Pathophysiology and Grading of the Ventral Displacement of Dorsal Spinal Cord Spectrum

Study DesignA retrospective study of the ventral displacement of dorsal spinal cord (VDDSC) spectrum pathophysiology and grading.PurposeThis study aimed at examining the pathophysiology of VDDSC between D3 and D7, using magnetic resonance imaging (MRI) correlation and severity grading.Overview of LiteratureThe pathologies that lead to VDDSC were previously discussed in various articles. We attempted to group these pathological conditions under a single spectrum, and grade them according to their severity.MethodsWe reviewed the MRI images of the dorsal spines of 1,350 patients over a period of 4 years (February 2013–February 2017); all MRI images were analyzed by two experienced radiologists.ResultsOf the 1,350 patients, 28 exhibited VDDSC between D3 and D7. Additional findings included ventral transdural herniation of the spinal cord (n=10), anterior spinal cord adhesion (n=7), arachnoid web (n=6), and arachnoid cyst (n=5).ConclusionsWe grouped the pathologies that lead to VDDSC at the thoracic level into a single spectrum of varying severity and graded VDDSC, from mild to severe

Dorsal Spinal Ligamentum Flavum Thickening: A Magnetic Resonance Imaging Study

Study DesignA retrospective radiological study of the ligamentum flavum (LF).PurposeWe determined the relationship of dorsal spinal LF thickening with age and sex using magnetic resonance imaging (MRI). We also determined whether LF thickening has a predominant tendency to occur at a specific dorsal level and on a specific side.Overview of LiteratureMany researchers have studied LF thickness at dorsal levels in patients with compressive myelopathy. However, there is a dearth of literature pertaining to the study of dorsal LF thickness in patients without myelopathy.MethodsLF thickness was measured at dorsal levels from T1 to T12 on both sides using MRI in 100 individuals. The patients were divided into three groups based on age: 20 to 40, 41 to 60, and >60 years. On axial T2-weighted imaging at the mid-disc level, LF thickness was measured perpendicular to the lamina border, either at half the length of LF or at maximum thickness, whichever was greater.ResultsWe found that LF thickness does not increase significantly with increasing age and there was no significant disparity in LF thickness between the sides and sexes. We also found that there was a significant increase in LF thickness at the T10–T11 level (mean value, 3.27±0.94 mm).ConclusionsLF thickness does not appear to have any side/sex dominance. LF thickening has a predominant tendency to occur specifically at the T10–T11 level. This may be due to maximum tensile strength and mobility at this level. Because there is an increased tendency for LF thickening at the T10–T11 level, this may be used as a reference point for counting the vertebral levels

Role of 3D SPACE sequence and susceptibility weighted imaging in the evaluation of hydrocephalus and treatment-oriented refined classification of hydrocephalus

Objective: The aim of our study was to evaluate the diagnostic utility of three-dimensional sampling perfection with application optimized contrast using different flip angle evolution (3D SPACE) sequence and Susceptibility Weighted Imaging (SWI) in hydrocephalus and to propose a refined definition and classification of hydrocephalus with relevance to the selection of treatment option. Materials and Methods: A prospective study of 109 patients with hydrocephalus was performed with magnetic resonance imaging (MRI) brain using standardized institutional sequences along with additional sequences 3D SPACE and SWI. The images were independently read by two senior neuroradiologists and the etiopathogenesis of hydrocephalus was arrived by consensus. Results: With conventional sequences, 46 out of 109 patients of hydrocephalus were diagnosed as obstructive of which 21 patients showed direct signs of obstruction and 25 showed indirect signs. In the remaining 63 patients of communicating hydrocephalus, cause could not be found out in 41 patients. Whereas with 3D SPACE sequence, 88 patients were diagnosed as obstructive hydrocephalus in which all of them showed direct signs of obstruction and 21 patients were diagnosed as communicating hydrocephalus. By including SWI, we found out hemorrhage causing intraventricular obstruction in three patients and hemorrhage at various sites in 24 other patients. With these findings, we have classified the hydrocephalus into communicating and noncommunicating, with latter divided into intraventricular and extraventricular obstruction, which is very well pertaining to the selection of surgical option. Conclusion: We strongly suggest to include 3D SPACE and SWI sequences in the set of routine MRI sequences, as they are powerful diagnostic tools and offer complementary information regarding the precise evaluation of the etiopathogenesis of hydrocephalus and have an effective impact in selecting the mode of management

Volume assessment in hemodialysis: A comparison of present methods in clinical practice with sonographic lung comets

Dry weight assessment in dialysis patients remains a challenging endeavor owing to the limitations of the available methods for volume assessment. Lung ultrasound is emerging as an invaluable tool to assist in the appropriate assessment and assignment of dry weight. The objectives of this study are (1) to determine the reliability of clinical signs and symptoms for volume assessment, (2) to compare lung ultrasound with High Resolution Computed Tomography (HRCT) chest-A noninvasive gold standard tool for detecting pulmonary congestion and with inferior vena cava diameter (IVCD) – another time-tested volume assessment method, and (3) to analyze if lung ultrasound could detect dialysis induced fluid status variations. The cross-sectional study involves 50 patients on maintenance hemodialysis. Lung ultrasound for B line estimation and ultrasonographic measurement of IVCD performed before and after hemodialysis by a nephrologist trained in ultrasonography. Limited HRCT was obtained just before hemodialysis. Edema, crackles, and dyspnea had a poor sensitivity of 37.9%, 11.5%, and 52.6%, respectively, to detect clinically significant pulmonary congestion by lung ultrasound. A highly significant correlation was obtained between B-line score and HRCT signs of pulmonary congestion (P < 0.001) before dialysis. B lines showed statistically significant reduction with dialysis. The absolute reduction of B lines showed significant correlation with ultrafiltration volume and weight loss. Bedside lung ultrasound appears a sensitive tool for evaluating real-time changes in extravascular lung water and would serve to optimize volume status in dialysis patients