Postoperative Resolution of Magnetic Resonance Imaging Signal Intensity Changes and the Associated Impact on Outcomes in Degenerative Cervical Myelopathy

Spine ◽  
2018 ◽  
Vol 43 (12) ◽  
pp. 824-831 ◽  
Author(s):  
So Kato ◽  
Aria Nouri ◽  
Hamed Reihani-Kermani ◽  
Yasushi Oshima ◽  
Joseph Cheng ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cervical Myelopathy ◽  
Signal Intensity ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Signal ◽  
Intensity Changes ◽  
Degenerative Cervical Myelopathy

Congenital Cervical Spine Stenosis in a Multicenter Global Cohort of Patients With Degenerative Cervical Myelopathy: An Ambispective Report Based on a Magnetic Resonance Imaging Diagnostic Criterion

Neurosurgery ◽  
2018 ◽  
Vol 83 (3) ◽  
pp. 521-528 ◽  
Author(s):  
Aria Nouri ◽  
Lindsay Tetreault ◽  
Satoshi Nori ◽  
Allan R Martin ◽  
Anick Nater ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Surgical Outcomes ◽  
Cervical Myelopathy ◽  
Spinal Canal ◽  
Resonance Imaging ◽  
Baseline Severity ◽  
Degenerative Cervical Myelopathy

Abstract BACKGROUND Congenital spinal stenosis (CSS) of the cervical spine is a risk factor for acute spinal cord injury and development of degenerative cervical myelopathy (DCM). OBJECTIVE To develop magnetic resonance imaging (MRI)-based criteria to diagnose preexisting CSS and evaluate differences between patients with and without CSS. METHODS A secondary analysis of international prospectively collected data between 2005 and 2011 was conducted. We examined the data of 349 surgical DCM patients and 27 controls. Spinal canal and cord anteroposterior diameters were measured at noncompressed sites to calculate spinal cord occupation ratio (SCOR). Torg–Pavlov ratios and spinal canal diameters from radiographs were correlated with SCOR. Clinical and MRI factors were compared between patients with and without CSS. Surgical outcomes were also assessed. RESULTS Calculation of SCOR was feasible in 311/349 patients. Twenty-six patients with CSS were identified (8.4%). Patients with CSS were younger than patients without CSS (P = .03) and had worse baseline severity as measured by the modified Japanese Orthopedic Association score (P = .04), Nurick scale (P = .05), and Neck Disability Index (P < .01). CSS patients more commonly had T2 cord hyperintensity changes (P = .09, ns) and worse SF-36 Physical Component scores (P = .06, ns). SCOR correlated better with Torg–Pavlov ratio and spinal canal diameter at C3 than C5. Patients with SCOR ≥ 65% were also younger but did not differ in baseline severity. CONCLUSION SCOR ≥ 70% is an effective criterion to diagnose CSS. CSS patients develop myelopathy at a younger age and have greater impairment and disability than other patients with DCM. Despite this, CSS patients have comparable duration of symptoms, MRI presentations, and surgical outcomes to DCM patients without CSS.

EXTENSIVE WHITE MATTER CHANGES AFTER STEREOTACTIC RADIOSURGERY FOR BRAIN ARTERIOVENOUS MALFORMATIONS

Neurosurgery ◽  
2008 ◽  
Vol 63 (6) ◽  
pp. 1064-1070 ◽  
Author(s):  
René van den Berg ◽  
Dennis R. Buis ◽  
Frank J. Lagerwaard ◽  
Geert J. Lycklama à Nijeholt ◽  
W. Peter Vandertop
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Signal Intensity ◽  
Arteriovenous Malformations ◽  
High Signal Intensity ◽  
High Signal ◽  
Resonance Imaging ◽  
White Matter Changes ◽  
Intensity Changes ◽  
Brain Avms

Abstract OBJECTIVE Perinidal high-signal-intensity changes on T2-weighted magnetic resonance imaging can be seen surrounding radiosurgically treated brain arteriovenous malformations (AVM). Occasionally, these signal intensity changes develop far beyond the irradiated volume. A retrospective analysis of both the pre- and postradiosurgery magnetic resonance imaging and angiographic studies was performed to analyze the cause of these extensive perinidal white matter changes. METHODS The pre- and postradiosurgical magnetic resonance imaging and angiographic studies of 30 patients with T2 high-signal-intensity changes surrounding a brain AVM were analyzed retrospectively. Patients were divided into 2 groups on the basis of the extension of the signal intensity changes within or beyond the 10-Gy isodose area. The angiographic analysis was focused on the venous drainage pattern (deep versus superficial), venous stenosis, and the number of draining veins before and after radiosurgery. In addition, the obliteration rate was determined for the 2 subgroups. RESULTS Fourteen patients (47%) showed high-signal-intensity changes far beyond the 10-Gy isodose area. A single draining vein was more often present in these patients with extensive T2 hyperintensity signal changes than in the other group. Obliteration was achieved in 12 (88%) of 14 patients with extensive signal intensity changes, as opposed to 8 (50%) of 16 patients in the other group. CONCLUSION High-signal-intensity changes after radiosurgery for brain AVMs, far beyond the 10-Gy isodose area on T2-weighted images, are especially seen in brain AVMs draining through a single vein. The higher occlusion rate of brain AVMs under these circumstances is well appreciated.

