A system for reporting the size and location of lesions in the spine.

STUDY DESIGN: A description of a method for standardizing the nomenclature used in reporting the size and location of lesions in the lumbar or thoracic spine is presented. OBJECTIVES: To make the reporting of findings on computed tomography or magnetic resonance imaging scans simpler and more accurate. SUMMARY OF BACKGROUND DATA: Over the past 10 years, three other systems have been proposed, and parts of each have been incorporated in this system. METHODS: This is a multicenter report. A group of 12 prominent physicians, including radiologists, neurosurgeons, orthopedic surgeons, and physiatrists, at 11 centers collaborated in the formulation of this system. RESULTS: In this system, areas in the axial plane, i.e., medial to lateral, are called "zones," and in the caudocranial direction, they are called "levels." The zones are the central canal zone, the subarticular zone, the foraminal zone, and the extraforaminal zone. In the caudocranial direction, the levels from above downward are the suprapedicle level, the pedicle level, the infrapedicle level, and the disc level. The size of a lesion can be rated by the descriptive words normal, mild, moderate, moderately severe, and severe, or by the numbers 1 to 5, with the number 1 indicating normal and the number 5 indicating severe. CONCLUSIONS: The authors of the present study believe that all health care professionals who care for the spine will find this nomenclature valuable in communicating with each other, in writing medical reports, in presenting reports at meetings, or in writing scientific articles.

Spine injuries in gymnasts and swimmers. An epidemiologic investigation.

Three groups of top level female gymnasts of preelite, elite, national and Olympic caliber were studied without regard to back pain or injury. These athletes were compared to a similar group of national caliber female swimmers. Magnetic resonance imaging scans of each participant were used to document disk or bony abnormalities. The relationship between magnetic resonance imaging findings and age, height, weight, previous injuries, back symptoms, and hours of training per week each year was examined. Nine percent of preelite (1/11), 43% of elite (6/14), and 63% of Olympic level (5/8) gymnasts had spine abnormalities; 15.8% of all swimmers had spine abnormalities. Average hours of training per week and age were found to be associated with abnormalities seen on magnetic resonance imaging. Increased intensity and length of training correlated with previous data that suggests the female gymnast is prone to spine injuries.

Occult osseous lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures.

Magnetic resonance images (MRI) were performed within three weeks of anterior cruciate ligament (ACL) rupture on 75 skeletally mature patients. Occult bony lesions were documented in 64 (85%) of the patients. Of the 64 patients with bone injuries, 83% had lesions of the lateral compartment. The lateral femoral condyle was involved in 50%, and the lateral tibial plateau was injured in 50% of the patients with changes. Nineteen of the 64 patients had more than one area of bony injury. Although the majority of bony lesions resolve, permanent alterations remained in some cases. This study has implications that may affect rehabilitation and the long-term prognosis in those patients with extensive bony and associated articular cartilage injuries.

MRI demonstration of radiographically occult fractures: what have we been missing?

During the course of MRI examinations of the knee for possible internal derangement, the hip for avascular necrosis, and the shoulder for rotator cuff tears, we have encountered many examples of unsuspected fractures of the tibial plateau, femoral condyles, pelvis, hip and proximal humerus. These fractures were either radiographically inapparent or demonstrated very subtle abnormalities that were missed on prospective interpretation. In addition, a large number of patients have been found to demonstrate evidence of intraosseous trabecular disruption, or edema and hemorrhage of medullary bone, or stress type injuries, all of which are radiographically occult. The clinical significance of these osseous abnormalities varies and is dependent upon the degree of injury. It is believed that an awareness of these osseous abnormalities will improve the accuracy of MRI interpretation, will heighten an appreciation of the subtle radiographic abnormalities that may be present, and will improve patient evaluation and management.

Magnetic resonance imaging of the knee.

Magnetic resonance imaging (MRI) is an accepted non-invasive modality for evaluation of soft tissue pathology without exposure to ionizing radiation. Current applications demonstrate excellent visualization of the anatomy and pathology of various organs. Preliminary studies in the knee reveal fine resolution of anatomy and pathology involving the meniscus. The purpose of this study is to determine a prospective correlation between MRI scans and actual meniscal pathology as documented at the time of arthroscopy. MRI scans were obtained in 155 patients, on 156 knees (one patient with bilateral scans), with 86 patients (87 knees) eventually undergoing diagnostic and operative videoarthroscopy performed by the same surgeon (DWJ). All images were obtained on the same high-resolution 1.5 Tesla GE Signa Magnetic Resonance Scanner with the same radiologist performing all readings (PEB). The knees were studied in the coronal and sagittal plane using a spin echo sequence and 5 mm slice thicknesses. The menisci were described as having Grade 1, 2, or 3 changes, with Grade 3 reserved for complete tears. Using arthroscopy as the diagnostic standard, the accuracy of MRI in diagnosing medial and lateral meniscal tears was 93.1% and 96.6%, respectively with a Grade 3 MRI reading. For tears of the ACL, the accuracy was 96.6% as confirmed at arthroscopy. Five tears of the PCL were also documented by MRI and correlated with clinical evaluation. Other abnormalities seen were articular cartilage and osteochondral defects, bone tumors, tibial plateau fractures, Baker's cysts, and meniscal cysts. The MRI scan is a highly accurate, noninvasive modality for documentation of meniscal pathology as well as cruciate ligament tears in the knee.

