Whole spine MRI in children with suspected child abuse

ObjectivesPaediatric lumbosacral lipomas are commonly assessed by whole spine MRI, which is costly, time consuming and reduces imaging detail at the region of interest. This study evaluates the utility of whole spine vs local spine MRI in paediatric lumbosacral lipoma (LSL).DesignSingle centre, retrospective, radiological review.Subjects119 patients (77F:46M) aged 0.8 years (0.2–3.9) (median ±IQR) with complex LSL who had whole spine MRI between 2001–2017.MethodsLumbosacral lipomas were identified from a prospectively collected database. Cases where whole spine MRI was available were included. Type of lipoma and any associated spinal anomalies were recorded.Results347 patients had LSL, of which 119 (34%) patients had whole spine MRI. 3% were excluded due diagnosis of fatty filum terminale. 13% scans were unavailable. 119 patients were studied: 77F:46M aged 0.8 years at scan. Type of LML: transitional 36%; caudal 18%; dorsal 19%; unclassified 26%. Additional imaging abnormalities included: syrinx 18%; Chiari 1%; dermal sinus tract 13%; vertebral segmentation 13%; other 2%. None were associated with clinical symptoms nor required surgical treatment. Investigating the cost-benefit analysis of modality, lumbar spine required less MR time and cost less (40 vs 20 mins; £228.69 vs £282.39).ConclusionsThe low incidence of clinically relevant secondary lesions suggests that lumbosacral MRI only is necessary in the assessment of LSL. Imaging quality of the ROI can be optimised and MRI time and costs reduced.

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Investigation of Whole Spine MRI in the Emergency Department at Two Large Tertiary Care Academic Medical Centers in the United States

Current Problems in Diagnostic Radiology ◽

10.1067/j.cpradiol.2020.07.005 ◽

2020 ◽

Author(s):

Montana Morris ◽

Sylvie Destian ◽

Youngmin Chu ◽

Matthew Klumpp ◽

Vahe M. Zohrabian

Keyword(s):

United States ◽

Emergency Department ◽

Tertiary Care ◽

The United States ◽

Academic Medical Centers ◽

Medical Centers ◽

Academic Medical ◽

Large Tertiary Care ◽

Whole Spine ◽

Spine Mri

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The evidence for whole-spine MRI in the assessment of axial spondyloarthropathy

Rheumatology ◽

10.1093/rheumatology/kep427 ◽

2010 ◽

Vol 49 (3) ◽

pp. 426-432 ◽

Cited By ~ 13

Author(s):

A. N. Bennett ◽

H. Marzo-Ortega ◽

A. Rehman ◽

P. Emery ◽

D. McGonagle ◽

...

Keyword(s):

Axial Spondyloarthropathy ◽

Whole Spine ◽

Spine Mri

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Lumbar hemivertebra resection in congenital scoliosis utilizing cone-beam navigation: less radiation, more accuracy—proof of concept

Child s Nervous System ◽

10.1007/s00381-021-05055-5 ◽

2021 ◽

Author(s):

Christian Fisahn ◽

Chris Lindemann ◽

Brittni Burgess ◽

Patrick Strube ◽

Timo Zippelius

Keyword(s):

Cobb Angle ◽

Radiation Exposure ◽

Congenital Scoliosis ◽

Cone Beam ◽

Pediatric Case ◽

Case Presentation ◽

Hemivertebra Resection ◽

Preoperative Ct ◽

Whole Spine ◽

Spine Mri

Abstract Purpose To present the first known pediatric utilization of cone-beam navigation system (CBNS) for hemivertebra resection and spondylodesis Case presentation A 14-year-old female with congenital scoliosis, diagnosed at 8 years of age, presenting with progressive symptoms, a Cobb angle (L3-5) of 38° at time of surgery, treated historically with conservative measures. Presence of spinal intramedullary disease was excluded prior to operation via whole spine MRI. Results Patient successfully underwent surgical correction utilizing the CBNS (O-arm™, Medtronic®). Post-operative Cobb angle (L3-5) was restored to 8°. Following four different pediatric patient’s radiation exposures (two receiving correction via the O-arm platform and two via the traditional method employing fluoroscopy), we show a reduction in radiation exposure using the CBNS system. Conclusion We present the first known pediatric case of the utilization of the CBNS system for hemivertebra correction. We demonstrate that utilizing the CBNS platform can not only increase surgical accuracy but also decrease pediatric patient’s radiation exposure as a preoperative CT scan is not needed. Future studies should continue to explore additional benefits of implementing the system into surgical practice.

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Evaluation of Whole-Body MRI (WB-MRI) in Smoldering Multiple Myeloma (SMM)

Blood ◽

10.1182/blood-2020-136185 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 19-20

Author(s):

Elizabeth Hill ◽

Baris Turkbey ◽

Evrim Turkbey ◽

Candis Morrison ◽

Peter Choyke ◽

...

