Magnetic Resonance Imaging of the Lumbar Spine in Young Arabs with Low Back Pain

STUDY DESIGN: A prospective study. PURPOSE: To Investigate the prevalence of magnetic resonance imaging (MRI) changes of the lumbar spine in low back pain (LBP) and the associated risk factors in young Arab population. OVERVIEW OF LITERATURE: Studies on the prevalence of MRI findings and their relationship with LBP have been conducted; these have occurred in adult populations in developed countries. The prevalence of MRI changes in the young Arab population with LBP is not known. METHODS: Two hundred and fourteen patients of Arab origin in the 16 to 29 year age group with LBP symptoms underwent MRI examinations. The prevalence of MRI changes in the lumbar spine and associated risk factors were determined and compared to age, race, and gender-matched controls. RESULTS: A majority (64%) of the patients with LBP (138 out of 214) were found to have MRI evidence of degenerative disc disease (DD) compared to 10% (22 out of 214) in the control group. The majority (61%) of patients had multiple level disease, most commonly involving the lowest 2 disc levels. Reduced signal of the disc followed by disc bulge was the most common MRI features seen in the symptomatic subjects. Obesity correlated with MRI prevalence of abnormalities, while activity demonstrated a positive trend. CONCLUSIONS: The MRI prevalence of DD among the young Arab patients with LBP is high when compared to other reports in literature. Obesity correlated with MRI prevalence of abnormalities while activity demonstrated a positive trend.

Significance of virchow-robin spaces in patients newly diagnosed with multiple sclerosis: a case-control study in an arab population

To assess the frequency and extent of dilatation of Virchow-Robin [VR] spaces at three levels of the brain in patients of Arab ethnicity in Kuwait recently diagnosed with multiple sclerosis [MS] and compare the results with age-and gender-matched controls. Methods:The magnetic reso-nance imaging [MRI] scans performed within 3 months of the clinical diagnosis of 80 patients recently diagnosed with active MS were compared to those of 80 age- and gender-matched controls with headache but without any neurological deficits for the frequency and size of VR spaces. MRI was done with noncontrast axial and coronal T[1]W FSE, axial T[2]W FSE, axial T[2]W FLAIR and sagittal FLAIR sequences followed by postcontrast axial and coronal T

Ossification of ligamentum flavum in middle east Arabs: a hospital-based study

To investigate the frequency of ossification of the ligamentum flavum [OLF] in the spine among the Arab population in Kuwait using magnetic resonance imaging [MRI] surveillance of the whole spine. A consecutive series of 102 patients with low back pain were recruited from the outpatient clinic of Mubarak Al-Kabeer Hospital, Kuwait. MRI of the whole spine in the sagittal plane was obtained in at least two sequences [T[1] and T[2]]. The OLF was defined as low signal intensity thickening of the ligament in both T[1] and T[2] sequences on the posterior margin of the spinal canal, causing indentation of the theca with or without cord compression. Of the 102 cases, 19 [18.6%] patients had OLF. Of the 19 positive cases, 12 [63.2%] were present at a single level, and 7 [36.8%] at multiple levels. A total of 26 OLF segments were identified in the following anatomical distribution: cervical: 15 [57.7%]; upper thoracic [T1-T4]: 1 [3.8%]; mid thoracic [T5-T8]: 4 [15.4%]; lower thoracic [T9-T12]: 4 [15.4%], and lumbar region: 2 [7.7%]. Of the 19 OLF patients, 2 [10.5%] had tandem ossification of the posterior longitudinal ligament in the cervical spine and were symptomatic. The frequency of OLF appears to be high among this hospital-based cohort of the Arab population. OLF should be kept in mind if a patient presents with radiculopathy, particularly in the cervical region, for which surgical intervention is contemplated

Accuracy of 64-multidetector-row computed tomography in the diagnosis of coronary artery disease

The aim of this prospective study was to assess the accuracy of 64-multidetector-row computed tomography coronary angiography [CTA] in the diagnosis of coronary artery disease [CAD Ninety-two patients suspected of having CAD underwent CTA using a 64-slice CT scanner before a scheduled, conventional coronary angiogram [CCA]. Blinded assessment of CTA to detect CAD was performed. The accuracy of CTA in detecting significant stenoses [>/= 50%] was compared to CCA. Data analysis was performed on 73 patients because the scans were nondiagnostic in 5 patients and 14 refused to undergo coronary angiography The CTAs of 21 of these 73 patients were considered as normal; 19 were confirmed on CCA. For the remaining 52 diagnosed as abnormal, 51 were confirmed on CCA. For patient-based analysis, CTA had a sensitivity of 95%, a specificity of 96%, a positive predictive value of 98% and a negative predictive value of 90%. For the whole vessel, the sensitivity of CTA was 60-100%, for all vessels and the specificity was 82-100%. Pooled sensitivity was 92% and pooled specificity was 98%. For the segments, the sensitivity of CTA was 64% or above for all vessels except for the distal left anterior descending artery [40%], mid circumflex artery [50%] and posterior descending artery [60%]; the pooled sensitivity was 79%. The specificity for the segments was 82-100% for all vessels and pooled specificity was 94%. The sensitivity and specificity for patient-based analysis and for the main coronary vessels were high whereas for the segments, the sensitivity was moderately good, but the specificity was high, confirming that a negative CTA is useful to rule out significant CAD. A coordinated classification system between radiologists and cardiologists is required to eliminate errors in segment classification

