RESUMEN
This study revealed the change in the paravertebral muscles in patients with osteoporotic vertebral fracture. Increased pain is likely to be the driver for reduced activity, reduced activities of daily living, and consequent increase in fat infiltration of the paravertebral muscles, assumed to be secondary to reduced activity level or, conversely, partial immobilization. INTRODUCTION: To reveal the time courses and impact of the paravertebral muscles (PVMs) on the healing process of osteoporotic vertebral fractures and risk factors for PVM decrease. METHODS: Consecutive patients with symptomatic osteoporotic vertebral fractures were enrolled in 11 hospitals. At enrollment and 3- and 6-month follow-up, PVMs, including the multifidus and erector spinae, were examined using magnetic resonance imaging (MRI). The PVM cross-sectional area (CSA) and fat signal fraction (FSF) were measured at L3. Low back pain (LBP), activities of daily living (ADLs), and risk factors for PVM decrease at the 6-month follow-up were investigated. PVM decrease was defined as > 1 standard deviation decrease of the CSA or > 1 standard deviation increase of the FSF. RESULTS: Among 153 patients who completed the 6-month follow-up, 117 (92 women, 79%) had MRI of L3 at enrollment and 3- and 6-month follow-up (mean age at enrollment, 78.5 years). The CSA did not change 6 months from onset (p for trend = 0.634), whereas the FSF significantly increased (p for trend = 0.033). PVM decrease was observed in 30 patients (26%). LBP was more severe, and delayed union was more frequent in patients with PVM decrease (p = 0.021 mixed-effect model and p = 0.029 chi-square test, respectively). The risk factors for PVM decrease were ADL decline at the 3-month follow-up (adjusted odds ratio = 5.35, p = 0.026). CONCLUSION: PVM decrease was significantly related to LBP and delayed union after osteoporotic vertebral fracture onset. ADL decline at the 3-month follow-up was a risk factor for PVM decrease. Therefore, restoring ADLs within 3 months after onset is important.
Asunto(s)
Actividades Cotidianas , Músculos de la Espalda/fisiopatología , Dolor de la Región Lumbar , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Anciano , Femenino , Humanos , Dolor de la Región Lumbar/etiología , Imagen por Resonancia Magnética , Masculino , Fracturas Osteoporóticas/complicaciones , Fracturas Osteoporóticas/fisiopatología , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/fisiopatologíaRESUMEN
This study revealed the time course of osteoporotic vertebral fracture by magnetic resonance imaging using a simple classification. Signal changes were associated with the compression degree and mobility of the fractured vertebral body. This classification showed sufficient reliability in categorizing magnetic resonance imaging findings of osteoporotic vertebral fractures. INTRODUCTION: Magnetic resonance imaging (MRI) is useful in diagnosing osteoporotic vertebral fractures (OVFs). This study investigated the time course of OVFs by MRI using a simple classification. METHODS: This multicenter cohort study was performed from 2012 to 2015. Consecutive patients with ≤2-week-old OVFs were enrolled in 11 institutions. MRI was performed at enrollment and at 1-, 3-, 6-, and 12-month follow-up. Signal changes on T1-weighted imaging (T1WI), T2WI, and short τ inversion recovery (STIR) were classified according to signal intensity. Height and angular motion of vertebral bodies were also measured. RESULTS: The 6-month follow-up was completed by 153 patients. At enrollment, fractured vertebrae signal changes were 43 % diffuse and 57 % confined low on T1WI; on T2WI, 56, 24, and 5 % were confined low, high, and diffuse low, respectively; on STIR, 100 % were high. On T1WI, diffuse low remained most common (90 % at 1 month and 60 % at 3 months) until 6 and 12 months, when most were confined low (54 and 52 %, respectively). On T2WI, confined low remained most common (decreasing to 41 % at 12 months). On STIR, high signal change was shown in 98, 87, and 64 % at 3, 6, and 12 months, respectively. At 3, 6, and 12 months, diffuse low signal change was associated with significantly lower vertebral height, and high signal change was associated with significantly greater angular motion. CONCLUSIONS: MRI signal changes were associated with the compression degree and angular motion of fractured vertebrae. This classification showed sufficient reliability in categorizing MRI findings of OVFs.
