Cerebrospinal fluid signal loss sign: assessment of a new radiological sign in lumbar spinal stenosis.

PURPOSE: Sedimentation sign was reported to have high sensitivity and specificity for diagnosis of lumbar spinal stenosis (LSS). We aimed to determine cerebrospinal fluid signal loss (CSFSL) at the intervertebral disc levels in the sagittal plane using a numerical scoring system and to evaluate the diagnostic value of this method in differential diagnosis of LSS and non-specific low back pain (LBP) and compare it with SS. MATERIALS AND METHODS: We included consecutive patients between 50 and 80 years old, with lumbar spinal MRI examination in our institution. These patients were divided into two groups as LSS and LBP, according to symptoms and radiological findings. CSFSL sign was evaluated for both groups by two radiologists independently, using MR images. Sensitivity and specificity of both signs were calculated. RESULTS: A total of 406 patients (98 LSS and 308 non-specific LBP) were included. SS and CSFSL sign had a sensitivity of 90.8% and 82.7% and specificity of 75.4% and 84.1% in the whole cohort, respectively. When patients were grouped by dural sac cross-sectional areas (CSA), sensitivity and specificity of SS were 100% and 4.4%, 87.5% and 31.8%, and 41.7% and 76%, respectively, and sensitivity and specificity of CSFSL sign were 95.7% and 11.1%, 75% and 77.3%, and 16.7 and 92% for severe (CSA < 80 mm2), moderate (CSA: 80-100 mm2), mild (CSA: 100-120 mm2) radiologic stenosis, respectively. In moderate stenosis, accuracies of SS and CSFSL sign were 76.3% and 55.3%, respectively. CONCLUSION: CSFSL sign might be used to distinguish LSS from LBP and unlike SS it is successful in moderate stenosis.

Assessment of Postoperative Tendon Quality in Patients With Achilles Tendon Rupture Using Diffusion Tensor Imaging and Tendon Fiber Tracking.

Although pre- and postoperative imaging of Achilles tendon rupture (ATR) has been well documented, radiographic evaluations of postoperative intratendinous healing and microstructure are still lacking. Diffusion tensor imaging (DTI) is an innovative technique that offers a noninvasive method for describing the microstructure characteristics and organization of tissues. DTI was used in the present study for quantitative assessment of fiber continuity postoperatively in patients with acute ATR. The data from 16 patients with ATR from 2005 to 2012 were retrospectively analyzed. The microstructure of ART was evaluated using tendon fiber tracking, tendon continuity, fractional anisotropy, and apparent diffusion coefficient values by way of DTI. The distal and proximal portions were measured separately in both the ruptured and the healthy extremities of each patient. The mean patient age was 41.56 ± 8.49 (range 26 to 56) years. The median duration of follow-up was 21 (range 6 to 80) months. The tendon fractional anisotropy values of the ruptured Achilles tendon were significantly lower statistically than those of the normal side (p = .001). However, none of the differences between the 2 groups with respect to the distal and proximal apparent diffusion coefficient were statistically significant (p = .358 and p = .899, respectively). In addition, the fractional anisotropy and apparent diffusion coefficient measurements were not significantly different in the proximal and distal regions of the ruptured tendons compared with the healthy tendons. The present study used DTI and fiber tracking to demonstrate the radiologic properties of postoperative Achilles tendons with respect to trajectory and tendinous fiber continuity. Quantifying DTI and fiber tractography offers an innovative and effective tool that might be able to detect microstructural abnormalities not appreciable using conventional radiologic techniques.

[The prevalence of low back pain and risk factors among adult population in Afyon region, Turkey]. / Afyonkarahisar ilinde eriskinlerde bel agrisi sikligi ve etkileyen faktörler.

OBJECTIVES: This study was designed to determine the prevalence of and risk factors for low back pain (LBP) in a sample of Turkish population among adults living in the Afyon region, Turkey. METHODS: A field screening investigation was performed in a total of 75 areas including the city center, 18 districts, and 57 associated small municipalities. Adequate sample size was determined as 1,990 and a total of 2,035 individuals (1,194 females, 841 males) were enrolled. Participants were inquired about age, occupation, sex, height, weight, history of LBP, hypertension, diabetes, and smoking. Depression symptoms were evaluated using the Symptom Checklist-90-Revised. RESULTS: The prevalence of lifetime LBP was 51%, and the prevalence of chronic LBP was 13.1%. Overall, 63.2% of women and 33.8% of men had LBP at least once in their lives (p=0.001). With regard to occupation, the highest incidence of LBP was seen in housewives (64.2%; p=0.0001), whose age and body mass index (BMI) were also higher compared to employed women. Depression (p=0.016) and increased BMI (p=0.000) were found to increase the risk for LBP, whereas smoking, hypertension, or diabetes were not correlated with the prevalence of LBP. Poverty was found to be the leading cause (39.7%) for not presenting to a physician. CONCLUSION: Among risk factors reported for LBP, many are also effective in Turkish population. Special attention should be given to the education of housewives in terms of low back protection, healthy nutrition, and family planning. Poverty seems to be a significant barrier to patient presentation to physicians, requiring extended social security coverage.