Symptomatic lumbar synovial cyst: management with direct CT-guided puncture and steroid injection.
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Aged↗
Biomedical subjects
A Saifuddin
Publications and source records attributed to A Saifuddin.
Imaging of adult brachial plexus traction injuries.
Closed, high-energy transfer traction injuries of the adult brachial plexus lead to rupture or avulsion of the spinal nerves. Accurate preoperative diagnosis is crucial for surgical planning and reconstruction. Myelography, computerised tomographic myelography and magnetic resonance imaging are the main radiological methods for preoperative diagnosis of the lesion. This article reviews the current status of imaging of traction injuries of the adult brachial plexus.
Adult↗
Osteofibrous dysplasia of the ulna.
Osteofibrous dysplasia is a rare condition usually ffecting the tibiae and fibulae of males in the first two decades of life. Involvement at the ulna has also been reported in some cases. We describe an extensive, rapidly progressive lesion of the ulna in a three-year-old girl. The progression of the disease accelerated after a local marginal removal, and required extensive resection of the ulna with reconstruction using a fibular autograft. The particular features of this case are the change in the aggressive nature of the condition, which has not been previously reported. We believe that this is only the second recorded case of histologically proven involvement of the ulna.
Bone Transplantation↗
Malignant round cell tumours of bone: atypical clinical and imaging features.
OBJECTIVE: To describe the clinical, radiological and MRI features of six atypical cases of histologically proven appendicular Ewing sarcoma/primitive neuroectodermal tumour (PNET). DESIGN: Retrospective review of case notes and available imaging was carried out. PATIENTS: Six patients (4 male, 2 female; mean age 27 years, range 19-44 years), presenting over a 77-month period, were identified from the Bone Tumour Register. All had unusual clinical and imaging features for Ewing sarcoma/PNET. RESULTS AND CONCLUSIONS: Four tumours were centred on the distal femoral metaphysis, one in the proximal tibial metaphysis and one in the distal tibial metaphysis. Plain radiographs were available in four cases and showed minor cortical changes. MRI demonstrated a relatively small, eccentrically located intraosseous component with a large, eccentric extraosseous component. Extension into the epiphysis was seen in three cases and into the adjacent joint in two cases. Intraosseous "skip" metastases were present in three cases. The clinical and imaging features were atypical for conventional intraosseous Ewing sarcoma/PNET and the exact site of origin (intraosseous, periosteal or soft-tissue) was unclear.
Adult↗
An audit of MRI for bone and soft-tissue tumours performed at referral centres.
AIM: Magnetic resonance imaging (MRI) is essential in the pre-operative staging of suspected primary bone and soft-tissue sarcomas. Such lesions are ideally managed in specialist centres but it is becoming increasingly common for patients to undergo MRI before referral. The aim of this study was to assess the adequacy of such studies. MATERIALS AND METHODS: Fifty patients (30 men, 20 women; mean age 39 years, range 9-89 years) were included over a 1-year period. Tumours included 31 suspected primary bone tumours and 19 soft-tissue tumours. RESULTS: The total number of sequences used was 225 (mean 4, range 2-8). Enhancement was used in 19 cases. The commonest mistake was the failure to image the whole bone for 'skip' metastases in 50% of appropriate cases (high-grade malignant lesions of bone). Reports were available in 40 cases. Specific information regarding precise intraosseous and extraosseous extent of tumour and relationship to the neurovascular bundle and adjacent joint was commonly not included. CONCLUSIONS: This audit indicates that a greater awareness is needed amongst general radiologists of the MR imaging and reporting requirements for musculoskeletal tumours. In particular, all important axial imaging is sometimes omitted.Saifuddin, A. (2000). Clinical Radiology 55, 537-541.
Adolescent↗
The imaging of lumbar spinal stenosis.
