Ultra Low Field MR Imaging of Cervical Spine Involvement in Rheumatoid Arthritis

In a study of 30 patients with longstanding rheumatoid arthritis the diagnostic usefulness of ultra low field MR equipment was analyzed in assessing lesions of the craniocervical junction. It was found that at 0.04 T all the examinations were diagnostic and that in combination with plain radiography the diagnostic information obtained was valuable in further planning of the treatment strategies. The neurologic findings were related to the degree and severity of atlantoaxial luxation, either horizontal or vertical, and to the periodontoid pannus formation. The correlation between the degree of cord compression shown with MR imaging and the clinical symptoms, especially long tract symptoms, was poor. The only correlating factor was the duration of the disease.

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Painful Ankle Region in Rheumatoid Arthritis

Acta Radiologica ◽

10.1177/02841851960373p229 ◽

1996 ◽

Vol 37 (3P2) ◽

pp. 572-577 ◽

Cited By ~ 9

Author(s):

A. Lehtinen ◽

L. Paimela ◽

J. Kreula ◽

M. Leirisalo-Repo ◽

M. Taavitsainen

Keyword(s):

Rheumatoid Arthritis ◽

Mr Imaging ◽

Clinical Features ◽

High Frequency ◽

Plain Radiography ◽

Imaging Method ◽

Extensor Tendons ◽

Diagnostic Usefulness ◽

Prolonged Pain

Purpose: To establish the diagnostic usefulness of ultrasonography (US) and MR imaging in patients with rheumatoid arthritis (RA) suffering from prolonged pain in the ankle region, where plain radiography did not demonstrate any changes. Material and Methods: Seventeen patients were studied with 0.1 T MR imaging and with high-frequency US. Talocrural and subtalar joints (including talonavicular joints), and medial, lateral, and extensor tendons and their synovial sheaths were examined by MR and US. Results: Abnormal findings were found by MR imaging and US in altogether 76% of the patients, by MR alone in 53%, and by US alone in 59%. In 41% of the patients, lesions were demonstrated only by one method. Talocrural and subtalar joints were the most often affected sites (41% each), followed by the peroneus tendon (23%). In the joints, the abnormal findings were interpreted as synovitis; in the tendon areas, mostly as tenosynovitis. MR and US were highly significantly concordant (p<0.0001), but correlation with clinical features was poor. Conclusion: In patients with pain in the ankle region, US and MR imaging can contribute to the diagnosis and localization of the abnormality when the plain radiography is normal. Easily available and inexpensive US can be recommended as the first imaging method after plain radiography. Some divergence seems to exist between US and MR, and in complicated cases both methods are recommended.

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Corticosteroid Treatment for Metastatic Spinal Cord Compression: A Review

Global Spine Journal ◽

10.1177/2192568217699189 ◽

2017 ◽

Vol 7 (3) ◽

pp. 272-279 ◽

Cited By ~ 11

Author(s):

Gordon D. Skeoch ◽

Matthew K. Tobin ◽

Sajeel Khan ◽

Andreas A. Linninger ◽

Ankit I. Mehta

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Clinical Symptoms ◽

Treatment Strategies ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Treatment Modalities ◽

High Dose ◽

Dexamethasone Treatment ◽

Corticosteroid Administration

Study Design: Narrative review. Objective: Metastatic spinal cord compression (MSCC) is a very frequent complication among cancer patients. Presenting commonly as nocturnal back pain, MSCC typically progresses to lower extremity paresis, loss of ambulatory capabilities, and paraplegia. In addition to standard treatment modalities, corticosteroid administration has been utilized in preclinical and clinical settings as adjunctive therapy to reduce local spinal cord edema and improve clinical symptoms. This article serves as a review of existing literature regarding corticosteroid management of MSCC and seeks to provide potential avenues of research on the topic. Methods: A literature search was performed using PubMed in order to consolidate existing information regarding dexamethasone treatment of MSCC. Of all search results, 7 articles are reviewed, establishing the current understanding of metastatic spine disease and dexamethasone treatment in both animal models and in clinical trials. Results: Treatment with high-dose corticosteroids is associated with an increased rate of potentially serious systemic side effects. For this reason, definitive guidelines for the use of dexamethasone in the management of MSCC are unavailable. Conclusions: It is still unclear what role dexamethasone plays in the treatment of MSCC. It is evident that new, more localizable therapies may provide more acceptable treatment strategies using corticosteroids. Looking forward, the potential for more targeted, localized application of the steroid through the use of nanotechnology would decrease the incidence of adverse effects while maintaining the drug’s efficacy.

