Effect of spinal segment variants on numbering vertebral levels at lumbar MR imaging.

PURPOSE: To verify iliolumbar ligament (ILL) location, to evaluate magnetic resonance (MR) imaging morphologic features for detecting lumbosacral transitional vertebrae (TVs) (LSTVs), and to determine whether transitional situations are associated with anomalous vertebral numbering. MATERIALS AND METHODS: Investigational review board approval was obtained for this HIPAA-compliant retrospective study. A review of 147 subjects was performed by using spine radiography as the reference standard to determine total and segmental vertebral count and transitional anatomy. Thoracolumbar TVs (TLTVs) and LSTVs were identified. The lumbosacral intervertebral disk angle (LSIVDA), defined as the angle between the endplates, was measured, S1-2 disk morphology was rated according to the classification by O'Driscoll et al, and the ILL level was determined from MR images. Statistical analysis was performed by using χ(2) tests for dichotomous and ordinal variables and the t test for continuous variables. RESULTS: An anomalous total number of vertebrae were present in 12 (8.2%) of 147 subjects. The ILL was identified in 126 (85.7%) of 147 subjects and was present at L5 in 122 (96.8%) subjects; the remaining four (3.2%) subjects had an anomalous total number of vertebrae. A complete S1-2 intervertebral disk was associated with LSTVs (P = .004); however, LSIVDA was not (P = .2). TLTVs were present in six (4.1%) and LSTVs were present in 22 (15.0%) of 147 subjects. Both were present in four (2.7%) subjects. The presence of a TLTV was associated with a higher incidence of a concomitant LSTV and vice versa (P < .001; odds ratio [OR], 13.7; 95% confidence interval [CI]: 2.7, 68.4]). A TLTV was not associated with an anomalous total number of vertebrae (P = .46), but an LSTV was (P < .001; OR, 7.4; 95% CI: 2.2, 24.8). CONCLUSION: The ILL denotes the lowest lumbar vertebra, which does not always represent L5. A well-formed, complete S1-2 intervertebral disk is associated with LSTVs, but alteration in LSIVDA is not. LSTVs are associated with anomalous vertebral numbering.

Bilateral emphysematous pyelonephritis combined with subcapsular hematoma and disseminated necrotizing fasciitis.

Emphysematous pyelonephritis (EPN) is a rapidly progressive and potentially life-threatening necrotizing infection of the renal parenchyma characterized by the presence of gas. Bilateral EPN is a rare disease process with a high mortality rate. Bleeding associated with EPN is an extremely rare complication. Necrotizing fasciitis is a rare but serous condition with a poor prognosis. Herein we present a rare case of bilateral EPN combined with subcapsular hematomas which progressed to the development of disseminated necrotizing fasciitis.

Advantages of real-time spatial compound sonography of the musculoskeletal system versus conventional sonography.

OBJECTIVE: Spatial compound sonography is a method that obtains sonographic information from several different angles of insonation and combines them to produce a single image. By reducing speckle and improving definition of tissue planes, this method can potentially improve image quality in musculoskeletal sonography. The purpose of our study was to compare real-time spatial compound sonography with conventional high-resolution musculoskeletal sonography. MATERIALS AND METHODS: Thirty-four patients underwent sonography of the musculoskeletal system for a variety of indications. All patients were evaluated using conventional high-resolution sonography and real-time spatial compound sonography performed with a 12-5-MHz multifrequency linear array transducer. Conventional images and compound images depicting the same musculoskeletal structure were obtained in pairs. A total of 118 images (59 image pairs) were randomly assorted and reviewed on a computer monitor by three experienced sonologists working independently. The reviewers were unaware of the type of images they were evaluating. Image quality was rated using a 5-point scale. The image parameters evaluated were definition of tissue planes, speckle, other noise, and image detail. RESULTS: Analysis of variance revealed that real-time spatial compound sonography significantly improved definition of soft-tissue planes, reduced speckle and other noise, and improved image detail when compared with conventional high-resolution sonography (p < 0.0001 for all evaluated parameters). CONCLUSION: Real-time spatial compound sonography significantly improved sonographic image quality in the musculoskeletal system when compared with conventional high-resolution sonography. Because musculoskeletal sonography is highly dependent on image quality and tissue-plane definition, spatial compound sonography represents an important development.