Preterm very-low-birth-weight neonates: relationship of EEG to intracranial hemorrhage, perinatal complications, and developmental outcome.

EEGs were performed on 102 preterm low-birth-weight neonates within the first 7 days of life. Babies were later separated into those without intracranial hemorrhage, those who had only subependymal hemorrhage (SEH), and those with intraventricular/intracerebral hemorrhage. The incidence and types of EEG abnormalities, 42% overall and including positive rolandic sharp waves, did not differ in the three groups. The incidence and distribution of EEG abnormalities between groups were not influenced by perinatal events. Developmental follow-up of 73 patients was similarly not correlated with neonatal EEG results, although the most severe EEG abnormalities were associated with subsequent mortality or morbidity.

High resolution surface coil magnetic resonance imaging of the spine: normal and pathologic anatomy.

In a brief two year period, magnetic resonance imaging of the spine has developed from a single slice, low signal/noise ratio, extremely time consuming technique to a multiplanar, high resolution examination that can be performed in a time frame similar to that of CT imaging. MR has already assumed a primary imaging role in myelopathic states. It is premature to evaluate its place vis-a-vis CT and myelography in many other disease states of the spine, but clearly, MR is assuming an ever expanding role. As technical improvements continue, it is perhaps realistic to predict that magnetic resonance will, in the near future, assume a dominant role in the imaging of the spine for the demonstration of most types of spinal disease.

Gastrointestinal tract angiography in infants and children.

In the past 10 years since the development of newer imaging modalities, the method of evaluation of gastrointestinal diseases has changed to less invasive examinations. Angiography of the gastrointestinal tract and its accessory organs, which once was one of the primary procedures for hepatic tumors especially, is now considered nonessential except for occasional demonstration of vascular distribution prior to attempted surgery. As for gastrointestinal bleeding, although the incidence of ulcer disease is not as common in children as in adults, a child with bleeding who is at high risk for surgery will benefit occasionally from intra-arterial infusion of vasopression. As the major cause of gastrointestinal bleeding in children is from esophageal varices, though great anatomical detail of portal circulation can be seen in computed tomography and ultrasound, the coronal mapping of vascular anatomy of portal circulation is of utmost benefit prior to any attempt for surgery. Intra-arterial portography and splenoportography can be very helpful to delineate the anatomy and hemodynamics of portal hypertension, as well as for evaluation of suspected shunt thrombosis. Briefly, an update of information on digital subtraction angiography in gastrointestinal pathology will be given though the pediatric application has not been as popular as in adults.

Rhabdoid tumor of the kidney: a case report.

Rhabdoid tumor of the kidney may simulate other pediatric renal tumors radiographically but it has a characteristic clinical course with a high incidence of intracranial tumors. This clinical course and its implications for prognosis and radiographic work-up are discussed.

Multifocal nephroblastomatosis: clinical significance and imaging.

The correlation between nephroblastomatosis and Wilms' tumor has been established in the pathology literature. Two cases of multifocal nephroblastomatosis in the kidney contralateral to a Wilms' tumor are presented. The importance of these lesions and their recognition is discussed.

Childhood diskitis: computed tomographic findings.

The spectrum of computed tomographic findings in seven children with diskitis is reported. Paravertebral inflammatory masses, intraspinal (epidural) soft-tissue extension with thecal sac deformity, and psoas involvement with abscess were demonstrated in 7/7, 6/7, and 1/7 patients, respectively. Plain radiographic findings of disk space narrowing and vertebral end-plate destruction were confirmed by CT in all cases. Follow-up CT in two patients revealed persistent bone destruction despite resolution of soft-tissue inflammation and clinical abnormalities. CT proved most useful in the diagnosis of early and atypical cases. The CT spectrum of childhood diskitis may simulate other diseases, including neoplasm, tuberculosis, and disk herniation. While CT is not routinely indicated in typical childhood diskitis, it may confirm the diagnosis in those patients with atypical clinical presentation or nonspecific plain radiographs, and exclude other lesions in patients unresponsive to routine treatment.

[Abrikosov's tumor of the tongue associated with a sialometaplasia lesion]. / Tumeur d'Abrikossof de la langue associée à une lésion de sialométaplasie.

One case of Abrikossof's tumor of the tongue associated with sialometaplasia is reported. The autors discuss the histogenesis of the granular-cell tumor. Actually, most of the autors agree to acknowledge a neurogene origin of the tumor: the typical granular cell of the myoblastoma, first described by Abrikossof, would originate from the schwann's cell, due to the ultrastructural morphological likeness of these cells with the phagocytic form of the schwann's cell.

CT of blunt abdominal trauma in childhood.

Computed tomography (CT) was performed on 23 children who had sustained moderate or severe blunt abdominal trauma. The major advantages of CT over excretory urography, sonography, and radionuclide imaging include superior anatomic detail and ability to visualize all organs, the peritoneal cavity, and retroperitoneum simultaneously. In suspected renal injury, CT best defines the extent of parenchymal injury and provides an easy method for accurate follow-up when conservative management is elected. Angiography is necessary for direct demonstration of vascular injury, for demonstration of active bleeding, and in therapeutic embolization of active bleeding sites. CT seems well suited to evaluation of the liver and retroperitoneum. Evaluation of the spleen has been satisfactory, but may be less accurate because of potential pitfalls. Duodenal hematomas are best evaluated by the upper gastrointestinal series. For CT scanning of the traumatized child to be of maximum value, intravenous contrast enhancement and meticulous attention to technique is necessary.