Does collagenase injection disrupt or digest the Dupuytren’s cord: a magnetic resonance imaging study

2016 ◽  
Vol 41 (6) ◽  
pp. 614-620 ◽  
Author(s):  
K. M. Crivello ◽  
H. G. Potter ◽  
E. S. Moon ◽  
S. K. Rancy ◽  
Scott W. Wolfe
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Signal Intensity ◽  
Imaging Study ◽  
Resonance Imaging ◽  
Level Of Evidence ◽  
Collagenase Injection ◽  
Intensity Changes ◽  
Full Correction ◽  
Magnetic Resonance Imaging Mri

Collagenase clostridium histolyticum has been extensively studied as a treatment modality for Dupuytren’s contracture. Its mechanism of action has been documented. It is unknown whether injected collagenase weakens the Dupuytren’s cord sufficiently to cause failure during manipulation or if there is digestion and reduction in cord volume. We examined five patients with isolated contractures of the ring or middle metacarpalphalangeal (MP) joint using magnetic resonance imaging (MRI) prior to injection with collagenase and again 1 month following injection. All patients had full correction after manipulation which was maintained at follow-up. The Dupuytren’s cord was evaluated with respect to volume, signal intensity, inflammatory changes and continuity. Additionally, signal intensity changes of the flexor tendons and neurovascular structures were recorded. MRI demonstrated cord discontinuity, significant reduction of cord volume and a significant increase in cord signal intensity after treatment with collagenase. There was a slight increase in flexor tendon signal intensity that was not significant. These findings suggest that there may be local chemical dissolution of the cord. Future studies may establish whether or not this will have prognostic implications in terms of correction and recurrence following collagenase injection. Level of evidence: IV

The Relationship Between Preoperative Clinical Presentation and Quantitative Magnetic Resonance Imaging Features in Patients With Degenerative Cervical Myelopathy

Neurosurgery ◽  
2016 ◽  
Vol 80 (1) ◽  
pp. 121-128 ◽  
Author(s):  
Aria Nouri ◽  
Lindsay Tetreault ◽  
Kristian Dalzell ◽  
Juan J. Zamorano ◽  
Michael G. Fehlings
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Lower Limb ◽  
Cervical Myelopathy ◽  
Clinical Presentation ◽  
Resonance Imaging ◽  
Mri Features ◽  
Degenerative Cervical Myelopathy ◽  
The Relationship

Abstract BACKGROUND: Degenerative cervical myelopathy encompasses a group of conditions resulting in progressive spinal cord injury through static and dynamic compression. Although a constellation of changes can present on magnetic resonance imaging (MRI), the clinical significance of these findings remains a subject of controversy and discussion. OBJECTIVE: To investigate the relationship between clinical presentation and quantitative MRI features in patients with degenerative cervical myelopathy. METHODS: A secondary analysis of MRI and clinical data from 114 patients enrolled in a prospective, multicenter study was conducted. MRIs were assessed for maximum spinal cord compression (MSCC), maximum canal compromise (MCC), signal changes, and a signal change ratio (SCR). MRI features were compared between patients with and those without myelopathy symptoms with the use of t tests. Correlations between MRI features and duration of symptoms were assessed with the Spearman ρ. RESULTS: Numb hands and Hoffmann sign were associated with greater MSCC (P < .05); broad-based, unstable gait, impairment of gait, and Hoffmann sign were associated with greater MCC (P < .05); and numb hands, Hoffmann sign, Babinski sign, lower limb spasticity, hyperreflexia, and T1 hypointensity were associated with greater SCR (P < .05). Patients with a T2 signal hyperintensity had greater MSCC and MCC (P < .001). CONCLUSION: MSCC was associated with upper limb manifestations, and SCR was associated with upper limb, lower limb, and general neurological deficits. Hoffmann sign occurred more commonly in patients with a greater MSCC, MCC and SCR. The Lhermitte phenomenon presented more commonly in patients with a lower SCR and may be an early indicator of mild spinal cord involvement. Research to validate these findings is required.

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