Degenerative marrow (modic) changes on cervical spine MRI scans: prevalence, inter- and intra-examiner reliability and link to disc herniation

ABSTRACT: Study Design. A prevalence and reliability study of Modic changes in the cervical spine.Objective. To assess the prevalence and reliability of diagnosing and classifying Modic changes and their relationship to disc herniations in the cervical spine.Summary of Background Data. Degenerative marrow (Modic) changes in the spine can be seen on MRI with some evidence linking them to pain. Many studies have been published on Modic changes in the lumbar spine, but only 1 small prevalence study focusing on Modic changes in the cervical spine has been reported.Methods. The cervical MRI scans of 500 patients over the age of 50 were retrospectively evaluated for the prevalence, type and location of Modic changes and disc herniations. 200 of these same scans were independently analyzed by a second observer to evaluate interobserver reliability of diagnosis with 100 re-evaluated by the same observer 1 month later to assess intraobserver reliability. The SPSS program and Kappa statistics were used to assess prevalence and reliability. The risk ratio comparison of DH and MC was calculated.Results. 426 patients (85.2 %) met the inclusion criteria. Modic changes were observed in 40.4% of patients (14.4% of all motion segments). 4.3% were type 1 and 10.1% were type 2. Disc herniations were seen in 78.2% of patients (13.3% of motion segments). Both MC and DH were most frequently observed at C5/6 and C6/7. Disc extrusions were positively associated with MC (RR = 2.4). The reliability demonstrated an upper moderate interobserver (k = 0.54) and an almost perfect intraobserver agreement (k = 0.82).Conclusions. A high prevalence of Modic changes was observed with type 2 predominating. The C5/6 and C6/7 levels are most effected. Patients with MC are more likely to have a disc herniation at the same level. MC type 2 predominates. The classification is reliable

Evidence-based radiology (part 1): Is there sufficient research to support the use of therapeutic injections for the spine and sacroiliac joints?

INTRODUCTION: This review article addresses the best evidence currently available for therapeutic injection therapy for conditions targeting the spine and sacroiliac joints. The article is presented by spinal region. Controversies and areas of interest for further studies are identified. DISCUSSION: There is conclusive evidence supporting the effectiveness of the caudal approach for the administration of epidural steroid injections for patients with low back pain from a variety of causes. In general, there is moderate-to-strong evidence supporting the use of transforaminal therapeutic epidural injections for lumbar nerve-root compression and facet injections for joint pain arising from these joints in the cervical, thoracic and lumbar spine, but further subgroup analysis is needed to help predict which specific patients may receive the most benefit from these procedures. CONCLUSION: No randomized controlled trials, meta-analyses or systematic reviews addressing the effectiveness of therapeutic sacroiliac joint injections have been found. For some injections, corticosteroids may not provide better outcomes compared to local anesthetic injections alone

MR/CT image fusion of the spine after spondylodesis: a feasibility study

The objective of this study is to evaluate feasibility, accuracy and time requirements of MR/CT image fusion of the lumbar spine after spondylodesis. Sagittal MR and CT images derived from standard imaging protocols (sagittal T2-weighted MR/sagittal reformatted multi-planar-reformation of the CT) of the lumbar spine with correct (n=5) and incorrect (n=5) implant position were fused by two readers (R1, R2) using OsiriX in two sessions placing one (session 1) or two (session 2) reference point(s) on the dorsal tip(s) of the cranial and caudal endplates from the second lumbar to the first sacral vertebra. R1 was an experienced musculoskeletal radiologist; R2 a spine surgeon, both had received a short training on the software tool. Fusion times and fusion accuracy, defined as the largest deviation between MR and CT in the median sagittal plane on the ventral tip of the cranial end plate of the most cranial vertebra visible on the CT, were measured in both sessions. Correct or incorrect implant position was evaluated upon the fused images for all patients by an experienced senior staff musculoskeletal radiologist. Mean fusion time (session 1/session 2; in seconds) was 100.4/95 (R1) and 104.2/119.8 (R2). Mean fusion deviation (session 1/session 2; in mm) was 1.24/2.20 (R1) and 0.79/1.62 (R2). The correct/incorrect implant position was identified correctly in all cases. In conclusion, MR/CT image fusion of the spine with metallic implants is feasible, fast, accurate and easy to implement in daily routine wor

Late solitary bone metastasis of a primary pulmonary synovial sarcoma with SYT-SSX1 translocation type: case report with a long follow-up

Primary synovial sarcoma outside its classical presentation in para-articular soft tissue of young patients is rare but regularly reported. One of the rarest primary locations is the lung. We describe a 73-year-old female patient who presented with a solitary malignant bone tumor 8years after the resection of a lung neoplasm. The bone tumor was classified as an osteosarcoma and the lung tumor as an atypical carcinoid tumor at their first respective diagnostic work-ups. The resection of the affected humerus with allograft and endoprosthesis implantation followed. Reevaluation of the tumor samples at the time of the local recurrence of the bone tumor 6years following the initial symptoms of the bone tumor lead to the reclassification of both specimens as synovial sarcomas. Both neoplasms contained the SYT-SSX1 type of the diagnostic translocation t(X;18) as detected by the reverse-transcription polymerase chain reaction analysis. The patient died 14years after the resection of the primary synovial sarcoma of the lung and 6years following the occurrence of the bone metastasis. This prolonged clinical course is uncommon for the SYT-SSX1 translocation, which, in other locations, is usually associated with an unfavorable prognosi

