Frequent Benign, Nontraumatic, Noninflammatory Causes of Low Back Pain in Adolescents: MRI Findings.

INTRODUCTION: Low back pain (LBP) is common in children and adolescents. There are many factors that cause LBP, including structural disorders, degenerative changes, Scheuermann's disease, fractures, inflammation, and tumors. Magnetic Resonance Imaging is the gold standard for diagnosing spinal abnormalities and is mandatory when neurological symptoms exist. The study focuses on common MRI findings in adolescents with persistent LBP, without history of acute trauma or evidence of either inflammatory or rheumatic disease. MATERIALS AND METHODS: Eleven adolescents were submitted to thoracic and/or lumbar spine MRI due to persistent LBP. The protocol consisted of T1 WI, T2 WI, and T2 WI with FS, in the axial, sagittal, and coronal plane. RESULTS: MRI revealed structural abnormalities (scoliosis and kyphosis) in 4/11 (36.36%); disc abnormalities and endplate changes were found on 11/11 (100%). Typical Scheuermann's disease was found in 3/11 (27.27%). Endplate changes were severe in Scheuermann's patients and mild to moderate in the remaining 8/11 (72.72%). Kyphosis was in all cases secondary to Scheuermann's disease. Disk bulges and hernias were found in 8/11 (72.72%), all located in the lumbar spine. CONCLUSION: In adolescents with LBP, structural spinal disorders, degenerative changes, and Scheuermann's disease are commonly found on MRI; however, degenerative changes prevail.

Occurrence of bifid median nerve in healthy and carpal tunnel syndrome patients.

We investigated the possible association between median nerve morphology and carpal tunnel size, hand side and nerve conduction measurements. The study included a patient group (n = 58; 44 women) with idiopathic carpal tunnel syndrome (CTS) in 100 hands and a control group of healthy volunteers (n = 56, 112 hands; 44 women). The following data were recorded: (1) median and ulnar motor and sensory nerve conduction parameters (2) ultrasonographic dimensions of the carpal tunnel inlet area (CTAin) and inlet area of the median nerve. The prevalence of bifid median nerve was 19% in the CTS hands and 13.3% in the control group. Bilateral bifid nerve was detected in 7 subjects and unilateral in 23, with no side or sex preponderance. The median nerve area was larger in the participants with single than those with bifid median nerve. No correlation was found between CTAin and median nerve area for single or bifid nerves in controls or patients. It was concluded that bifid median nerve was not a rare variation. We could not, however, support its etiological relation to CTS. Ultrasonographic examination of the carpal tunnel region supplementing neurophysiology provided a reliable means to detect median nerve size and morphology. CLINICAL TRIAL REGISTRATION NUMBER: 84; 5/3/15.

Coronary atherosclerosis burden is not advanced in patients with ß-thalassemia despite premature extracardiac atherosclerosis: a coronary artery calcium score and carotid intima-media thickness study.

BACKGROUND: Thalassemic patients demonstrate an increased rate of extracardiac vascular complications and increased carotid wall intima-media thickness (cIMT), but very low prevalence of coronary artery disease (CAD). We investigated the atheroma burden by assessing the coronary artery calcium (CAC) and cIMT in these patients. METHODS: We examined 37 patients with ß-thalassemia and 150 healthy control volunteers with multi-detector computer tomography (CT) and ultrasonography to determine CAC score and cIMT, respectively. RESULTS: Propensity score matching (C-statistic: 0.88; 95% CI: 0.83-0.93) resulted in 27 pairs of patients; severe CAC was observed in 2 (7.4%) and 0 of ß-thalassemia patients and healthy volunteers respectively (P = 0.5). Median calcium score was 0 (0-0) in ß-thalassemia patients and 0 (0-4) in healthy volunteers (P = 0.8). Median intima-media thickness was higher in ß-thalassemia patients compared to control group [0.45 (0.06-0.65) vs. 0.062 (0.054-0.086); P = 0.04]. CONCLUSIONS: Patients with ß-thalassemia in comparison with healthy control subjects exhibit similar CAC score and increased cIMT. Our findings indicate a disparate rate of progression of atherosclerosis between coronary and extracardiac arteries in these patients lending support to the epidemiological evidence.

Role of anthropometric characteristics in idiopathic carpal tunnel syndrome.

OBJECTIVE: To investigate the possible association of external and ultrasonographic measurements of the hand and wrist with median nerve conduction studies. DESIGN: Two group comparison study. SETTING: Outpatient neurophysiology laboratory and radiology department in a university hospital. PARTICIPANTS: Patient group (n=50; 40 women) with clinically overt and electrophysiologically proven idiopathic carpal tunnel syndrome and a control group of age- and sex-matched healthy volunteers (n=50). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The following measurements were taken: (1) motor and sensory conduction studies of the median nerve; (2) external hand and wrist dimensions (hand ratio and wrist ratio); and (3) ultrasonographic dimensions of the carpal tunnel (carpal tunnel inlet ratio and carpal tunnel outlet ratio) and inlet cross-sectional area and outlet cross-sectional area of the median nerve at the tunnel. RESULTS: Differences between patients and controls were significant for hand and wrist ratios and all ultrasonographic dimensions. Sensory conduction velocity and distal motor latency of the median nerve in all 100 subjects were well correlated with hand ratio, wrist ratio, carpal tunnel inlet ratio, and carpal tunnel outlet ratio estimates. Wrist ratio was significantly correlated with carpal tunnel inlet ratio and carpal tunnel outlet ratio. CONCLUSIONS: A particular hand and wrist configuration, that is, short and wide hand with square wrist matching to narrow and deep tunnel entrance demonstrated increased liability for idiopathic carpal tunnel syndrome. For screening purposes, it was suggested that simple external hand or wrist measurements could be used to predict the tendency for carpal tunnel syndrome.

Intraosseous hemangioma of the appendicular skeleton: imaging features of 15 cases, and a review of the literature.

OBJECTIVE: We performed a retrospective study of the imaging findings of 15 patients (nine female, six male, mean age 43 years) with the histopathological diagnosis of hemangioma. MATERIALS AND METHODS: Radiographs, magnetic resonance imaging (MRI), computed tomography, and bone scan were performed. RESULTS: Lower extremity was involved in nine cases, upper extremity in three cases, the acetabulum in two cases and the ilium in one case. Fourteen of the lesions were intramedullary and one was subperiosteal. Radiographs identified the lobular osteolytic intramedullary lesions with sclerotic margins (eight cases) and coarse linear trabeculation (four cases) or matrix ossification (one case) within it or a heavily calcified lesion (one case). Lesion expanded and breached the cortical cortex in four cases. The subperiosteal hemangioma presented as a soft tissue mass with proximal periosteal reaction. MRI also identified the soft tissue mass in the case of the subperiosteal hemangioma. The CT scan demonstrated the lobular osteolytic lesions, the prominent trabeculation and matrix mineralization and evaluated the cortex. In all six cases, the lesion showed increased uptake in the bone scan. CONCLUSIONS: This is the largest reported series of imaging features of intraosseous hemangiomas of appendicular skeleton. The lesion should be differentiated from other chondral or expansile lytic tumors. The final diagnosis can only be confirmed by histopathology.