Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers.

STUDY DESIGN: Prospective MR analysis of the cervical spine of 30 asymptomatic volunteers. OBJECTIVES: To evaluate the prevalence of annular tears, bulging discs, disc herniations and medullary compression on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images of the cervical spine in symptom free volunteers. SUMMARY OF BACKGROUND DATA: Few studies have reported the prevalence of cervical disc herniations in asymptomatic people, none have reported the prevalence of cervical annular tears on MR images of symptom free volunteers. MATERIALS AND METHODS: Thirty symptom-free volunteers (no history or symptoms related to the cervical spine) were examined using sagittal T2-weighted fast spin-echo (SE), sagittal gadolinium-enhanced T1-weighted SE imaging and axial T2(*)-weighted gradient echo (GRE). The prevalence of bulging discs, focal protrusions, extrusions, nonenhancing or enhancing annular tears and medullary compression were assessed. RESULTS: The prevalence of bulging disk and focal disk protrusions was 73% (22 volunteers) and 50% (15 volunteers), respectively. There was one extrusion (3%). Eleven volunteers had annular tears at one or more levels (37%) and 94% of the annular tears enhanced after contrast injection. Asymptomatic medullary compression was found in four patients (13%). CONCLUSION: Annular tears and focal disk protrusions are frequently found on MR imaging of the cervical spine, with or without contrast enhancement, in asymptomatic population. The extruded disk herniation and medullary compression are unusual findings in a symptom-free population.

Optimization of sequence parameters in fast MR imaging of the brain with FLASH.

Owing to the intrinsically complex behavior of the signal intensity of fast gradient-refocusing MR sequences, agreement as to the clinically most useful sequence parameters has not yet been reached. This study evaluates the FLASH (fast low-angle shot) sequence for gray-white matter differentiation on normal volunteers at 1.5 T. The FLASH gradient-echo sequence is essentially T1-dependent. For very fast imaging and T1 weighting, the following parameters yield the best results: a flip angle of 30-50 degrees with TR = 20 and TE = 10. To replace T1-weighted SE by the faster FLASH sequence, the best results are achieved by a flip angle of 70-120 degrees with TR = 150-300 and TE = 10 (or shorter, if possible). The most valuable proton-density aspect is achieved by a flip angle of 30 degrees with TR = 300 and TE = 16.

Diffusion-weighted MR imaging of intracerebral masses: comparison with conventional MR imaging and histologic findings.

BACKGROUND AND PURPOSE: The purposes of this study were to find the role of diffusion-weighted MR imaging in characterizing intracerebral masses and to find a correlation, if any, between the different parameters of diffusion-weighted imaging and histologic analysis of tumors. The usefulness of diffusion-weighted imaging and apparent diffusion coefficient (ADC) maps in tumor delineation was evaluated. Contrast with white matter and ADC values for tumor components with available histology were also evaluated. METHODS: Twenty patients with clinical and routine MR imaging/CT evidence of intracerebral neoplasm were examined with routine MR imaging and echo-planar diffusion-weighted imaging. The routine MR imaging included at least the axial T2-weighted fast spin-echo and axial T1-weighted spin-echo sequences before and after contrast enhancement. The diffusion-weighted imaging included an echo-planar spin-echo sequence with three b values (0, 300, and 1200 s/mm(2)), sensitizing gradient in the z direction, and calculated ADC maps. The visual comparison of routine MR images with diffusion-weighted images for tumor delineation was performed as was the statistical analysis of quantitative diffusion-weighted imaging parameters with histologic evaluation. RESULTS: For tumors, the diffusion-weighted images and ADC maps of gliomas were less useful than the T2-weighted spin-echo and contrast-enhanced T1-weighted spin-echo images in definition of tumor boundaries. Additionally, in six cases of gliomas, neither T2-weighted spin-echo nor diffusion-weighted images were able to show a boundary between tumor and edema, which was present on contrast-enhanced T1-weighted and/or perfusion echo-planar images. The ADC values of solid gliomas, metastases, and meningioma were in the same range. In two cases of lymphomas, there was a good contrast with white matter, with strongly reduced ADC values. For infection, the highest contrast on diffusion-weighted images and lowest ADC values were observed in association with inflammatory granuloma and abscess. CONCLUSION: Contrary to the findings of previous studies, we found no clear advantage of diffusion-weighted echo-planar imaging in the evaluation of tumor extension. The contrast between gliomas, metastases, meningioma, and white matter was generally lower on diffusion-weighted images and ADC maps compared with conventional MR imaging. Unlike gliomas, the two cases of lymphomas showed hyperintense signal on diffusion-weighted images whereas the case of cerebral abscess showed the highest contrast on diffusion-weighted images with very low ADC values. Further study is required to find out whether this may be useful in the differentiation of gliomas and metastasis from lymphoma and abscess.