Asunto(s)
Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas de la Columna Vertebral/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Curación de Fractura , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Variaciones Dependientes del Observador , Fracturas Osteoporóticas/patología , Pronóstico , Estudios Prospectivos , Reproducibilidad de los Resultados , Fracturas de la Columna Vertebral/patologíaRESUMEN
This study demonstrated the predictive values of radiological findings for delayed union after osteoporotic vertebral fractures (OVFs). High-signal changes on T2WI were useful findings. INTRODUCTION: The purpose of the present study is to determine predictive radiological findings for delayed union by magnetic resonance imaging (MRI) and plain X-rays at two time points in the acute phase of OVFs. METHODS: This multicenter cohort study was performed from 2012 to 2015. A total of 218 consecutive patients with OVFs ≤2 weeks old were enrolled. MRIs and plain X-rays were performed at the time of enrollment and at 1- and 6-month follow-ups. Signal changes on T1-weighted imaging (T1WI) were classified as diffuse low-, confined low-, or no-signal change; those on T2WI were classified as high (similar to the intensity of cerebrospinal fluid), confined low-, diffuse low-, or no-signal change. The angular motion of the fractured vertebral body was measured with X-rays. RESULTS: A total of 153 patients completed the 6-month follow-up. A high-signal change on T2WI was most useful in predicting delayed union. Sensitivity, specificity, and positive predictive values were 53.3, 87.8, and 51.6 % at enrollment and 65.5, 84.8, and 51.4 % at the 1-month follow-up, respectively. The positive predictive value increased to 62.5 % with observation of high- or diffuse low-signal changes at both enrollment and the 1-month follow-up. The cutoff value of vertebral motion was 5 degrees. Sensitivity and specificity at enrollment were 52.4 and 74.1 %, respectively. CONCLUSIONS: This study demonstrated the radiological factors predicting delayed union after an OVF. T2 high-signal changes showed the strongest association with delayed union. Consecutive MRIs were particularly useful as a differential tool to predict delayed union following OVFs.
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Fracturas no Consolidadas/diagnóstico por imagen , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas de la Columna Vertebral/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Fracturas no Consolidadas/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Valor Predictivo de las Pruebas , Radiografía , Sensibilidad y Especificidad , Fracturas de la Columna Vertebral/patología , Columna VertebralRESUMEN
We studied a patient with atypical multiple sclerosis (MS) using high field magnetic resonance image scanning and documented the evolution of the lesions from the acute phase to clinical remission. The acute lesions showed the clear concentric structure that is characteristic of Balo's concentric sclerosis on magnetic resonance imaging (MRI). Lesions were enhanced with gadolinium-DTPA (Gd-DTPA). Over a four-month period, the patient recovered clinically, with some evidence of residual intellectual impairment, and the MRI lesions regressed markedly, leaving hypointense areas on T1-weighted images in the corona radiata.