Lumbar spinal stenosis (LSS) is a relatively common condition of varied aetiology which results in chronic compression of the cauda equina. It becomes clinically relevant when giving rise to symptoms of neurogenic claudication or leg pain. Lumbar spinal stenosis can be classified based on anatomy or aetiology and the diagnosis in any single case should include a consideration of both the site and the cause. Plain radiography is of limited value. Myelography with erect lateral flexion/extension views will demonstrate the dynamic component of the stenosis which cannot be appreciated on plain computed tomography (CT) or magnetic resonance imaging (MRI). Therefore, in patients with a good history of symptomatic LSS, and a borderline stenosis on MRI, CT myelography is recommended as the definitive pre-operative imaging investigation.
Humans↗
Magnetic resonance imaging of spinal plasmacytoma.
AIM: To describe the magnetic resonance imaging (MRI) features of spinal plasmacytoma. MATERIALS AND METHODS: The clinical records and MRI findings in six patients (five men, one woman; age range 41-61 years) with histologically proven plasmacytoma of the spine were reviewed. All studies included sagittal T1- and T2-weighted spin-echo sequences and axial T1-weighted spin-echo sequences. Intravenous gadolinium DTPA was administered in four cases. RESULTS: MRI showed a characteristic appearances in four cases of low signal intensity curvilinear areas within the vertebra or cortical irregularity. CONCLUSION: Recognition of these imaging features can initiate the appropriate investigation as the commonest differential diagnosis for such lesions is metastasis.Shah, B. K. (2000). Clinical Radiology55, 439-445.
Adult↗
Modulation of spinal deformities in patients with neurofibromatosis type 1.
STUDY DESIGN: A consecutive case retrospective chart and radiographic review. OBJECTIVES: To determine the incidence of nine radiographic dystrophic features acquired during the process of modulation, and to analyze the statistical correlation of these acquired dystrophic features with clinical progression of a spinal deformity. SUMMARY OF BACKGROUND DATA: In patients with neurofibromatosis, spinal deformities with seemingly few initial dystrophic features have shown a tendency to acquire dystrophic changes during long-term follow-up periods. Similarly, deformities with dystrophic changes can acquire further dystrophic features. This phenomenon is termed "modulation," a feature unique to spinal deformities in neurofibromatosis. These dystrophic changes may evolve slowly or aggressively, and may spread to other regions as well. METHODS: A review was done of the clinical records, photographs, radiographs, and other imaging studies of 457 patients referred between 1982 and 1995 with the diagnosis of neurofibromatosis Type 1. One hundred twenty-eight patients were diagnosed with a spinal deformity. Ninety-one patients who had a complete set of clinical and radiographic data were included in the study. Location and type of curve as well as the extent of spinal deformity were studied for their effect on the tendency for modulation. Initial spinal radiographs were analyzed for nine radiographic dystrophic features: rib penciling, vertebral rotation, posterior vertebral scalloping, anterior vertebral scalloping, lateral vertebral scalloping, vertebral wedging, spindling of the transverse process, widened interpedicular distance, and enlarged intervertebral foramina. Subsequent radiographs were analyzed critically for evolution, progression, or spread of these features. Correlation of acquisition in these dystrophic features with clinical progression in the spinal deformity, as measured in increments of scoliosis and kyphosis, was analyzed. RESULTS: In 81% of patients with spinal deformity diagnosed before 7 years of age and in 25% of patients with such a diagnosis after 7 years of age, evidence of modulation was observed. Location, side, and extent of the deformity and patient gender did not influence the propensity of the deformity to modulate. Correlation of modulation with clinical progression of the deformity showed rib penciling to be the only singular factor statistically influencing risk of progression. Of the deformities that acquired three or more penciled ribs, 87% showed significant clinical progression. No other radiographic dystrophic feature individually influenced progression. However, when three or more of the dystrophic skeletal features were acquired, the risk of progression reached statistical significance in 85% of patients. CONCLUSIONS: Spinal deformities in patients with neurofibromatosis 1 should be regarded as deformities in evolution. One should resist assigning these evolving deformities to either the dystrophic or nondystrophic end of the spectrum without considering the possibility of modulation across the spectrum. A spinal deformity that develops before 7 years of age should be followed closely for evolving dystrophic features (i.e., modulation). When a curve acquires either three penciled ribs or a combination of three dystrophic features, clinical progression is almost a certainty.
