Hatice Lakadamyali

STIR Sequence for Depiction of Degenerative Changes in Posterior Stabilizing Elements in Patients with Lower Back Pain

OBJECTIVE The aims of this study were to investigate whether degenerative posterior paraspinal changes are a cause of lower back pain and to determine the age- and sex-related distribution of these changes on MR images acquired with a STIR sequence. SUBJECTS AND METHODS The lumbar MRI findings of 372 patients (141 men, 231 women; mean age, 51.2 years) with nonradicular lower back pain and of 249 healthy persons acting as controls (126 men, 123 women; mean age, 49.3 years) were analyzed. The sagittal STIR sequence was used for all MRI examinations. Presence of interspinous ligament edema, facet joint effusion, neocysts, paraspinal muscle edema, subcutaneous edema, disk herniation, and disk degeneration was evaluated, and the incidence of each finding was determined. All findings were grouped according to age and sex. Chi-square, Fishers exact, and independent-samples Students t tests and Spearmans rank correlation analysis were used for statistical analysis. RESULTS The incidences of facet joint effusion, interspinous ligament edema, neocyst formation, and paraspinal muscle edema were found to be statistically significantly higher in patients with lower back pain than in controls. The incidences of intervertebral disk degeneration, disk herniation, and subcutaneous edema in persons with and those without lower back pain were similar. Intervertebral disk degeneration, disk herniation, subcutaneous edema, and muscle edema were found to increase with age in both persons with and those without symptoms. CONCLUSION Degenerative changes in the posterior paraspinal structures were found in a higher percentage of subjects with lower back pain than in controls. Use of a STIR sequence with homogeneous fat suppression facilitates visualization of these changes.

Subpubic cartilaginous cyst: incidental finding detected by abdominopelvic computed tomography

Subpubic cartilaginous cysts are rare cystic lesions that have been radiologically identified only in recent years, and the our understanding of the cautions to be observed in the diagnostic approach and the radiologic characteristics is still incomplete. The medical literature search revealed three reported cases of a subpubic cartilaginous cyst diagnosed histopathologically and one case that was suggested by radiological findings. Definitive diagnosis of all the cases was confirmed by excisional biopsy. This report discusses the radiological features and the important issues necessary in the diagnostic approach of subpubic cartilaginous cysts.

Magnetic Resonance Imaging in the Visualization of Benign Tumors and Tumor-like Lesions of Hand and Wrist

The differential diagnosis of benign tumors and tumor-like lesions of the hand and wrist region is important with regard to choosing the therapy (medical versus surgical), or to decide to just follow-up the lesion. In most of the cases the proper analysis of MRI findings in correlation with the patients history is sufficient to meet a specific diagnosis. However, diagnostic confusion is not uncommon as there are numerous lesions affecting the hand and wrist region. This pictorial essay offers a practical radiological approach to benign tumors and tumor-like lesions of the hand and wrist region based on most frequently observed MRI findings.

The relation between sagittal morphology of the lumbosacral spine and the degree of lumbar intervertebral disc degeneration.

OBJECTIVES We investigated the relationship between the lumbosacral morphology and degree of intervertebral disc degeneration in a large sample of young patients. In addition, the relation between various morphological parameters (sacral table angle and sacral kyphosis) and lumbar disc herniation or degeneration was also evaluated. METHODS The magnetic resonance imaging (MRI) of low back pain patients referred to our department in 2008-2009 were retrospectively evaluated. Patients with prior lumbar spinal surgery, serious congenital anomalies on MRI, incomplete or complete lumbosacral trancision, severe scoliosis, spondylolysis, or spondylolisthesis were excluded from the study. A sample of 131 females between 20-30 years of age was studied. Patients were evaluated for the presence of intervertebral disc herniation or degeneration, and the degree of degeneration was assessed. Angles of lumbar lordosis, sacral table, and sacral kyphosis were also measured for each patient. RESULTS The degree of intervertebral disc degeneration increased in parallel to the decrease in the sacral kyphosis and lumbar lordosis angles, and to the increase in sacral table angle. A statistically significant difference with regard to the angles of lumbar lordosis, sacral kyphosis, and sacral table was determined between individuals with (23.37±7.09°, 163.09±9.48°, 104.34±5.47°, respectively) and without intervertebral disc degeneration (26.94±7.39°, 168.94±10.52°, 100.83±4.32°; p=0.006, p=0.001, p=0.0001, respectively). In addition, a statistically significant difference with regard to the angles of lumbar lordosis, sacral kyphosis, and sacral table was determined between individuals with (22.82±6.94°, 162.23±9.53°, 104.94±5.19°, respectively) and without intervertebral disc herniation (27.25±7.26°, 169.39±9.96°, 100.48±4.33°; p=0.001, p=0.0001, p=0.0001, respectively). CONCLUSION The degree and risk of intervertebral disc degeneration and herniation increases in parallel to the decrease in sacral kyphosis and lumbar lordosis, and to the increase in sacral surface angle.

Multiple rice body formation accompanying the chronic nonspecific tenosynovitis of flexor tendons of the wrist

Rice body formation is generally a rare disorder related to rheumatoid arthritis. It can also be observed in cases of systemic lupus erythematosus, seronegative arthritis, infectious arthritis (tuberculosis, atypical mycobacterial infection), nonspecific arthritis, and osteoarthritis. It is generally located within joints or bursae. Multiple rice bodies of tendon sheaths are rarely encountered. Rice body formation may also be encountered without underlying systemic disorders. We present a case of multiple rice body formation that accompanied chronic nonspecific tenosynovitis of the flexor tendons of the wrist.