Contrast media extravasation: manual versus power injector

To compare the incidence and complications of extravasation of low-osmolar nonionic contrast media, injected manually and by the automatic power injector [API]. Subjects and Three thousand five hundred and sixty patients underwent contrast-enhanced abdominal and thoracic computerized tomography scan in the Department of Clinical Radiology, Al-Amiri Hospital, Kuwait, between June 1998 and De cember 2002. These patients were prospectively analyzed for contrast media extravasation, its relation to injection rate, cannula insertion and gauge and its complications. 920 patients were administered low-osmolar nonionic contrast media [Ultravist 300, Omni Paque 240 or 300] intravenously by manual injection and 2,640 patients by automatic power injector. Of the 3,560 patients contrast media extravasation occurred in 11 [0.3%]. The symptoms were observed in 9 patients [0.3%] in the API group and 2 patients [0.2%] in the manual injection group, respectively. None of the patients had any soft tissue injury. The incidence of contrast media extravasation is not significantly increased by the use of the API. Low-osmolar nonionic contrast media extravasation resulting from the use of API does not cause any morbidity

Spinal tuberculosis: CT and MRI features

Spinal tuberculosis [TB] is perhaps the most clinically important extrapulmonary form of the disease. Early recognition is therefore necessary to minimize residual spinal deformity and/or permanent neurological deficit. We defined the CT and MRI image morphology of spinal TB and correlated the imaging features of these two modalities. CT [29 patients] and MRI [11 patients] images were retrospectively analyzed in 30 patients with proved spinal TB. CT and MRI findings were compared in cases with both imaging tests [10 cases]. The parameters assessed were the type and extent of bone and soft tissue involvement. The majority of the 30 patients were males [n=18] in the 30-49 year age group [43%]. The most common clinical presentation was backache [73.3%] followed by fever [63.3%] and malaise [36.6%]. The lumbar spine was the commonest site of the disease [43.3%] followed by the thoracic region [36.6%]. A fragmentary type of bone destruction was the most frequent CT feature of the disease [48.2%] followed by the lytic type [24.1%]. Intervertebral disc destruction [72%] and paravertebral mass/abscess [65.5%] were other features. Of the 11 patients who had an MRI, contiguous vertebral disease with disc destruction was seen in 10 cases. In 4 patients, there was distant vertebral disease in addition to the disease at the symptomatic site. MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis and helps to identify disease at distant asymptomatic sites. CT is useful in assessing bone destruction, but is less accurate in defining the epidural extension of the disease and therefore its effect on neural structures. MR imaging clearly demonstrated the extent of soft tissue disease and its effect on the theca/cord and foramen in cases with doubtful CT findings

Percutaneous catheter drainage of pancreatic pseudocysts: Five years experience.

Pancreatic pseudocysts are common complications of pancreatitis. Pseudocysts can be treated by various drainage procedures such as endoscopic cystenterostomy or transpapillary drainage, percutaneously with image guidance or operatively. We report our experience with image-guided percutaneous evacuation of pancreatic pseudocysts. Materials and This retrospective study was conducted on 37 consecutive patients who underwent 45 percutaneous catheter placements for the drainage of pseudocysts. The catheters were introduced under ultrasound or computerized tomography guidance. The patients were followed up with a fluoroscopic catheter check for evaluation of size of collection, communication with gastrointestinal tract and the pancreatic duct. The catheter was removed when the patient was asymptomatic and the output from the catheter was less than 10 cm3 in 24 h. Forty-five procedures of percutaneous drainage of pancreatic pseudocysts were performed in 37 consecutive patients. The size of the cysts ranged between 4 and 20 cm. Drainage was performed on cysts larger than 5 cm in diameter. Forty-eight% of the patients had communication with the pancreatic duct. Percutaneous drainage was successful in 95% of the cases in our study regardless of pseudocyst communication with the main pancreatic duct. The average duration of catheter drainage was 30 days in cases without communication versus 33 days in patients with communication with the pancreatic duct. Percutaneous drainage is a safe and effective alternative to surgery in patients with pancreatic pseudocysts. The duration of catheter drainage in cases with or without communication with the pancreatic duct was nearly the same

Clostridium abscess [gas gangrene] of the brain

Objective and Importance: Anaerobic brain abscesses are rare. This case is presented for the rarity of the condition. A high clinical suspicion in a given clinical setting can lead to early diagnosis and appropriate treatment. Clinical Presentation: A child with a penetrating skull trauma presented to the casualty department with fever and drowsiness. A CT scan of the brain revealed an intracerebral air locule adjacent to skull vault fracture. The air locule was thought to be due to the penetrating skull injury Post operatively it proved to be clostridium abscess which was successfully treated with surgery and intensive antibiotic therapy. Conclusion: The importance of early diagnosis is stressed