Adolescent↗
Ultrasound-guided needle biopsy of primary bone tumours.
Needle biopsy is an established technique for the histological diagnosis of bone tumours, usually guided by fluoroscopy or CT. Surface lesions and aggressive tumours which have extended through the cortex are also amenable to imaging with ultrasound (US). We have assessed the diagnostic accuracy of US-guided Trucut needle biopsy in a consecutive series of patients referred to a Bone Tumour Unit with suspected primary bone tumours. Of 144 patients (83 men, 61 women; mean age 34.7 years) referred over a period of two years, 63 were considered suitable for US-guided biopsy. This was based on the presence of a relatively large extraosseous component, seen typically in osteosarcoma and malignant round-cell tumours. The results of needle biopsy were compared with those of surgical biopsy. The diagnostic accuracy was 98.4%, with only a single failed biopsy. Thus, in a selected group of patients, US is a very reliable technique of guidance for percutaneous needle biopsy of bone tumours.
Adolescent↗
Spinal osteoblastoma: CT and MR imaging with pathological correlation.
OBJECTIVES: To illustrate the CT and MRI features of spinal osteoblastomas and correlate the imaging with histological findings. DESIGN: In a retrospective review the CT and MRI features of spinal osteoblastomas with respect to mineralisation, signal intensity (SI), adjacent reactive changes, enhancement following gadolinium-DTPA (5 cases) and adjacent soft tissue masses were compared and correlated with the histological findings including the degree of osteoid formation and matrix mineralisation, vascularity and surrounding reactive changes in bone and soft tissue. PATIENTS: Eleven patients (7 males and 4 females; age range 8-43 years, mean age 19.5 years) with 12 osteoblastomas (1 patient suffered a recurrence) were studied. RESULTS: All lesions showed classical features on CT with varying degrees of matrix mineralisation, whereas MRI identified mineralisation in only eight of 12 cases. MRI showed low signal intensity of the lesion on both T1- and T2-weighted sequences in several cases in the absence of heavy mineralisation. In these cases, histological examination revealed diffuse osteoid production by the tumour. All patients given gadolinium showed enhancement within the tumour on MRI. Reactive bone marrow changes were identified on MRI in 10 cases, and in five of these the changes were at multiple levels. An adjacent soft tissue mass was demonstrated in five cases, but extraosseous tumour was present histologically in only two of these. CONCLUSIONS: The MRI appearances of spinal osteoblastomas are varied and show no characteristic features. MRI may also overestimate the extent of the lesion due to extensive reactive changes and adjacent soft tissue masses. CT should continue to be the investigation of choice for the characterisation and local staging of suspected spinal osteoblastomas.
Adolescent↗
Deep soft tissue leiomyoma of the thigh.
A case of ossified leiomyoma of the deep soft tissues of the left thigh is presented. The radiographic appearance suggested a low-grade chondrosarcoma. MRI of the lesion showed signal characteristics similar to muscle on both T1- and T2-weighted spin echo sequences with linear areas of high signal intensity on T1-weighted images consistent with medullary fat in metaplastic bone. Histopathological examination of the resected specimen revealed a benign ossified soft tissue leiomyoma.
Aged↗
Extradural inflammation associated with annular tears: demonstration with gadolinium-enhanced lumbar spine MRI.
