Role of 3D MRI with proset technique in the evaluation of lumbar radiculopathy.

The aim of this study is to demonstrate the effectiveness of 3-Dimensional Magnetic Resonance Imaging (3D MRI) using the ProSet technique in the diagnosis of lumbar radiculopathy and to compare morphological findings with clinical and neurophysiological data. 40 patients suffering from L5 or S1 mono-radiculopathy caused by a disc herniation were evaluated through preliminary clinical assessment and electromyography (EMG) technique. Both conventional spin-echo sequences and 3D coronal FFE with selective water excitation (ProSet imaging) were acquired. Indentation, swelling and tilt angle of the nerve root were assessed by means of a 3D MR radiculography. 3D ProSet multiplanar reconstructions (MPR) were used for quantitative measurements of L5 and S1 nerve root widths. Widths of the symptomatic nerve root were compared with those of the contralateral nerve. Data were processed using Epi Info 3.3 software (CDC, Atlanta, GA, USA) and were compared through a paired t-Student test. We observed an abnormal tilt angle in 22 patients (57,2 percent, P less than 0.05). Morphologic alterations such as monolateral swelling or indentation of the involved roots were found in 36 patients (90 percent, P less than0.01) using 3D MR radiculography. In 10 patients, EMG revealed more nerve roots involved, while 3D FFE with ProSet technique shows a single root involved. In 2 patients, alterations were demonstrated only through EMG technique. We suggest that 3D MR radiculography can provide more information than other techniques about symptomatic disc herniation, supporting the detection of morphological changes of all nerve segments. 3D FFE with ProSet technique demonstrates high sensibility to exactly identify the level of the root involved and can provide an extremely useful tool to lead a surgical planning.

Mechanism of traumatic knee injuries and MRI findings.

Bone bruises are focal abnormalities in subchondral bone marrow due to trabecular microfractures as a result of traumatic force. These trauma-induced lesions are better detected with magnetic resonance (MR) imaging using water-sensitive sequences. Moreover, the pattern of bone bruise is distinctive and allows us to understand the dynamics of trauma and to predict associated soft injuries. This article discusses the mechanism of traumatic injury and MR findings.

Financial impact of radiological reports on medical-legal evaluation of compensation for meniscal lesions.

To evaluate any discrepancy between radiological reports for clinical purposes and for medicolegal purposes and to quantify its economic impact on repayments made by private insurance companies for meniscal injuries of the knee. The medical records obtained pertaining to 108 knee injury patients (mean age 43.3 years) assessed over a period of 12 months were analysed. Clinical medical reports, aimed at assessing the lesion, and medicolegal reports, drawn up with a view to quantifying compensation, were compared. Unlike reports for clinical purposes in reports for medicolegal purposes, in the evaluation of meniscal lesions, in addition to morphological features of lesions, chronological, topographical, severity and exclusion criteria were applied. To estimate the economic impact resulting from the biological damage, we consulted an actuarial table based on the 9-point minor incapacity classification system. Meniscal lesions not compatible with a traumatic event and therefore not eligible for an insurance payout were found in 56 patients. Of these, 37 failed exclusion criteria, while 19 failed to meet chronological criteria. This difference resulted in a reduction in compensation made by private insurance companies with savings estimated with a saving between euro 203,715.41 and euro 622,315.39. The use of a clinical report for medicolegal purposes can be a source of valuation error, as chronological and/or dynamic information regarding the trauma mechanism may be lacking. Therefore, the use of a full radiological appraisal allows a better damage's assessment and an adequate compensation for injuries.

Lesions of the rotator cuff footprint: diagnostic performance of MR arthrography compared with arthroscopy.

BACKGROUND: To evaluate the diagnostic performance of magnetic resonance arthrography (MR-A) of the shoulder in the diagnosis of rotator cuff tears involving the humeral insertion of the supraspinatus and infraspinatus tendon (footprint), using arthroscopy as the reference standard. MATERIALS AND METHODS: The study population included 90 consecutive patients with history and clinical diagnosis of instability of the shoulder, rotator cuff tear or posterosuperior glenoid impingement. A total of 108 MR arthrograms were performed, since 18 patients had undergone a bilateral procedure. Arthroscopy, which was performed within 45 days after MR-A, was used as the reference standard. Sensitivity, specificity, accuracy, positive and negative predictive values were then calculated. RESULTS: Magnetic resonance arthrography showed a sensitivity of 92 % and a specificity of 78 % for the overall detection of tears involving the rotator cuff footprint. The diagnostic accuracy was 90 %, and the positive and negative predictive values were 95 and 64 %, respectively. Ten lesions were non-classifiable on surgery, of which eight were non-classifiable on MR-A also. CONCLUSIONS: Magnetic resonance arthrography is extremely accurate for the detection and classification of rotator cuff footprint tears. Most of these lesions are articular-sided (partial articular-sided supraspinatus tendon avulsion lesions) with predominance in younger patients and concealed type of tear (concealed interstitial delamination lesions).

Assessment of activity of Crohn's disease of the ileum and large bowel: proposal for a new multiparameter MR enterography score.

PURPOSE: We evaluated the diagnostic accuracy of magnetic resonance enterography (MR-E) in assessing Crohn's disease (CD) activity by differentiating acute, chronic and remission stages of disease through a quantitative MR-E assessment. MATERIALS AND METHODS: One hundred patients with a histological diagnosis of CD were studied with MR-E. Intestinal distension was obtained by oral administration of approximately 2 L of a polyethylene glycol solution (PEG). In all cases, the ileum and large bowel were imaged with morphological sequences (heavily T2-weighted single-shot, dual fast-field echo, balanced fast-field echo) and a postcontrast dynamic sequence (T1-weighted high-resolution isotropic volume excitation). Disease activity was assessed according to a multiparameter score (0-8) based on lesion morphology, signal intensity and contrast enhancement. MR-E findings were compared with clinical-laboratory data and disease activity indices [Crohn's Disease Activity Index (CDAI); Inflammatory Bowel Disease Questionnaire (IBDQ)]. Multiple regression analysis was performed by correlating MR-E score, CDAI and IBDQ. Frequencies were then compared using the χ (2) test. RESULTS: MR-E identified inactive disease in 9% of cases, chronic disease in 57% and active disease in the remaining 34%. The most frequently involved bowel segment was the terminal ileum (52%). A statistically significant correlation was found between MR-E score and CDAI (R=0.86; p<0.001) and between MR-E score and IBDQ (R=-0.83; p<0.001). The most suggestive parameter for disease activity was layered bowel-wall enhancement, a finding predominantly present in patients with increased CDAI (≥ 150) and/or local complications (χ (2)=7.13; p<0.01). CONCLUSIONS: MR-E is a noninvasive and diagnostic imaging modality for CD study and follow-up. The MR-E score proposed in this study proved to be useful in assessing disease severity and monitoring response to treatment.

Childhood Ataxia with Cerebral Hypomyelination Syndrome: a Variant of Patient with Early Childhood Onset Related to EIF2B3 Mutation. A Case Report.

Childhood ataxia with central nervous system hypomyelination (CACH) syndrome is an autosomal recessive transmitted leukodystrophy characterised by early childhood onset and acute deterioration following febrile illnesses or head trauma. We describe the case of a child with early onset of CACH syndrome. He presented with cerebellar ataxia beginning around two years of age with mild mental retardation. MRI showed diffuse white matter signal changes with thinning of the corpus callosum.