General Spine

Fernanda, Rueda Lopes, medical doctor
Costa, A, Joao vitor, technician, Non ASSR Member
Fernanda, Miraldi, MD student, Non ASSR Member
Romeu, C, Domingues, MD, Non ASSR Member
Meng, Law, MD,PhD, Non ASSR Member
Emerson, L, Gasparetto, MD,PhD, Non ASSR Member

Poster

Purpose

Multiple sclerosis (MS)and neuromyelitis optica (NO) are both demyelinating diseases,with spinal cord damage. Although conventional MRI lesion pattern is different between both of them, the WM damage extension is not clear. The aim is to evaluate NAWM damage pattern in NMO and MS patients using diffusion tensor MR imaging.

Methods & Materials

We compared 17 patients with RRMS and 8 patients with NMO (sex and age matched), including patients with and without sensorial symptoms.MR imaging of the cervical spinal cord was conducted on a 1.5 MR scanner (Siemens, Avanto). Fractional anisotropy (FA)and radial diffusivity (RD) were calculated within regions of interest (ROIs) at the C2 level. The ROIâ

General Spine

Raghid, Kikano, MD
Christopher, Buckle, MD, Non ASSR Member
Colin, Poon, Non ASSR Member
Jessie, Aw, Non ASSR Member
Said, Mojtahedi, Non ASSR Member

Poster

Purpose

Magnetic resonance imaging is the method of choice for the evaluation of brachial plexus pathology. In this pictorial exhibit, we will review technical aspects of brachial plexus MRI as well as MR anatomy and pathology of the brachial plexus. High-resolution imaging with well defined protocols is necessary for technical success, and basic sequence parameters will be discussed. The anatomy of the brachial plexus roots, trunks, divisions and cords is well depicted due to inherent contrast differences between nerves and the surrounding fat, a feature that will be illustrated in the exhibit through interactive labels. The following pathology, with imaging examples, will be also be addressed: neurogenic tumors of the brachial plexus and sympathetic chain, superior sulcus tumor, other tumors in the vicinity of the brachial plexus, the differentiation between radiation and metastatic plexopathy, trauma, neurogenic thoracic outlet syndrome and immune-mediated neuropathies.

References/Financial Disclosures

No Financial Disclosure

General Spine

Fernanda, Rueda Lopes, medical doctor
Fernanda, Miraldi, MD student, Non ASSR Member
Costa, A, Joao vitor, technician, Non ASSR Member
Romeu, C, Domingues, medical doctor, Non ASSR Member
Meng, Law, MD, PhD, Non ASSR Member
Emerson, L, Gasparetto, MD, PhD, Non ASSR Member

Poster

Purpose

Cervical spinal cord damage is quite common in Multiple sclerosis (MS). Although classical lesions are recognized as T2 hyperintensities, the normal appearing white matter damage (NAWM) is not well understood. Sensorial symptoms are the most common neurological manifestations in MS,but not always their existence is expalined by cervical spinal cord lesions. The aim of this study is to evaluate the correlation between sensory symptoms and NAWM damage using diffusion tensor MR imaging.

Methods & Materials

We compared 17 patients with MS (12 female and 5 male, mean age 36.5 years-old)including 9 patients with sensorial symptoms and 8 without any neurological symptom. MR imaging of the cervical spinal cord was conducted on a 1.5 MR scanner (Siemens, Avanto), including T2-WI and DTI images. Fractional anisotropy (FA), was calculated within regions of interest (ROIs) at the C2 level. The ROIâ

Interventional Spine

Lex, A, Mitchell, MD
Thomas, M, Pulling, MD, Non ASSR Member
Timothy, J, Biega, MD, Non ASSR Member

Poster

Purpose

Review common spinal procedures as well as their potential complications.

Methods & Materials

Retrospective review of imaging studies was performed in adult patients who presented for post operative follow up of a prior spine intervention. Cases depicted include pathologic fluid collections, infections, fractures, hardware complications and unexpected cement migration.

Results

Multiple spinal procedures occur daily in the United States. Though the majority of these occur without incident, a small percentage will result in a significant complication. A thorough understanding of potential complications allows for appropriate triage of requests and helps determine which imaging study best answers the diagnosis in question.

Conclusion

Spinal procedure complications fall into a limited number of categories and may be easily recognized with diagnostic imaging.