Annular tears are manifest on MRI as the high-intensity zone (HIZ) or as annular enhancement. Patients with annular tears may experience low back pain with radiation into the lower limb in the absence of nerve root compression. Inflammation of nerve roots from leak of degenerative nuclear material through full-thickness annular tears is a proposed mechanism for such leg pain. The aim of this study is to illustrate the appearance of extradural enhancement adjacent to annular tears in patients being investigated for low back pain with radiation into the lower limb(s). Sagittal T1- and T2-weighted spin echo and axial T1-weighted spin echo sequences were obtained in eight patients being investigated for low back and leg pain. In all patients, the T1-weighted sequences were repeated following intravenous gadopentetate dimeglumine (Gd-DTPA). Annular tears were identified at 12 sites in eight patients. Extradural inflammation appeared as a region of intermediate signal intensity replacing the fat between the posterior disc margin and the theca, which enhanced following Gd-DTPA. The inflammatory change was always associated with an annular tear, and in four cases directly involved the nerve root. Enhancement of the nerve root was seen in two cases. The findings may be relevant in the diagnosis of chemical radiculopathy secondary to inflammation at the site of an annular leak from a degenerating disc.
Adult↗
Imaging features of cervical spondylolysis--with emphasis on MR appearances.
AIM: To describe the imaging features of cervical spondylolysis, with emphasis on magnetic resonance imaging (MRI) appearances. MATERIALS AND METHODS: The clinical and imaging features (plain radiographic, CT and MRI) of three patients with cervical spondylolysis were reviewed. RESULTS AND CONCLUSIONS: Three cases of C6 cervical spondylolysis have been described and the world literature reviewed. The plain radiographic features in two cases with bilateral defects showed spondylolisthesis and abnormalities of the pars and adjacent facet joints. CT demonstrated well corticated defects and associated spina bifida occulta in all cases. The defects were seen in only one case on MRI but in all cases, absence of the spinous process of C6 was noted on sagittal sequences due to the spina bifida occulta. Cervical spondylolysis is an uncommon condition that must be distinguished from an acute fracture and diagnosed radiologically to prevent mismanagement. Although the defect may be difficult to identify on MRI, absence of the spinous process on sagittal sequences should raise the suspicion of the abnormality.
Adult↗
MRI of the lumbar intervertebral disc.
The lumbar spine is one of the commonest regions of the body imaged with MRI. Various pathological processes can involve the lumbar intervertebral disc, including degeneration, infection and trauma and these may present with a variety of signal intensity and morphological changes as depicted by MRI. The aim of this pictorial review is to illustrate these abnormalities and discuss their clinical relevance where appropriate.
Humans↗
The variation of position of the conus medullaris in an adult population. A magnetic resonance imaging study.
STUDY DESIGN: Sequential study of magnetic resonance images of the lumbar spine. OBJECTIVES: To determine the variation in position of the conus medullaris in a living adult population without spinal deformity. SUMMARY OF BACKGROUND DATA: Cadaveric studies have shown that the position of the conus medullaris in the adult most commonly is located at L1-L2. There have been several studies documenting the changing level of the conus throughout infancy and childhood, but there is no detailed study that documents the range of conus positions in a living adult population without spinal deformity. METHODS: The T1-weighted, midline, sagittal, spin-echo magnetic resonance imaging studies of 504 patients were assessed to identify the tip of the conus medullaris. This location was recorded in relation to the upper, middle, or lower third of the adjacent vertebral body or the adjacent intervertebral disc. RESULTS: The study group consisted of 231 men and 273 women with a mean age 46 years (range, 16-85 years). Most patients were being examined for low back pain. Patients with spinal deformity were excluded. The mean conus position was the lower third of L1 (range, middle third of T12 to upper third of L3). The variation in conus positions followed a normal distribution. No significant difference in conus position was seen between male and female patients or with increasing age. CONCLUSIONS: The distribution of conus location in a large adult population was shown to range from the middle third of T12 to the upper third of L3.
Adolescent↗
The value of lumbar spine magnetic resonance imaging in the demonstration of anular tears.
