Differentiation of osteoporotic and neoplastic vertebral fractures by [in-phase and out-of- chemical shift MR imaging

Objective: The objective of this study was to establish the cutoff value of the signal intensity drop on chemical shift magnetic resonance imaging [MRI] with appropriate sensitivity and specificity to differentiate osteoporotic from neoplastic wedging of the spine

Patients and Methods: All patients with wedging of vertebral bodies were included consecutively between February 2006 and January 2007. A chemical shift MRI was performed and signal intensities after [in-phase and out-of-phase] images were obtained. A DEXA was performed

Results: A total of 40 patients were included, 20 with osteoporotic wedging [group. 1] and 20 neoplastic [group.2]. They were 21 males and 19 females. On the chemical shift MRI a substantial reduction in signal intensity was found in all lesions in both groups. The proportional changes observed in signal intensity of bone marrow lesions on in-phase compared with out-of-phase images showed significant differences in both groups [p <0.05]. At a cut-off value of 35%, the observed sensitivity of out-of-phase images was 95%, specificity was 100%, positive predictive value was 100% and negative predictive value was 95.2%

Conclusion: A chemical shift MRI is useful in order to differentiate patients with vertebral collapse due to underlying osteoporosis or neoplastic process

Fibromyalgia syndrome in pediatric and adolescent populations

The objectives of this study were to describe the characteristic features of FS in children and adolescents, to note similarities and differences of FS in adults and to determine the outcome after treatment. Twenty-three children and adolescents with FS and a similar number of adult patients with FS were selected for this study. The characteristic features of FS were used for the evaluation of these patients at the initial visit and two successive visits with three-month interval. The patients were subjected to full clinical examination, routine urine and stool analysis, ESR, ASOT, CRP and RF. The mean cumulative number of tender points of all visits was 8.3 +/- 2.6. The sites of tender points were trapezius, knee, occiput, lateral epicondyle, upper gluteal area, greater trochanter, supraspinatus, lower cervical area and second costochondral junction