References/Financial Disclosures

No financial disclosures

General Spine

Sedat, Alibek, MD
Hubertus, Gloger, MD, Non ASSR Member

Poster

Purpose

To study the value of a 3D GRE sequence in comparison to conventional cervical spine MR with special focus on detectability of pathology and scan time

Methods & Materials

IRB approved study, written informed patient consent available. A total of 18 patients were scanned on 1.5T MR scanner (HDXT, GE Medical) with sequence protocol approved by medical authorities/insurance companies including sag T2 FSE/T1SE, cor T2 STIR, ax 2D GRE (MEDIC, 3 mm slice thickness) and additionally 3D GRE (COSMIC, slice thickness: 1 mm) was performed. Images were reviewed retrospectively by two radiologists in consensus, both blinded for patient history with the question of detectability of pathology. 2D sequences were reviewed with a standard DICOM viewer, 3D COSMIC was reviewed on a 3D DICOM viewer in MPR-mode, interactively.

Results

All MR sequences were performed successfully without artefacts which lead to repetition of sequences or complete exam. A total of 14 (77.8%) disc protrusions, 6 (33.3%) dorsal displacement of anterior dura, 3 (16.7%) disc extrusions, 3 (16.7%) unilateral neuroforaminal stenosis, 2 (11.1%) syrinx was found. Mean imaging time was 12 min 15 s for c-spine, while 2 min 25 s was necessary for 3D COSMIC sequence. Regarding comparison of 3D COSMIC vs. conventional 2D MR sequences, all reported pathology was detected by readers in both sequences (n=28, 100%).

Conclusion

3D GRE sequence (i.e. COSMIC) seems to be technically feasible for use within a routine c-spine scan protocol, detection rates of pathology is equal to conventional 2D sequences in our series.
If medical authorities (esp. local insurance companies) accepted the use of this sequence and MPR images, conventinal 2D sequences could be replaced by 3D COSMIC sequence and exam time could be saved without penalty in detection rates of pathology.
Further studies with special focus on quantitative assessment (e.g. SNR/CNR) with greater number of patients should be performed to confirm clinical value of initial results.

Interventional Spine

Bartlomiej, Urbanski, Medical Student
Jaroslaw, Andrychowski, MD, PhD, Non ASSR Member
Marcin, Majewski, Medical Student, Non ASSR Member
Zbigniew, Czernicki, MD, PhD, Prof, Non ASSR Member

Poster

Purpose

Fractures of the vertebral column are one of the most common complications of osteoporosis. Percutaneous vertebroplasty is a minimally invasive technique applying for the relief of pain and for the strengthening of bone in vertebral body lesions. Bone cement is injected into the fractured vertebra through a needle. Complication after injection such as pulmonary emboli may occur when the cement leaks into the veins. The authors aimed to describe the anatomy of the vertebral and paravertebral venous system and to establish its clinical implications, in order to better understand and anticipate complications that are related to the application of vertebroplasty.

Methods & Materials

20 patients from the Department of Neurosurgery were included in the study. All patients underwent contrast-enhanced MR venography (CE-MRV). Patients were imaged in the supine position. Imaging was performed without breath-hold. MR images were evaluated in consensus by three observers. All available MR images were scrutinized for the presence of venous structures.

Results

The lumbar venous system was subdivided into two main vascular systems â

Interventional Spine

Bryan, A, Pukenas, MD
Gaurav, Jindal, MD, Non ASSR Member
Robert, W, Hurst, MD, Non ASSR Member

Poster

Purpose

Kyphoplasty and vertebroplasty for treatment of osteoporotic compression fractures is well described in the literature. Although there is controversy regarding efficacy of these procedures, studies show that when performed in a timely manner, patients usually experience significant pain relief,1and the use of high viscosity cement results in decreased complications due to cement leakage.2 A unipedicular approach decreases procedure time, operator radiation exposure, and cost.3 We describe our initial experience with the StabiliT (Dfine, San Jose, CA) vertebral augmentation system.

