scholarly journals Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Janne Pesonen ◽  
Michael Shacklock ◽  
Juha-Sampo Suomalainen ◽  
Lauri Karttunen ◽  
Jussi Mäki ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Lumbar Disc ◽  
High Sensitivity ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Resonance Imaging ◽  
Structural Differentiation ◽  
High Incidence ◽  
Straight Leg Raise

Abstract Background The straight leg raise test (SLR) is one of the most utilized and studied physical tests in patients with low back pain (LBP) for the detection of lumbar disc herniation (LDH), showing high sensitivity and heterogeneous or low specificity. The high incidence of asymptomatic ‘pathologic’ findings in the magnetic resonance imaging (MRI) scans may cause verification bias to these results. We studied an extended SLR (ESLR) by adding location-specific structural differentiation movements (hip internal rotation or ankle dorsiflexion) to the traditional SLR for it to better differentiate neural symptoms from musculoskeletal. Previously, the ESLR has shown almost perfect interrater reliability between examiners and ability to detect sciatic patients. In this study, we investigated whether a ’positive’ ESLR finding is associated with pathology seen on MRI. Methods Forty subjects comprised the study population, 20 in sciatic group and 20 in control group. The ESLR was performed ‘blinded’ to the subjects. After the ESLR, each subject’s lumbar MRI was evaluated. The MRIs were analyzed independently by 2 senior radiologists and a spine specialist clinician. The ESLR and MRI results were cross-tabulated. To obtain the odds ratio (OR) with positive ESLR or SLR results for LDH or nerve root compression (NC), a binary logistic regression analysis with subjects’ age, gender, height and weight was performed. ESLR’s validity was assessed by combination of interrater agreement and percentage prevalence of both LDH and NC. Results Of sciatic (ESLR+) patients, 85 % had LDH and 75 % NC in the MRI. Not surprisingly, MRI showed a very high incidence of ‘false-positive’ findings with the ESLR negative group. The ESLR showed 0.85 sensitivity and 0.45 specificity for LDH and 0.75 sensitivity and 0.50 specificity for NC. A positive result in the ESLR was found to be strongly associated with for both LDH and NC: the OR was 8.0 (p = 0.028) and 5.6 (p = 0.041), respectively. Conclusions The ESLR shows high validity in detecting neural symptoms and is strongly associated with pathology seen in the MRI when judged positive. We suggest the use of ESLR in clinical practice as a part of clinical examination, where it may prove to be a valuable tool in detecting patients with sciatic symptoms.

scholarly journals Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging

2021 ◽  
Author(s):  
Janne Pesonen ◽  
Michael Shacklock ◽  
Juha-Sampo Suomalainen ◽  
Lauri Karttunen ◽  
Jussi Mäki ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Lumbar Disc ◽  
High Sensitivity ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Resonance Imaging ◽  
Structural Differentiation ◽  
High Incidence ◽  
Straight Leg Raise

Abstract Background: The straight leg raise test (SLR) is one of the most utilized and studied physical tests in patients with low back pain (LBP) for the detection of lumbar disc herniation (LDH), showing high sensitivity and heterogeneous or low specificity. The high incidence of asymptomatic ‘pathologic’ findings in the magnetic resonance imaging (MRI) scans may cause verification bias to these results. We added location-specific structural differentiation movements to the traditional SLR for it to better differentiate neural symptoms from musculoskeletal. Previously, the ESLR has shown almost perfect interrater reliability between examiners and ability to detect sciatic patients. In this study, we investigated whether a ’positive’ ESLR finding predicts pathology seen on MRI.Methods: 40 subjects comprised the study population, 20 in sciatic group and 20 in control group. The ESLR was performed ‘blinded’ to the subjects. After the ESLR, each subject’s lumbar MRI was evaluated. The MRIs were analyzed independently by 2 senior radiologists and a spine specialist clinician. The ESLR and MRI results were cross-tabulated. To obtain the odds ratio (OR) with positive ESLR or SLR results for LDH or nerve root compression (NC), a binary logistic regression analysis with subjects’ age, gender, height and weight was performed. ESLR’s validity was assessed by combination of interrater agreement and percentage prevalence of both LDH and NC.Results: Of sciatic (ESLR+) patients, 85% had LDH and 75% NC in the MRI. Not surprisingly, MRI showed a very high incidence of ‘false-positive’ findings with the ESLR negative group. The ESLR showed 0.85 sensitivity and 0.45 specificity for LDH and 0.75 sensitivity and 0.50 specificity for NC. A positive result in the ESLR was found to be highly predictive for both LDH and NC: the OR was 8.0 (p=0.028) and 5.6 (p=0.041), respectively. Conclusion: The ESLR shows high validity in detecting neural symptoms and pathology seen in the MRI when judged positive. We suggest the use of ESLR in clinical practice, where it may prove to be a valuable tool in detecting patients with sciatic symptoms.