Actual trends in diagnosis/thrombolytic therapy of acute cerebral stroke.

The recent reports confirm the idea that the selection of cerebral stroke patients for thrombolysis should be performed by MRI. These studies suggested that DWI/PWI/MRA may be able to identify patients who are most likely to benefit from thrombolytics, and that the PWI>DWI pattern in particular is associated with an improved outcome from thrombolytic therapy. However, many questions remain unanswered and a lot of work is necessary before MRI guided thrombolysis in acute cerebral stroke becomes a part of the standard care.

Diagnosis of herniated nucleus pulposus by digital spinal phlebography with false negative CT and/or radiculosaccography.

Saccoradiculography, spinal phlebography or NMR can be performed in cases of discrepancy between CT and clinical symptoms. We believe that the introduction of DSA must generate a renewed interest in spinal phlebography for cases with radicular syndrome and normal CT.

CT-assisted chemonucleolysis.

The safety and success rate of chemonucleolysis are largely dependent on correct needle insertion. The neurological complications of chemonucleolysis are related to inadvertent puncture of the dura, nerve root and/or spinal nerve. To avoid this complication, a puncture angle of 50 degrees to 60 degrees above the sagittal plane is widely recommended (1). Our CT study of the location of the spinal nerve L4-L5 and L5-S1 demonstrates a great variability of this location and also explains some of the possible hazards of 50 degrees to 60 degrees puncture (2). The CT-evaluation of the relationship between the nerve root, spinal nerve and apophyseal joint with respect to the puncture angle is suitable. In our experience, this method is helpful for fast, safe and easy insertion of the needle.

[Superselective cerebral embolization of an arteriovenous malformation in the temporal lobe following partial neurosurgical resection]. / Superselectieve cerebrale embolisatie van een arterioveneuze malformatie in de temporale lob na partiële neurochirurgische resectie.

We report a case of cerebral embolization of an arteriovenous malformation in the temporal lobe after partial neurosurgical resection. The lesion consisted of two compartments of which only the lateral part with combined large hematoma was resected. The medial compartment was treated by superselective embolization using a microcatheter and polyvinyl alcohol particles. Because of his psychiatric condition, general anaesthesia was used in this young male.

Intracranial tumors examined by intraarterial DSA: a comparative angiography study.

We compared intraarterial digital subtraction angiography (DSA) studies with those of conventional angiography, performed for 24 patients who had intracranial tumors. Intraarterial DSA is more effective in evaluating tumoral blush and venous phase, but neovascularization can be judged better by conventional angiography. In most cases, intraarterial DSA can replace conventional angiography for the diagnostic and preoperative evaluation of intracranial tumors. However, conventional angiography remains the technique of choice for the evaluation of neovascularization or if the patient is not cooperative.

Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica.

PURPOSE: To evaluate the prevalence and radiologic findings of annular tear (especially of contrast material enhancement), bulging disk, and disk herniation on T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images in people without low back pain (LBP) or sciatica. MATERIALS AND METHODS: Thirty-six volunteers without LBP and/or sciatica (18 with no symptoms in their lifetime and 18 who were pain free for at least 6 months) were examined with sagittal and axial T2-weighted fast spin-echo (SE) and sagittal gadolinium-enhanced T1-weighted fast SE imaging. The prevalence and MR findings of bulging disk, focal protrusion, extrusion, and nonenhancing or enhancing annular tears were assessed. RESULTS: The prevalence of bulging disk and focal disk protrusion was 81% (29 volunteers) and 33% (12 volunteers), respectively. There were no extrusions. Twenty-eight annular tears were found in 20 patients (56%); 27 tears (96%) also showed contrast enhancement. CONCLUSION: Annular tears and focal disk protrusions on MR images, with or without contrast enhancement, are frequently found in an asymptomatic population. Extruded disk herniation, displacement of nerve root, and interruption of annuloligamentous complex are unusual findings in an asymptomatic population and can be more closely related to patients with LBP or sciatica.