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Low-Field MR Imaging (0.1 T) in Patients with Clinically Suspected Acute Spinal Block

Acta Radiologica ◽

10.1177/028418519503600103 ◽

1995 ◽

Vol 36 (1) ◽

pp. 15-18 ◽

Cited By ~ 1

Author(s):

U. Heldmann ◽

H. S. Thomsen ◽

T. Mygind

Keyword(s):

Surgical Treatment ◽

Mr Imaging ◽

Clinical Findings ◽

Clinical Impact ◽

Clinical Suspicion ◽

Spinal Block ◽

True Positive ◽

Therapeutic Consequence ◽

Low Field ◽

Diagnostic Usefulness

The diagnostic usefulness of a 0.1 T MR unit in patients with clinical suspicion of acute spinal block was studied in 59 patients who were referred to acute MR investigation. The records were reviewed retrospectively 1 month after the MR for assessing the clinical impact of the examination. Ninety-eight per cent had a true-positive examination confirmed by surgery (21%) or observation (77%). In 60% of the patients the MR imaging had a therapeutic consequence. In only one patient did the level of visualised pathology at the MR examination not correlate with the clinical findings; the patient subsequently refused surgical treatment. We conclude that a low-field MR unit is excellent for acute examination of patients clinically suspected of acute spinal block.

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Pericranial and scalp rotation flaps for occipitocervical hardware exposure with CSF leak in rheumatoid arthritis patient: A case report and review of the literature

Surgical Neurology International ◽

10.25259/sni_351_2021 ◽

2021 ◽

Vol 12 ◽

pp. 229

Author(s):

Claudio Schonauer ◽

Ciro Mastantuoni ◽

Oreste de Divitiis ◽

Francesco D’Andrea ◽

Raffaele de Falco ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cord Compression ◽

Craniocervical Junction ◽

Csf Leak ◽

Cervical Cord ◽

Congenital Deformity ◽

Rotation Flap ◽

Pull Out ◽

Csf Leakage ◽

High Cervical

Background: There are several etiologies of craniocervical junction instability (CCJI); trauma, rheumatoid arthritis (RA), infections, tumors, congenital deformity, and degenerative processes. These conditions often require surgery and craniocervical fixation. In rare cases, breakdown of such CCJI fusions (i.e., due to cerebrospinal fluid [CSF] leaks, infection, and wound necrosis) may warrant the utilization of occipital periosteal rescue flaps and scalp rotation flaps to achieve adequate closure. Case Description: A 33-year-old female with RA, cranial settling, and high cervical cord compression underwent an occipitocervical instrumented C0–C3/C4 fusion. Two months later, revision surgery was required due to articular screws pull out, CSF leakage, and infection. At the second surgery, the patient required screws removal, the application of laminar clamps, and sealing the leak with fibrin glue. However, the CSF leak persisted, and the skin edges necrosed leaving the hardware exposed. The third surgery was performed in conjunction with a plastic surgeon. It included operative debridement and covering the instrumentation with a pericranial flap. The resulting cutaneous defect was then additionally reconstructed with a scalp rotation flap. Postoperatively, the patient adequately recovered without sequelae. Conclusion: A 33-year-old female undergoing an occipitocervical fusion developed a postoperative persistent CSF leak, infection, and wound necrosis. This complication warranted the assistance of plastic surgery to attain closure. This required an occipital periosteal rescue flap with an added scalp rotation flap.

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Functional MR imaging of the cervical spine in patients with rheumatoid arthritis

Acta Radiologica ◽

10.1080/02841859809172222 ◽

1998 ◽

Vol 39 (5) ◽

pp. 543-546 ◽

Cited By ~ 21

Author(s):