Keyword(s):

Multiple Myeloma ◽

Bone Marrow ◽

Fdg Pet ◽

High Sensitivity ◽

Focal Lesions ◽

Pet Ct ◽

18F Fdg ◽

Whole Spine ◽

Fdg Pet Ct ◽

Spine Mri

Introduction Whole-body magnetic resonance imaging (WB-MRI), including multiplanar multisequence technique with diffusion weighted images, is a novel imaging technique being evaluated for patients with multiple myeloma (MM). WB-MRI is ideal for this population due to its high sensitivity for bone marrow signal changes and full anatomic coverage from vertex to mid-thighs. It is well established that patients with unequivocal focal lesions on MRI have worse outcomes. Currently the IMWG recommends that all patients with smoldering multiple myeloma (SMM) undergo WB-MRI (or whole spine MRI if WB-MRI is not available) to rule out two or more focal lesions which would classify the patient as having symptomatic myeloma requiring treatment. There is a clear benefit of using MRI for the detection of early focal myeloma lesions however less is known about findings in the SMM population. Detection of subtle findings such as one small focal lesion or heterogeneous bone marrow in WB-MRI has unknown clinical significance that needs to be further evaluated. This study aimed to evaluate the sensitivity of WB-MRI compared to other highly sensitive functional imaging modalities in patients with SMM both at baseline and after treatment. Methods Imaging of patients with WB-MRI performed at the National Institutes of Health Clinical Center Myeloma Program were reviewed and compared to whole spine MRI and 18F-FDG PET/CT completed at the same timepoint. The majority of patients were being evaluated for enrollment on clinical trials. Patients had undergone a WB-MRI with a 3-Tesla system either as a baseline study, after completion of induction treatment, or during follow up determined by the time DWI became available at our institution. The imaging protocol included sagittalT1 weighted (W) and Short tau inversion recovery (STIR) for spine and coronal, axial T1W and axial T2 TSE pulse sequences. The functional component included diffusion weighted imaging in the axial plane (b=0 and 900sec/mm2). Radiological interpretation was performed by two readers using myeloma response assessment and diagnosis system (My-RADS) {Messiou, 2019 #340}. WB-MRIs were categorized as positive if focal lesions or diffuse/heterogenous pattern of bone marrow infiltration were present. Similarly, 18F-FDG PET/CTs and whole spine MRIs were classified as positive if focal lesions or diffuse/heterogenous pattern of bone marrow were present. Results A total of 34 patients with SMM and 5 patients with relapsed refractory multiple myeloma (RRMM) had sequential WB-MRI and 18F-FDG PET/CT. Figure 1 summarizes the radiological data of the SMM population. Eleven of these patients had PET/CT, whole spine MRI, and WB-MRI at baseline. Twenty-five patients had PET/CT and WB-MRI completed after at least 8 cycles of treatment. Thirteen patients had consistently negative imaging at baseline, 7 of which also had negative imaging after treatment, while 2 patients were found to have new lesions seen on WB-MRI after treatment. Six patients had resolution of positive imaging seen at baseline after treatment. Among the 17 patients with a positive WB-MRI, 12 (71%; 95% CI 47% - 87%) had a negative correlating PET/CT. Among 5 patients with positive PET/CT at the same time point as a WB-MRI, only 1 (20%; 95% CI 2% - 64%) correlated to a negative WB-MRI. Figure 2 depicts findings from patients with RRMM for comparison. All imaging modalities showed multiple focal findings in all 5 patients. Conclusions This study depicts the high sensitivity of WB-MRI in the SMM population. Such a high sensitivity is especially needed in SMM and early myeloma when disease burden is lower and the decision for treatment is being considered. In comparison to the RRMM population where all three imaging modalities easily detect multiple focal lesions, WB-MRI tends to identify myeloma involvement in the SMM patients more than the other imaging techniques. This suggests the importance of utilizing WB-MRI when diagnosing SMM. In the SMM population, the prognostic significance of lesions that are discrepant between MRI and FDG PET/CT is not yet known. Further follow up is needed to evaluate any difference in hard endpoints such as progression free survival between patients with positive findings described by WB-MRI. Disclosures No relevant conflicts of interest to declare.

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An analysis of clinical risk factors for adolescent scoliosis caused by spinal cord abnormalities in China: Proposal for a selective whole-spine MRI examination scheme

10.21203/rs.2.17338/v3 ◽

2020 ◽

Author(s):

Wei Xu ◽

Xiangyang Zhang ◽

Ying Zhu ◽

Xiaodong Zhu ◽

zhikun li ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Abdominal Wall ◽

Incidence Rates ◽

Categorical Variables ◽

Continuous Variables ◽

Ankle Clonus ◽

Adolescent Patients ◽

Whole Spine ◽

Spine Mri

Abstract Objective This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities(IA). Method The clinical data of adolescent patients between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. 12 data were compared between the two groups. Student’s t test and the chi-square test were used to evaluate the differences in the continuous variables and categorical variables. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities. Result A total of 714 adolescent patients with scoliosis with a mean age of 13.5 (10-18 years) were included in the study, and IA were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P<0.01). Logistic regression showed that the ratios for sex, scoliosis direction, scoliosis type, abdominal wall reflex and ankle clonus were 2.987, 3.493, 4.823, 3.94 and 8.083, respectively. The ROC curve showed a sensitivity of 66.18% and a specificity of 89.01%(0.5519). Conclusion The incidence of scoliosis caused by IA was approximately 9.5%.The risk factors associated with AS caused by abnormal IA included the male sex, thoracic scoliosis on the left side, a sharp curvature of the spine, an abnormal abdominal wall reflex and ankle clonus.

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