Establishment and effect evaluation of an aortic dissection model induced by different doses of β-aminopropionitrile in rats

Vascular ◽  
2020 ◽  
pp. 170853812098405
Author(s):  
Xiaochai Lv ◽  
Yunnan Hu ◽  
Xiaodong Chen ◽  
Xingfeng Chen ◽  
Liangwan Chen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Aortic Dissection ◽  
Vascular Wall ◽  
Control Group ◽  
Sodium Pentobarbital ◽  
Resonance Imaging ◽  
Significant Difference ◽  
High Incidence ◽  
Group A

Introduction Given the controversy regarding the appropriate dose of β-aminopropionitrile for induction of aortic dissection models in rats, the purpose of this study was to explore the most suitable concentration of β-aminopropionitrile to establish a high-incidence and low-mortality aortic dissection model. Methods Eighty three-week-old male Sprague-Dawley rats were equally divided into four groups: a control group, a 0.06% β-aminopropionitrile group, a 0.08% β-aminopropionitrile group and a 0.1% β-aminopropionitrile group. Initial experiments were performed on the control group, which was not treated with β-aminopropionitrile (and drank water freely), and the other three groups, which were given different concentrations of β-aminopropionitrile solution daily (0.06%, 0.08% and 0.1%). Subsequently, on the 40th day, osmotic minipumps administering 1 μg/kg per min angiotensin II (Ang II) were implanted subcutaneously into the β-aminopropionitrile groups, while the control group was continuously pumped with normal saline. The rats were euthanized 48 h after implantation. All rats that died before the expected end time of the experiment were autopsied immediately, and the aortas were dissected. The rats surviving at the end of the experiment were sacrificed by an overdose of sodium pentobarbital, and tissue samples were harvested for further analyses. Results The mean survival days were significantly different among the groups, with 39.1 ± 6.04 days in the 0.08% β-aminopropionitrile group and 32.7 ± 9.85 days in the 0.1% β-aminopropionitrile group ( P = 0.0178) at the end of the experiment. Compared with those in the 0.06% β-aminopropionitrile group, the rates of aortic dissection were significantly higher in the 0.08% β-aminopropionitrile group and the 0.1% β-aminopropionitrile group ( P = 0.0015 and P = 0.0005, respectively), while there was no significant difference between the 0.08% β-aminopropionitrile group and the 0.1% β-aminopropionitrile group ( P = 0.723) at 70% and 75%, respectively. However, the rupture rates were significantly different between the 0.08% β-aminopropionitrile group and the 0.1% β-aminopropionitrile group (55% versus 20%, P = 0.022). Hematoxylin-eosin staining of the aortic tissue sections of the β-aminopropionitrile group showed that red blood cells entered the pseudocavity in the vascular wall, while the vascular wall structure of the control group was intact. Compared with control rats, which were intact and free from fracture, β-aminopropionitrile-treated rats had fewer collagen fibers and exhibited fracture. Magnetic resonance imaging showed that the aortic intimae of the aortic dissection rats showed double lumens and intimal tears. Conclusions An aortic dissection model with a high incidence and low mortality was successfully and stably developed with 0.08% β-aminopropionitrile. This model will enable further studies investigating aortic dissection pathogenesis and drug therapy. Magnetic resonance imaging may be a reliable technique for imaging the aorta in rats.