Asunto(s)
Encéfalo/patología , Imagen por Resonancia Magnética , Esclerosis Múltiple/diagnóstico , Adulto , Humanos , MasculinoAsunto(s)
Errores Innatos del Metabolismo de los Aminoácidos/enzimología , Ácidos Aminoisobutíricos/orina , Hígado/enzimología , Transaminasas/metabolismo , Adolescente , Adulto , Alelos , Errores Innatos del Metabolismo de los Aminoácidos/metabolismo , Ácidos Aminoisobutíricos/metabolismo , Animales , Autopsia , Isótopos de Carbono , Cicloserina/farmacología , Femenino , Genes Recesivos , Glioxilatos/metabolismo , Homocigoto , Humanos , Masculino , Persona de Mediana Edad , Piruvatos/metabolismo , Ratas , Transaminasas/antagonistas & inhibidores , Transaminasas/aislamiento & purificaciónRESUMEN
Benign notochordal cell tumours have recently been described as intraosseous benign lesions of notochordal cell origin. The lesions are found in vertebral bodies in 20% of autopsy studies and are a potential precursor of chordoma. We report a rare case of lumbar vertebral chordoma that was thought to arise from a benign intraosseous notochordal cell tumour and which showed significant osteosclerotic change. Radiologically, the lumbar vertebral mass lesion showed hyperintensity on T2 weighted images, with scanty enhancement on post-contrast T1 weighted MR images. High uptake corresponding to the mass was noted on fluorine-18-fluorodeoxyglucose positron emission tomography. Bone biopsy revealed proliferation of the physaliphorous cells between thickened bone trabeculae; no nuclear mitosis was observed. Although the mass was diagnosed clinically as spinal chordoma, histopathology contained both benign notochordal cell tumour and conventional chordoma. After heavy particle (11C)-charged radiation therapy was applied to the lesion with a sufficient radiation field margin, the tumour volume significantly decreased and there was improvement in the patient's symptoms. On follow-up radiological studies, the tumour had markedly regressed and there was no tumour regrowth or distant metastasis. In this case report, benign notochordal cell tumour and conventional chordoma are histopathologically identified in the L1 vertebral body, which contains osteosclerotic and osteolytic areas. It is suggested that the benign notochordal cell tumour coexists with a conventional chordoma and that this histopathological finding supports a hypothetical relationship between benign notochordal cell tumour and chordoma.
Asunto(s)
Cordoma/diagnóstico , Vértebras Lumbares , Notocorda , Neoplasias de la Columna Vertebral/diagnóstico , Cordoma/patología , Cordoma/radioterapia , Femenino , Fluorodesoxiglucosa F18 , Humanos , Hallazgos Incidentales , Vértebras Lumbares/patología , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Notocorda/patología , Tomografía de Emisión de Positrones/métodos , Pronóstico , Radiofármacos , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/radioterapia , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Neurotic symptoms were considered to be present in 21.9% of the 210 employees of a company following data analysis from a General Health Questionnaire (GHQ, 60 question items). The results in middle-aged and aged executives were compared. The total GHQ score was > or = 17 in 18/55 executives aged 40 years or above, but in only 9/60 non-executives controls was a significant difference observed (P < 0.05) between executives and non-executives. The scores for three subordinate scales, namely somatic symptoms, anxiety and insomnia, and social dysfunction, were higher in the executives than in the non-executives and showed a significant difference (P < 0.05) in the anxiety and insomnia scale. These results suggest that middle-aged and aged executives are more likely to have neurotic symptoms and more frequently to have anxiety and insomnia than their controls. We would like to apply this method to aid in the prevention, early detection and early management of stress.
Asunto(s)
Personal Administrativo/psicología , Trastornos Mentales/diagnóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Estrés Psicológico/diagnóstico , Anciano , Trastornos de Ansiedad/diagnóstico , Empleo , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Inicio y del Mantenimiento del Sueño/diagnóstico , Encuestas y CuestionariosRESUMEN
A patient with atypical multiple sclerosis (MS) with clear concentric structure was studied using high field magnetic resonance imaging (MRI). This case was considered to be Baló's concentric sclerosis. Magnetic resonance imaging showed diffuse multiple concentric demyelinating lesions in the bilateral centrum semiovales, which finally regressed with the necrotic lesions remaining when the patient was discharged. During his clinical course, he showed some higher cerebral dysfunctions, such as memory disturbance, constructual apraxia and acalculia. He was treated with glycerin, prednisone and rehabilitation; all of which were effective in his recovery. Over a 4 month period, the patient recovered clinically, but some intellectual impairment remained.