radiology report are scarce and mostly focus on reporting in English. We have investigated the quality of radiology reporting in a university hospital in Flanders, the Dutch speaking part of Belgium. A weighed sample of 94 reports of 24 radiologists (staff members and radiologists-in-training) was blinded and evaluated by a qualified radiologist with ten years of experience as a writer and editor-in-chief medical magazines. A scoring system was applied, based on five criteria: comprehensible, problem-oriented, correct Dutch, concise, and direct. This article gives an overview of the results and...
Time of flight (TOF) and phase contrast (PC) magnetic resonance angiography (MRA) are two established magnetic resonance (MR) techniques that were described and developed in the 1980s. Both of these techniques usually do not involve the...
moreTime of flight (TOF) and phase contrast (PC) magnetic resonance angiography (MRA) are two established magnetic resonance (MR) techniques that were described and developed in the 1980s. Both of these techniques usually do not involve the use of intravascular contrast, but rather exploit the intrinsic contrast provided by flowing blood to produce vascular signal. Bolus infused (gadolinium-enhanced) MR angiography was only introduced in 1993. PC-MRA uses the phase shifts introduced to nuclei with motion in the presence of a magnetic field gradient. A bipolar magnetic field gradient will induce a phase shift to nuclei moving along the gradient dependent on the velocity, as well as acceleration and higher order motion terms. More complex gradient waveforms enable sensitivity to specific motion terms such as velocity or acceleration. By constructing an image in which the intensity is proportional to the phase shift of the nuclei, it is possible to create an angiographic image related to t...
Cerebral MR was performed in three patients with Sjögren-Larsson syndrome. In each case, a 1.5-T system was used, and the patient was under general anesthesia. The MR findings included confluent hyperintense white matter lesions in the...
moreCerebral MR was performed in three patients with Sjögren-Larsson syndrome. In each case, a 1.5-T system was used, and the patient was under general anesthesia. The MR findings included confluent hyperintense white matter lesions in the periventricular and deep white matter of the centrum semiovale, with sparing of the subcortical U fibers. The topography of the white matter abnormalities correlated well with the clinical signs and symptoms.
Spondylitis or infection of the spine is a spectrum of diseases involving the bone, disks, and/or ligaments. Because of a significant increase in the immunocompromised patient population, spinal infections are a growing and changing group...
moreSpondylitis or infection of the spine is a spectrum of diseases involving the bone, disks, and/or ligaments. Because of a significant increase in the immunocompromised patient population, spinal infections are a growing and changing group of conditions, making the diagnosis based on imaging more challenging. Most cases of spinal infections are pyogenic and occur after hematogeneous spread of an infection located elsewhere in the body. A prompt diagnosis remains crucial and MR imaging remains the cornerstone in the diagnosis. This article provides a pictorial overview of the complications and sequelae in spinal infections in general. Discussed are postoperative infections, extraspinal spread of infection, fractures and malformations, and neurologic complications.
Summary: Treatment of acute renal allograft rejection with mouse monoclonal antibody (OKT3) is associated with systemic and neurologic side effects. We describe cerebral abnormalities in a 13-year-old boy with steroid-resistant renal...
moreSummary: Treatment of acute renal allograft rejection with mouse monoclonal antibody (OKT3) is associated with systemic and neurologic side effects. We describe cerebral abnormalities in a 13-year-old boy with steroid-resistant renal allograft rejec- tion. After treatment with OKT3, an acute neurologic syndrome developed, including seizures, lethargy, and decreased mental function. CT and MR imaging revealed confluent cerebral lesions at the corticomedullary junction. Contrast-enhanced MR images showed patchy enhancement, indicating blood-brain barrier dys- function. The diagnosis of OKT3-induced encephalopathy with cerebral edema and capillary leak syndrome was made. Although CT and MR findings are nonspecific, neuroradiologists should be aware of this condition in transplant patients treated with OKT3.
Our aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations...
moreOur aim was to establish the normal range of MRI findings after successful lumbar discectomy. We prospectively examined 34 consecutive patients with an excellent clinical outcome by MRI 6 weeks and 6 months after surgery. All examinations included sagittal and axial spin-echo (SE) T1-weighted images before and after intravenous gadolinium-DTPA and fast SE T2-weighted images. Contrast enhancement along the surgical tract was seen in all patients 6 weeks and 6 months after surgery. After 6 months minimal or no mass effect on the dural sac by epidural scar was seen. In 20% of patients there was recurrent disc herniation, with mass effect. Enhancing nerve roots were seen in 20% of patients 6 weeks postoperatively, and half of these were associated with recurrent disc herniation at the same side. None of these patients still showed nerve root enhancement 6 months after surgery. Postoperative MRI studies must be interpreted with great care since the features described in the failed back surgery syndrome are also found, to some extent, in asymptomatic postoperative patients.
Our purpose was to evaluate the usefulness of a 3D T1-weighted gradient-echo sequence (MP-RAGE) in clinical practice. We prospectively examined 200 patients with a variety of neurological disorders and symptoms. We compared lesion...
moreOur purpose was to evaluate the usefulness of a 3D T1-weighted gradient-echo sequence (MP-RAGE) in clinical practice. We prospectively examined 200 patients with a variety of neurological disorders and symptoms. We compared lesion conspicuity and contrast enhancement on MP-RAGE images with conventional gadolinium-enhanced spin-echo (SE) T1-weighted images. Both the original MP-RAGE data and the reformatted images were characterised by improved differentiation between grey and white matter. More lesions were found on the 3D series, in both patients with neoplastic and non-neoplastic disease. Contrast enhancement of small oedematous lesions affecting the white matter in demyelinating disease was less obvious. Multiplanar reformatting, which can be realised in any desired plane and surface rendering with sophisticated segmentation algorithms superbly displayed the underlying anatomical relationships between lesions and normal brain structures. Excellent spatial resolution, the absence of posterior fossa artefacts and equivalent contrast enhancement resulted in an increased number of space-occupying lesions being found on the MP-RAGE images. Thus contrast-enhanced MP-RAGE is an alternative to conventional SE imaging in the investigation of intracranial masses. Although the total number of lesions found in patients with demyelinating disease was significantly higher on MP-RAGE, demonstration of blood-brain-barrier breakdown in active lesions was less obvious.