Multiple extradural spinal arachnoid cysts causing diffuse myelomalacia of the spinal cord.

Introduction:Extradural spinal cyst is a rare cause of compression myelopathy. It is usually solitary and its typical location is posterior to the spinal cord. We present a case of multiple spinal arachnoid cysts causing diffuse myelomalacia secondary to a significant compression of the spinal cord with no symptom relief after surgical decompression. Case Report:A 35-year-old female patient presented to our hospital complaining of progressive weakness and numbness of both lower extremities for the last 2 months, being more prominent on the right side. Her history was significant for back pain that started after a vaginal delivery 1 year ago. Spinal MRI revealed multiple extradural arachnoid cysts and diffuse myelomalacia. A T4-T6 level laminectomy was performed. The cyst was nearly totally resected. There was partial symptomatic relief after surgery, but 5 months later her symptoms worsened. MRI revealed nodular syringomyelia and atrophy of the thoracic spinal cord. Conclusions:Extradural spinal arachnoid cyst is to be considered in the differential diagnosis of spinal cord compression. Vaginal delivery may accelerate the process and symptoms by a sudden increase in the cyst size. In cases of myelomalacia secondary to cyst pressure postoperative results are quite poor.

MRI for acute neurologic complications in end-stage renal disease patients on hemodialysis.

Acute cerebrovascular disease is one of the most frequent causes of mortality and morbidity in patients on long-term hemodialysis therapy. Early recognition of cerebrovascular events improves the prognosis and quality of life of end-stage renal failure patients. This paper reviews the magnetic resonance imaging features of acute neurological findings in patients with end-stage renal failure.

High sensitivity C-reactive protein and cerebral white matter hyperintensities on magnetic resonance imaging in migraine patients

BackgroundMigraine is a common headache disorder that may be associated with vascular disease and cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scan. High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that may predict subclinical atherosclerosis. However, the relation between migraine, vascular risks, and WMHs is unknown. We evaluated hs-CRP levels and the relation between hs-CRP level and WMHs in adult migraine patients.MethodsThis case–control study included 432 subjects (216 migraine patients [without aura, 143 patients; with aura, 73 patients]; 216 healthy control subjects without migraine; age range 18–50 y). Migraine diagnosis was determined according to the International Classification of Headache Disorders II diagnostic criteria. The migraine patients and control subjects had no known vascular risk factors, inflammatory disease, or comorbid disease. The presence and number of WMHs on MRI scans were determined, and serum hs-CRP levels were measured by latex-enhanced immunoturbidimetry.ResultsMean hs-CRP level was significantly greater in migraine patients (1.94 ± 2.03 mg/L) than control subjects (0.82 ± 0.58 mg/L; P ≤ .0001). The mean number of WMHs per subject and the presence of WMHs was significantly greater in migraine patients (69 patients [31.9%]; 1.68 ± 3.12 mg/dL) than control subjects (21 subjects [9.7%]; 0.3 ± 1.3; P ≤ .001). However, there was no correlation between hs-CRP level and WMHs in migraine patients (r = 0.024; not significant). The presence of WMHs was increased 4.35-fold in migraine patients (odds ratio 4.35, P ≤ .001).ConclusionsHigh hs-CRP level may be a marker of the proinflammatory state in migraine patients. However, the absence of correlation between hs-CRP level and WMHs suggests that hs-CRP is not causally involved in the pathogenesis of WMHs in migraine patients. The WMHs were located mostly in the frontal lobe and subcortical area.

A posterior epidural mass causing paraparesis in a 20-year-old healthy individual

We present a case of a posterior epidural abscess at the thoracic vertebral level causing paraparesia in a young, healthy individual with no otherwise predisposing factors, with normal laboratory findings, as diagnosed using fat-suppressed MR imaging. Spinal epidural abscess is a rare condition, encountered mostly in the midthoracic or lower lumbar vertebral levels of elderly patients, that has a high mortality and morbidity (18-31%) when diagnosis and treatment is delayed. It is rarely spontaneous and is usually accompanied by spinal osteomyelitis. Diagnosis is rather easy in cases of vertebral osteomyelitis or when classical clinical, laboratory and imaging findings are present. However, cases of spontaneous development, with no predisposing factors, and lack of abscess suggesting clinical and laboratory findings may be a diagnostic challenge. In such cases, other posterior epidural masses such as schwannoma, neurofibroma, meningioma and hematoma should be considered in the differential diagnosis. Both the clinician and the radiology physician should have a high suspicion of epidural abscesses, because their early diagnosis and treatment is important. In addition to routine MR images, fat-suppressed MR images prove helpful in the diagnosis of spontaneous epidural abscesses by showing the inflammatory changes in the paraspinal area.

Myositis ossificans in the right inferior thoracic wall as an unusual cause of lower thoracic-upper abdominal pain: Report of a case

We report a case of thoracic wall myositis ossificans (MO) located anterior to the ninth rib, causing right lower thoracic-upper abdominal pain. The diagnosis was based on the findings of ultrasonography (US) and computed tomography (CT). Numerous disorders can be included in the differential diagnosis of right lower thoracic-upper abdominal pain, so we must first establish if the pain is somatic or visceral in origin. Somatic pain in this region can be caused by traumatic muscle pain, overuse myalgia, costochondritis, or thoracic wall malignancies. Although rare, MO should also be considered in the differential diagnosis of pain and thoracic wall masses in this region. As the calcifications may not be seen on a plain chest X-ray in the early course of this condition, superficial tissue US or CT should be performed to establish the diagnosis.