Methods & Materials

4 patients with acute (less than 6 weeks old) osteoporotic compression fractures were treated with the StabiliT ultra high viscosity radiofrequency (RF) vertebral augmentation system. Assessment of pain was performed using the visual analog scale (VAS) performed during the preprocedure office visit and via telephone at day 3. A unipedicular approach was used for all patients. In some cases, intra-procedural DynaCT was performed for further evaluation. Procedure time and procedural radiation exposure was not measured during this initial experience. In 3 patients one level was treated, one patient had 3 levels treated, for a total of 6 vertebral levels. In one patient, cement encroachment on the inferior endplate was noted. Due to the prolonged working time of the cement, the cement introducer cannula was removed from the patient for approximately 5 minutes, allowing the interbody cement to cure. Cement was again deployed after the cannula was repositioned in the vertebral body with an excellent result.

Results

Three patients experienced significant reduction in pain by day 3. Although patient 2 only experienced a 3 point reduction in the VAS, she inadvertently failed to continue on her oral pain medication regimen. There was one asymptomatic cement disc extravasation. Radiation exposure was not measured, but the manufacturer provided tubing allowed the operator to stand at least 6 feet from the X-ray source for all procedures.

Conclusion

Unipedicular RF vertebral augmentation using ultra high viscosity cement is technically feasible and safe. All patients had decreased VAS scores at 3 days. The asymptomatic disc extravastion was likely secondary to over-aggressive cement deployment and operator inexperience with the ultra high viscosity cement flow dynamics. The unipedicular approach may potentially reduce procedure time, and operator and patient radiation exposure.

References/Financial Disclosures

1. Klazen CA, Lohle PN, de Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. Sep 25 2010;376(9746):1085-1092.
2. Rapan S, Jovanovic S, Gulan G, Boschi V, Kolarevic V, Dapic T. Vertebroplasty–high viscosity cement versus low viscosity cement. Coll Antropol. Sep 2010;34(3):1063-1067.
3. Papadopoulos EC, Edobor-Osula F, Gardner MJ, Shindle MK, Lane JM. Unipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: early results. J Spinal Disord Tech. Dec 2008;21(8):589-59

No Financial Disclosures

General Spine

Karuna, V, Shekdar, MD
Tamara, Feygin, MD, Non ASSR Member
Erin, Schwartz, MD, Non ASSR Member
Robert, A, Zimmerman, MD, Non ASSR Member

Poster

Purpose

To demonstrate utility of diffusion-weighted imaging in characterization of a wide spectrum of pediatric spine pathology

Methods & Materials

Cases for this study were retrospectively selected from pediatric patient population who had undergone spine imaging, at our institute, from June 2005 to June 2010. Imaging was performed on either 1.5 or 3 T Siemens magnet. Diffusion-weighted (DW) MR imaging with apparent diffusion coefficient (ADC) maps, were included in addition to routine sequences. Examples of different pathologies have been selected from these cases demonstrating restricted diffusion.

Results

Several lesions of varying etiologies demonstrated restricted water diffusion. They could be more specifically characterized into the following categories:
A)Cytotoxic edema: seen in acute spinal cord ischemia/infarct; B)Infections: Pus collections as seen in sub-dural empyemas; C)Acute inflammatory and demyelinating conditions; D)Neoplastic lesions: Benign-epidermal inclusion cysts and Malignant-either primary or secondary, small round blue cell tumors, neuroblastoma among others;
E)Neuro-toxic complication of chemotherapy; F)Marrow disorders: infective and neoplastic

Lack of restricted diffusion and facilitated diffusion in some cases proved useful in providing valuable information impacting immediate patient management.

Images of above mentioned pathology will be illustrated in our exhibit.

Conclusion

Diffusion- weighted imaging is a powerful tool in the diagnosis of a wide spectrum of pathologic entities which occur in the pediatric spine. Appreciation of restricted versus facilitated water motion on diffusion weighted imaging increases diagnostic accuracy and in some cases helps prediction of histology.

References/Financial Disclosures

Nothing to disclose

General Spine

Sedat, Alibek, MD
Hubertus, Gloger, MD, Non ASSR Member

Poster

Purpose

To study the value of a 3D T2w MR sequence in comparison to 2D T2w sequence for cervical/lumbar spine MRI with special focus on detectability of pathology and scan time.

