The neuroradiology journal
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The purpose of this study was to investigate the usefulness of diffusion tensor imaging (DTI) for early detection of pathological alterations in the myelon in patients with cervical spondylotic myelopathy (CSM) without T2-weighted imaging (T2W) signal abnormalities but with a narrowed spinal canal with corresponding clinical correlation. Axial DTI at 1.5T together with routine magnetic resonance imaging was performed on 18 patients fulfilling above mentioned criteria. Quantitative fractional anisotropy (FA) and apparent diffusion coefficient (ADC) maps were generated. ⋯ ADC values correlated significantly with the width of the spinal canal at the prestenotic level, but not at the poststenotic level. Findings indicate sufficient robustness of routine implementation of DTI at 1.5T to detect abnormalities in the spinal cord of CSM patients, before apparent T2W signal abnormalities and marked clinical deterioration. Therefore, larger and long-term studies should be conducted to establish the DTI scalar metrics that would indicate early intervention for a better clinical outcome in patients with clinical signs of CSM.
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Functional magnetic resonance imaging (fMRI) has been widely used for pre-neurosurgical planning and may eventually become a routine pre-surgical imaging modality. The validity of fMRI for clinical application depends on various factors such as proper task selection, correct statistical analysis and threshold setting with appropriate patient cooperation. ⋯ Accurate and reproducible fMRI strongly depends on the patient's cooperation. In this study we observed that a pre-test mock fMRI session held by a radiologist may help to predict which patients are more or less suitable candidates for fMRI.
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Spondylodiscitis is a rare complication of unwitnessed button battery ingestion in children. We report a case of a 20-month-old girl who presented to the emergency room 2 weeks after endoscopic removal of unwitnessed, impacted esophageal battery. ⋯ The bilaminar shape of an unknown ingested foreign body should alert the treating physician that it might be a battery rather than a coin. Prompt evaluation with magnetic resonance imaging is essential to prevent neurological deficit and/or spinal deformities.
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A large number of patients do not have cauda equina syndrome (CES) on MRI to account for their clinical findings; consequently, the majority of urgent scans requested are normal. We aimed to determine whether any clinical manifestation of CES, as stated in Royal College of Radiology guidelines, could predict the presence of established CES on MRI. We also aimed to support a larger study to develop a more universal assessment tool for acute lower back pain. ⋯ No clinical features that were able to predict the presence of an established CES on MRI were elucidated. Findings included decreased anal tone 7.6% (p=0.282), faecal incontinence 3.8% (p=0.648), urinary retention 7.6% (p=0.510), bladder incontinence 8.9% (p=0.474), constipation 2.5% (p=0.011) and saddle anaesthesia 8.9% (p=0.368). Patients who had an abnormal MRI spine for back pain prior to this presentation showed a correlation with a newly diagnosed CES on MRI (p=0.016) with a correlation coefficient of 0.272.
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Congenital aortic arch and vertebral artery anomalies are a relatively rare finding discovered on imaging either incidentally or for evaluation of entities like dysphagia or subclavian steal. Right aortic arch is an uncommon anatomical anomaly that occurs in less than 0.1% of the population, and in half of these cases the left subclavian artery is also aberrant.(1) Unilateral vertebral artery (VA) duplication is rare with an observed prevalence of 0.72% in cadavers.(2) Fenestration of the VA is more common than duplication, with a prevalence of approximately 0.23%-1.95%.(3,4) We describe the case of a 25-year-old female who was found to have a right aortic arch with aberrant left subclavian artery, duplicated left vertebral artery and a fenestrated right vertebral artery on CT angiography performed for evaluation of dysphagia. ⋯ The incidence of these entities, resultant symptoms and clinical implications are also reviewed. The increased associated incidence of aneurysm formation, dissection, arteriovenous malformations and thromboembolic events with fenestration is also discussed.