scholarly journals Clinical Outcomes of Transforaminal Endoscopic Lumbar Discectomy with or without Platelet-rich Plasma Injection in the Treatment of Lumbar Disc Herniation: A Prospective, Randomized, Controlled Pilot Study

2020 ◽  
Author(s):  
Yi Jiang ◽  
Rujun Zuo ◽  
Shuai Yuan ◽  
Jian Li ◽  
Chang Liu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Lumbar Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Control Group ◽  
Imaging Data ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Data ◽  
Endoscopic Lumbar Discectomy

Abstract Background: This study aimed to evaluate the effectiveness of transforaminal endoscopic lumbar discectomy with or without platelet-rich plasma (PRP) in lumbar disc herniation treatment. Additionally, we aimed to identify whether the PRP injection could improve annulus fibrosus defects based on magnetic resonance imaging data.Methods: Sixty patients with lumbar disc herniation were recruited and randomized to receive either transforaminal endoscopic lumbar discectomy with (PRP group, n=30) or without (control group, n=30) PRP injection. The visual analog scale score of back/leg pain and Oswestry disability index were recorded at 3 days, 6 months, and 1 year after surgery. Postoperative magnetic resonance imaging data were examined to determine the effects of PRP injection.Results: No adverse events were reported in our study following the injection of PRP. Clinical improvement was noted in both groups. The visual analog scale score for leg pain at 3 days post-operation and back pain at 6 months post-operation were lower in the PRP group than those in the control group (P<0.05). The magnetic resonance imaging data indicated the disc height decreased by 12% in the PRP group and 17% in the control group, whereas the spinal cross-sectional area increased by 15% in the PRP group and 6% in the control group after a 1-year follow-up. However, no statistically significant differences were found.Conclusions: Transforaminal endoscopic lumbar discectomy with PRP injection around the annulus fibrosus defect was safe and could improve the clinical outcomes at the early postoperative stage. Moreover, PRP injection exerted no negative effects.Trial Registration: ChiCTR 1800017228

Does diffusion-weighted magnetic resonance imaging have a place in the differential diagnosis of brucella sacroiliitis and seronegative spondyloarthropathy?

2020 ◽  
pp. 028418512093837
Author(s):  
Sunay Sibel Karayol ◽  
Kudret Cem Karayol
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bone Marrow ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Control Group ◽  
Resonance Imaging ◽  
Visual Evaluation ◽  
Mean Values ◽  
Diffusion Weighted ◽  
The Mean

Background The aim of this study is to investigate the role of diffusion-weighted imaging (DWI) in the differential diagnosis of sacroiliitis. Purpose To compare the sacroiliac magnetic resonance imaging (MRI) examinations of patients with suspected active sacroiliitis with patients with acute SpA MR findings and the DWI examinations of patients with acute brucella sacroiliitis, and thereby determine whether DWI can contribute to the differential diagnosis. Material and Methods A total of 84 patients were included in the study and were separated into three groups: group 1 (13 women, 6 men) comprised cases with brucella positive for sacroiliitis; group 2 (17 women, 19 men) comprised cases negative for brucella but with sacroiliitis; and group 3 (16 women, 13 men) comprised cases negative for brucella and sacroiliitis. Results The mean bone marrow apparent diffusion coefficient (ADC) values independently of edema were determined as 0.71 × 10−3 in sacroiliitis and brucella-positive patients, as 0.53 × 10−3 in brucella-negative and sacroiliitis-positive patients, and as 0.43 × 10−3 in the control group of brucella-negative sacroiliitis-negative patients. In the ADC measurements taken from areas of evident edema in patients with sacroiliitis, the mean values were 0.13 × 10−3 in the brucella-positive group and 0.12 × 10−3 in the brucella-negative group. Conclusion By adding DWI, which is a rapid MR sequence, to sacroiliac joint MR examination, normal bone marrow and bone marrow with sacroiliitis can be objectively differentiated with ADC measurements in addition to visual evaluation.

