Optimal thoracic and lumbar spine imaging for trauma: are thoracic and lumbar spine reformats always indicated?

BACKGROUND: Computed tomography (CT) of the thoracic and lumbar (T/L) spine with reformats has become the imaging modality of choice for the identification of T/L spine fractures. The objective of this study was to directly compare chest/abdomen/pelvis CT (CAP CT) with CT with T/L reformats (T/L CT) for the identification of T/L spine fractures. METHODS: Patients who had both a CAP CT scan (5-mm imaging spacing) and T/L CT reconstruction (2.5-mm image spacing with sagittal and coronal reformats) were selected. A "fracture" group (N = 35) and a "no fracture" group (N = 57) were identified. The type and level of fracture were recorded. RESULTS: The CAP CT correctly identified all 35 patients with a thoracolumbar fracture (100% sensitivity; 95% confidence interval: 88-100%). A total of 80 separate fracture sites were present in the 35 patients. The CAP CT accurately identified 78 of those fractures (97.5% sensitivity; 95% confidence interval: 90.4-99.6%). The two fractures not identified on the CAP CT were both the transverse process fractures in patients with multiple fractures at different levels. CONCLUSION: Patients who have a CAP CT do not require reformats for clearance of the T/L spine.

Focal lesion in the splenium of the corpus callosum on FLAIR MR images: a common finding with aging and after brain radiation therapy.

BACKGROUND AND PURPOSE: Focal high signal intensity in the splenium of the corpus callosum on fluid-attenuated inversion-recovery (FLAIR) images is generally considered an abnormal MR finding. We identified high signal intensity in the splenium on FLAIR images in patients of advanced age with otherwise normal images and in patients who had received brain radiation therapy. We undertook an investigation to determine the frequency of this finding in these patient groups. METHODS: We reviewed the FLAIR images and medical records of 67 patients (group 1) imaged for suspicion of CNS disease and of 18 consecutive patients (group 2) with history of brain radiation therapy. All FLAIR images were evaluated for focal signal intensity abnormalities in the splenium and for diffuse white matter abnormalities. Also, autopsy specimens from two cases not part of either study group were examined. RESULTS: Among the initial 67 patients in group 1, focal high signal intensity in the splenium was associated with aging, radiation therapy, and white matter changes. Focal high signal intensity in the splenium was evident on FLAIR images in 16 of the 18 patients in the post-radiation therapy group. Histologic examination of the splenium in one autopsy case with a history of chest and neck radiation therapy demonstrated isomorphic gliosis. CONCLUSION: High signal intensity in the splenium of the corpus callosum on FLAIR images is a common finding after brain radiation therapy and can be seen with aging. The radiologist should be aware of this common finding and not mistake it for more commonly recognized causes of splenial lesions.

Quick-brain magnetic resonance imaging for nonhydrocephalus indications.

OBJECT: In 2002, "quick-brain" (QB) MR imaging (ultrafast spin echo T2-weighted imaging) was introduced as an alternative technique to CT scanning for assessing children with hydrocephalus. The authors have observed high patient and physician satisfaction with this technique at their institution, which has led to an increasing frequency of its use for nonhydrocephalic indications. The goal in this study was to characterize, quantitate, and assess the use of QB MR imaging for these additional indications. METHODS: Between February 2003 and December 2007, 1146 consecutive QB MR imaging studies were performed, and the findings were entered prospectively into a radiology database. All available clinical records were retrospectively reviewed to assign > or = 1 of the following indications to each study: hydrocephalus, macrocephaly, Chiari malformation, intracranial cyst, screening prior to lumbar puncture, screening for congenital anomalies, trauma, and other. Changes in the distribution of indications over time and clinical experience for each indication were reviewed. RESULTS: The total number of QB imaging studies performed increased each year. The proportion of studies performed for nonhydrocephalic indications also increased (from 23 to 50%). The most common indication was screening for macrocephaly, and all other indications were nearly evenly distributed. Quick-brain MR imaging was used extensively for the initial evaluation and follow-up in patients with little need for additional studies. Its false-negative rate, however, remains unknown. CONCLUSIONS: The role of QB MR imaging for nonhydrocephalic indications is expanding, and it appears promising for a number of screening and surveillance paradigms. "Quick-brain plus" protocols for specific indications may add sensitivity and are under development.

Preoperative functional MR imaging localization of language and motor areas: effect on therapeutic decision making in patients with potentially resectable brain tumors.

PURPOSE: To prospectively evaluate the effect of preoperative functional magnetic resonance (MR) imaging localization of language and motor areas on therapeutic decision making in patients with potentially resectable brain tumors. MATERIALS AND METHODS: The Institutional Review Board approved this HIPAA-compliant study, and each patient gave written informed consent. Thirty-nine consecutive patients (19 male, 20 female; mean age, 42.2 years) referred for functional MR imaging for possible tumor resection were prospectively evaluated. A preoperative diagnosis of brain tumor was made in all patients. Sentence completion and bilateral hand squeeze tasks were used to map language and sensory motor areas. Neurosurgeons completed questionnaires regarding the proposed treatment plan before and after functional MR imaging and after surgery. They also gave confidence ratings for functional MR imaging results and estimated the effect on surgical time, extent of resection, and surgical approach. The effect of functional MR imaging on changes in treatment plan was assessed with the Wilcoxon signed rank test. Differences in confidence ratings between altered and unaltered treatment plans were assessed with the Mann-Whitney U test. The estimated influence of functional MR imaging on surgical time, extent of resection, and surgical approach was denoted with summary statistics. RESULTS: Treatment plans before and after functional MR imaging differed in 19 patients (P < .05), with a more aggressive approach recommended after imaging in 18 patients. There were no significant differences in confidence ratings for functional MR imaging between altered and unaltered plans. Functional MR imaging resulted in reduced surgical time (estimated reduction, 15-60 minutes) in 22 patients who underwent surgery, a more aggressive resection in six, and a smaller craniotomy in two. CONCLUSION: Functional MR imaging enables the selection of a more aggressive therapeutic approach than might otherwise be considered because of functional risk. In certain patients, surgical time may be shortened, the extent of resection increased, and craniotomy size decreased.