STUDY DESIGN: Retrospective review of magnetic resonance imaging and discography in patients investigated for low back pain before spinal fusion. OBJECTIVE: To determine the sensitivity of magnetic resonance imaging in the detection of painful anular tears manifested by the high-intensity zone. SUMMARY OF BACKGROUND DATA: Two studies have produced results showing that magnetic resonance imaging has a high specificity for the detection of painful anular tears manifested by a high-intensity zone. However, in a recent study, results showed no significant correlation between the high-intensity zone and pain reproduction. The sensitivity of magnetic resonance imaging in identifying anular tears in a symptomatic population has not been determined. METHODS: Anular tears were identified in magnetic resonance images by the presence of a high-intensity zone in the posterior anulus. The results were compared with the demonstration of painful anular tears on discogram, which has been considered the gold standard. RESULTS: The study group comprised 58 patients (31 men, 27 women; mean age 42, range 21-63 years). One hundred and fifty-two discs were injected and examined by discography, and 108 were considered degenerate. Of these, 86 had anular tears (54 posterior, 6 anterior, 26 both). Seventy anular tears were associated with concordant pain provocation. Twenty-seven high-intensity zones were identified in magnetic resonance imaging, of which 24 were associated with pain reproduction by discography. The sensitivity, specificity, positive predictive value, and negative predictive value of magnetic resonance imaging in the diagnosis of concordantly painful posterior anular tears are therefore 26.7%, 95.2%, 88.9%, and 47%, respectively. CONCLUSION: These results confirm that the high-intensity zone is a marker of a painful posterior anular tear. However, the usefulness of this sign is limited by low sensitivity.
Adult↗
Osteoid osteoma and osteoblastoma of the spine. Factors associated with the presence of scoliosis.
STUDY DESIGN: A retrospective study of 44 museum cases of spinal osteoid osteoma or osteoblastoma and a meta-analysis using 421 additional cases from a review of the literature. OBJECTIVES: To identify the factors that are associated with the development of scoliosis in these patients. SUMMARY OF BACKGROUND DATA: Painful scoliosis is a well recognized presentation of spinal osteoid osteoma and osteoblastoma and is considered to be secondary to pain-provoked muscle spasm on the side of the lesion. Previous studies have been based on small numbers of patients that did not permit statistical validation of the reported observations. METHODS: Eight factors were assessed including: age, gender, duration of symptoms, site of lesion in the spine, vertebral level of lesion, site of lesion in the individual vertebra, type of lesion, and Cobb angle at presentation. Reports were reviewed only if the presence or absence of scoliosis could be determined. Statistical analyses initially were performed on the museum cases and then on a combination of museum cases and cases from the literature. RESULTS: Overall, 63% of subjects had scoliosis. The lesions were typically present on the concave aspect of the curve. Three cases of scoliosis from the literature involved lesions that were reported to be on the convexity. Scoliosis is significantly more common in cases of osteoid osteoma than in cases of osteoblastoma (P < 0.0001); lesions are more common in the thoracic and lumbar regions than in the cervical region (P < 0.0001), in lower cervical region than in the upper cervical region (P value = 0.0027), and they are more commonly located to one side of the midline (P < 0.0001). Age, gender, and duration of symptoms were of no significance. CONCLUSIONS: The findings support the concept that scoliosis is secondary to asymmetric muscle spasm in patients with spinal osteoid osteoma or osteoblastoma.
Adolescent↗
Langerhans' cell histiocytosis of the spine: use of MRI in guiding biopsy.
The MRI features of two cases of spinal Langerhans' cell histiocytosis with multilevel involvement are presented in which MRI was of help in differentiating active from inactive healing lesions by the demonstration of signal changes in the vertebral body marrow of the active lesion, manifest as low signal intensity on T1-weighted sequences and high signal intensity on T2-weighted sequences. This distinction could not be made by plain radiography or bone scintigraphy. In cases where biopsy is required for diagnosis, MRI is recommended to guide the biopsy towards levels suggestive of active involvement.
Biopsy, Needle↗