Contrast-Enhanced Magnetic Resonance Imaging in Conservative Management of Lumbar Disc Herniation

Spine ◽  
1998 ◽  
Vol 23 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Hiromichi Komori ◽  
Atsusi Okawa ◽  
Hirotaka Haro ◽  
Takeshi Muneta ◽  
Haruyasu Yamamoto ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Conservative Management ◽  
Lumbar Disc ◽  
Resonance Imaging ◽  
Contrast Enhanced

scholarly journals Analysis of Combined Treatment of Embolic Stroke in Rat with r-tPA and a GPIIb/IIIa Inhibitor

2005 ◽  
Vol 25 (1) ◽  
pp. 87-97 ◽  
Author(s):  
Guangliang Ding ◽  
Quan Jiang ◽  
Li Zhang ◽  
Zheng Gang Zhang ◽  
Lian Li ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Thrombolytic Therapy ◽  
Combination Treatment ◽  
Infarct Volume ◽  
Embolic Stroke ◽  
Control Group ◽  
Resonance Imaging ◽  
Cerebral Microvessels ◽  
Magnetic Resonance Imaging Mri

Suppression of platelet activation improves the efficacy of thrombolytic therapy for stroke. Thus, combination treatment with recombinant tissue plasminogen activator (r-tPA) and 7E3 F(ab′)2, a GPIIb/IIIa inhibitor that binds the platelet to fibrin, may improve the efficacy of thrombolytic therapy in embolic stroke. Magnetic resonance imaging (MRI) was used to monitor treatment response in rats subjected to embolic middle cerebral artery (MCA) occlusion (MCAo). Animals were randomized into treated ( n = 12) and control ( n = 10) groups and received intravenous combination therapy or saline, respectively, 4 hours after MCAo. Magnetic resonance imaging (MRI) measurements performed 1 hour after MCAo showed no difference between groups. However, an increased incidence (50%) of MCA recanalization was found in the treated group at 24 hours compared with 20% in the control group. The area of low cerebral blood flow at 24 and 48 hours was significantly smaller in the combination treatment group, and the lesion size, as indicated from the T2 and T1 maps, differed significantly between groups. Fluorescence microscopy measurements of cerebral microvessels perfused with fluorescein isothiocyanate-dextran and measurements of infarct volume revealed that the combination treatment significantly increased microvascular patency and reduced infarct volume, respectively, compared with the control rats. The efficacy of combination treatment 4 hours after ischemia is reflected by MRI indices of tissue perfusion, MCA recanalization, and reduction of lesion volume. The treatment also reduced secondary microvascular perfusion deficits.

scholarly journals Functionalized Gold Nanoparticles as Contrast Agents for Proton and Dual Proton/Fluorine MRI

Nanomaterials ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. 879 ◽  
Author(s):  
Maria Şologan ◽  
Francesco Padelli ◽  
Isabella Giachetti ◽  
Domenico Aquino ◽  
Mariangela Boccalon ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Gold Nanoparticles ◽  
Magnetic Resonance ◽  
Contrast Agents ◽  
High Sensitivity ◽  
Mri Contrast Agents ◽  
Resonance Imaging ◽  
Mri Contrast ◽  
Gold Core ◽  
19F Magnetic Resonance Imaging

Gold nanoparticles carrying fluorinated ligands in their monolayer are, by themselves, contrast agents for 19F magnetic resonance imaging displaying high sensitivity because of the high density of fluorine nuclei achievable by grafting suitable ligands on the gold core surface. Functionalization of these nanoparticles with Gd(III) chelates allows adding a further functional activity to these systems, developing materials also acting as contrast agents for proton magnetic resonance imaging. These dual mode contrast agents may allow capitalizing on the benefits of 1H and 19F magnetic resonance imaging in a single diagnostic session. In this work, we describe a proof of principle of this approach by studying these nanoparticles in a high field preclinical scanner. The Gd(III) centers within the nanoparticles monolayer shorten considerably the 19F T1 of the ligands but, nevertheless, these systems display strong and sharp NMR signals which allow recording good quality 19F MRI phantom images at nanoparticle concentration of 20 mg/mL after proper adjustment of the imaging sequence. The Gd(III) centers also influence the T1 relaxation time of the water protons and high quality 1H MRI images could be obtained. Gold nanoparticles protected by hydrogenated ligands and decorated with Gd(III) chelates are reported for comparison as 1H MRI contrast agents.

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