Methods & Materials

IRB approved study, written informed patient consent available. A total of 30 patients (15 c-spine, 15 l-spine) were scanned on 1.5T MR scanner (HDXT, GE Medical) with sequence protocol approved by medical authorities/insurance companies (c-spine: sag T2 FSE/T1SE, tra T2*, cor T2 STIR; l-spine: sag T2 FSE/T1SE, tra T2FSE, cor T2 STIR) and additionally a sagittal 3D Cube (slice thickness: 1 mm) for c-/l-spine) was performed.
Images were reviewed retrospectively by two radiologists in consensus, both blinded for patient history with the question of detectability of pathology. 2D sequences were reviewed with a 2D DICOM viewer, the 3D Cube was reviewed on a 3D DICOM viewer in MPR-mode, interactively.

Results

All MR sequences were performed successfully without artefacts which lead to repetition of sequences or the complete exam. In l-spine exams n=6 (40%) disc protrusions, n=4 (26.7%) disc extrusions, n=1 (6,7%) stenosis of unilateral neuroforamen was found. In c-spin exams n=10 (66,7%) disc protrusions, n=1 (6,7%) disc extrusion, n=1 unilateral neuroforaminal stenosis, n=1 syrinx, n=1 dorsal displacement of anterior dura was found. Mean imaging time was 12 min 35 s for c-spine, while 3 min 37 s was necessary for 3D Cube sequence and 9 min 45 s for l-spine, while 4 min 41 s was needed for 3D Cube sequence. Regarding comparison of 3D Cube vs. T2/T1w imaging, all reported pathology was detected by readears in conventional as well as 3D sequence (n=25, 100%).

Conclusion

3D Cube sequence seems to be feasible technically for use within a routine c-/l-spine scan protocol, detection rates of pathology is equal to conventional MR sequences in our series.
If medical authorities (esp. local insurance companies) accepted the use of this sequence and MPR images, e.g. T2w sag/tra sequence could be replaced by 3D sequence, exam time could be saved without penalty in image quality. Further studies with special focus on quantitative assessment (e.g. SNR/CNR) with greater number of patients should be performed to confirm clinical value of initial results.

General Spine

Christopher, A, Kidd, B. Eng
Rachael, L, Bosma, B. Sc, Non ASSR Member
Patrick, W, Stroman, Ph.D, Non ASSR Member

Poster

Purpose

Spinal cord functional magnetic resonance imaging (spinal fMRI) is the only non-invasive, in vivo means available to assess neuronal changes that occur as a result of injury. However, in order to achieve its clinical potential, characterization of the fMRI response in healthy subjects is needed to demonstrate the sensitivity and reliability of this technique. Previous studies have shown spinal fMRI capable of detecting a signal response corresponding to peripheral heating stimuli.1,2 More importantly, recent studies have indicated that the signal is correlated with the change in temperature, as opposed to the constant heat. Here we demonstrate the effects of changing the heating stimuli parameters on the functional responses in the spinal cord to determine the sensitivity of our method. We hypothesized that there would be a neuronal response corresponding to rising/falling of temperature with significantly stronger responses occurring in response to faster ramping stimuli, than slower heating stimuli.

Methods & Materials

Functional MRI studies of the spinal cord were acquired in healthy subjects using a signal enhancement by extravascular water protons (SEEP) fMRI protocol.1,2 To examine the neuronal activity thermal stimulation was applied in a block paradigm by means of a custom-made device to the anterior side of the right thumb targeting the C6 dermatome at a constant temperature of 44°C. Studies were conducted by applying stimuli with varying ramp speeds (2 or 9 sec), and durations (45 or 72 sec).

Results

Group analysis from all the participants was completed for each of the different stimulus protocols, with results showing areas of consistent neuronal activity appearing in the target activation region. As expected, stronger positive signal responses occurred when the shorter ramps were a part of the stimulus protocol. This effect is even greater when examining protocols that incorporate shorter ramps for heating compared to having brief cooling ramps. In contrast, when longer ramp speeds are applied for the heating there is a notable increase in negative responses.

Conclusion

The results demonstrate that with this method it is possible to detect differences in activity in the spinal cord in response to various varying stimuli. This has implications for the development of a practical clinical method for assessing spinal cord function by means of spinal fMRI.

References/Financial Disclosures

References
1. C.R. Figley and P.W. Stroman, Neuroimage, 44(2), 421(2009)
2. P. W. Stroman, et al., Magn Reson. Imaging 20(1), 1 (2002)