Y Chromosomal Variation Tracks the Evolution of Mating Systems in Chimpanzee and Bonobo

The male-specific regions of the Y chromosome (MSY) of the human and the chimpanzee (Pan troglodytes) are fully sequenced. The most striking difference is the dramatic rearrangement of large parts of their respective MSYs. These non-recombining regions include ampliconic gene families that are known to be important for male reproduction,and are consequently under significant selective pressure. However, whether the published Y-chromosomal pattern of ampliconic fertility genes is invariable within P. troglodytes is an open but fundamental question pertinent to discussions of the evolutionary fate of the Y chromosome in different primate mating systems. To solve this question we applied fluorescence in situ hybridisation (FISH) of testis-specific expressed ampliconic fertility genes to metaphase Y chromosomes of 17 chimpanzees derived from 11 wild-born males and 16 bonobos representing seven wild-born males. We show that of eleven P. troglodytes Y-chromosomal lines, ten Y-chromosomal variants were detected based on the number and arrangement of the ampliconic fertility genes DAZ (deleted in azoospermia) and CDY (chromodomain protein Y)—a so-far never-described variation of a species' Y chromosome. In marked contrast, no variation was evident among seven Y-chromosomal lines of the bonobo, P. paniscus, the chimpanzee's closest living relative. Although, loss of variation of the Y chromosome in the bonobo by a founder effect or genetic drift cannot be excluded, these contrasting patterns might be explained in the context of the species' markedly different social and mating behaviour. In chimpanzees, multiple males copulate with a receptive female during a short period of visible anogenital swelling, and this may place significant selection on fertility genes. In bonobos, however, female mate choice may make sperm competition redundant (leading to monomorphism of fertility genes), since ovulation in this species is concealed by the prolonged anogenital swelling, and because female bonobos can occupy high-ranking positions in the group and are thus able to determine mate choice more freely

CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique

Objective To describe an “indirect” cervical nerve root injection technique with a dorsal approach that should carry less inherent risk than the “direct” cervical transforaminal injection approach, and to compare the immediate postinjection results of the two procedures. Materials and methods The indirect and direct cervical nerve root injection procedures are described in detail. Fifty-three consecutive patients receiving the indirect nerve root injections during 2009–2010 were age- and gendermatched to 53 patients who underwent direct transforaminal nerve root injections performed in 2006. Pain level data were collected immediately before and 20–30 min after each procedure. The percentages of pain change in the two groups were compared using the unpaired Student’s t test. Results Fifty-two men (mean age 49) and 54 women (mean age 55) were included. The mean percentage of pain reduction for patients receiving indirect nerve root injections was 38.4% and for those undergoing the direct nerve root injections approach it was 43.2%. This was not significantly different (P=0.455). No immediate or late adverse effects were reported after either injection procedure. Conclusions The indirect cervical nerve root injection procedure is a potentially safer alternative to direct cervical transforaminal nerve root injections. The short-term pain reduction is similar using the two injection methods

Articular cartilage and labral lesions of the glenohumeral joint: diagnostic performance of 3D water-excitation true FISP MR arthrography

OBJECTIVE: To evaluate the diagnostic performance of MR arthrography in the detection of articular cartilage and labral lesions of the glenohumeral joint using a transverse 3D water-excitation true fast imaging with steady-state precession (FISP) sequence. MATERIALS AND METHODS: Seventy-five shoulders were included retrospectively. Shoulder arthroscopy was performed within 6 months of MR arthrography. MR images were evaluated separately by two radiologists. They were blinded to clinical and arthroscopic information. Arthroscopy served as the reference standard. RESULTS: For the detection of humeral cartilage lesions, sensitivities and specificities were 86% (12/14)/89% (50/56) for observer 1 and 93%/86% for observer 2) for the transverse true FISP sequence and 64%/86% (50%/82% for observer 2) for the coronal intermediate-weighted spin-echo images. The corresponding values for the glenoidal cartilage were 60% (6/10)/88% (51/58) (80%/76% for observer 2) and 70%/86% (60%/74% for observer 2) respectively. For the detection of abnormalities of the anterior labrum (only assessed on true FISP images) the values were 94% (15/16)/84% (36/43) (88%/79% for observer 2). The corresponding values for the posterior labrum were 67% (8/12)/77% (36/47) (observer 2: 25%/74%). The kappa values for the grading of the humeral and glenoidal cartilage lesions were 0.81 and 0.55 for true FISP images compared with 0.49 and 0.43 for intermediate-weighted fast spin-echo images. Kappa values for true FISP evaluation of the anterior and posterior part of the labrum were 0.81 and 0.70. CONCLUSION: Transverse 3D true FISP MR arthrography images are useful for the difficult diagnosis of glenohumeral cartilage lesions and suitable for detecting labral abnormalities