K.-H. Allmann ◽

M. Uhl ◽

P. Uhrmeister ◽

K. Neumann ◽

J. von Kempis ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cervical Spine ◽

Mr Imaging ◽

Cord Compression ◽

Foramen Magnum ◽

Neutral Position ◽

Additional Information ◽

Functional Mr Imaging ◽

Flexion And Extension ◽

Mr Study

Purpose: to evaluate functional MR imaging in patients with rheumatoid arthritis (RA) involving the cervical spine Material and Methods: We used a device that allows MR examination to be made of the cervical spine in infinitely variable degrees of flexion and extension. Dynamic functional MR imaging was performed on 25 patients with RA Results: Functional MR imaging was able to show the degree of vertebral instability of the occipito-atlantal or atlanto-axial level as well as the subaxial level. by performing functional MR imaging, we were able to demonstrate the extent of synovial tissue around the dens, and the impingement and displacement of the spinal cord during flexion and extension. the basilar impression, the cord impingement into the foramen magnum, the cord compression, the slipping of vertebrae, and the angulation of the cord were all much more evident in functional than in static MR imaging Conclusion: Functional MR imaging provided additional information in patients with RA, and is valuable in patients who have a normal MR study in the neutral position and yet have signs of a neurological deficit. Functional MR imaging is important in the planning of stabilizing operations of the cervical spine

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Transformation of fibroblast‐like synoviocytes in rheumatoid arthritis; from a friend to foe

Autoimmunity Highlights ◽

10.1186/s13317-020-00145-x ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Mohammad Javad Mousavi ◽

Jafar Karami ◽

Saeed Aslani ◽

Mohammad Naghi Tahmasebi ◽

Arash Sharafat Vaziri ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Treatment Strategies ◽

Oxygen Metabolism ◽

Systemic Autoimmune Disease ◽

Epigenetic Alterations ◽

Pannus Formation ◽

Type B ◽

Comprehensive Understanding ◽

Genetic Abnormalities ◽

Fibroblast Like Synoviocytes

AbstractSwelling and the progressive destruction of articular cartilage are major characteristics of rheumatoid arthritis (RA), a systemic autoimmune disease that directly affects the synovial joints and often causes severe disability in the affected positions. Recent studies have shown that type B synoviocytes, which are also called fibroblast-like synoviocytes (FLSs), as the most commonly and chiefly resident cells, play a crucial role in early-onset and disease progression by producing various mediators. During the pathogenesis of RA, the FLSs’ phenotype is altered, and represent invasive behavior similar to that observed in tumor conditions. Modified and stressful microenvironment by FLSs leads to the recruitment of other immune cells and, eventually, pannus formation. The origins of this cancerous phenotype stem fundamentally from the significant metabolic changes in glucose, lipids, and oxygen metabolism pathways. Moreover, the genetic abnormalities and epigenetic alterations have recently been implicated in cancer-like behaviors of RA FLSs. In this review, we will focus on the mechanisms underlying the transformation of FLSs to a cancer-like phenotype during RA. A comprehensive understanding of these mechanisms may lead to devising more effective and targeted treatment strategies.

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Low-Field MR Imaging of the Spine

Acta Radiologica ◽

10.1177/028418519503600438 ◽

1995 ◽

Vol 36 (4-6) ◽

pp. 505-509 ◽

Cited By ~ 3

Author(s):

J. Drejer ◽

H. S. Thomsen ◽

J. Tanttu

Keyword(s):

Steady State ◽

Mr Imaging ◽

Region Of Interest ◽

Posterior Longitudinal Ligament ◽

Intervertebral Discs ◽

Low Field ◽

Diagnostic Usefulness ◽

Spinal Region ◽

Very High ◽

Better Than

Purpose: To evaluate a new steady-state sequence in the delineation of the various structures in the spine at low-field MR imaging with a very high homogeneity of the main field. Methods: 49 patients underwent 53 examinations with both a traditional T1-weighted gradient-echo (PS) sequence and a new completely balanced steady-state 3-D (CBASS3D) sequence; 20 examinations included the cervical spine, 8 the thoracic spine and 25 the lumbar spine. All 106 examinations were reviewed twice regarding visibility of selected structures in the spinal region and diagnostic usefulness. Results: The CBASS3D sequence delineated the medulla, nerve roots, CSF, the intervertebral discs and the posterior longitudinal ligament significantly better than the PS sequence. Disc hernia was also better visualised (p<0.01). There were significantly more artefacts on images obtained with the CBASS3D sequence, but they were usually outside the region of interest and occurred less frequently over time due to increased experience of the staff. Both reviewers found the diagnostic usefulness of CBASS3D to be superior compared to that of PS and excellent for diagnostic purposes. Conclusion: The CBASS3D sequence is a considerable improvement in the visualisation of degenerative changes of the spine at low-field MR imaging.

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