The Relationship of Minor Trauma with the Surgical Outcome in Patients with Cervical Myelopathy

Abstract INTRODUCTION Several reports have investigated the relationship between MRI signal changes and the extent of spinal cord dysfunction and potential for postoperative neurological recovery in patients with Degenerative Cervical Myelopathy (DCM). However, there remains ambiguity if these signal changes relate with baseline severity, and predict neurological recovery after surgical treatment. The present study aims to address this knowledge gap by investigating a large global cohort of DCM patients. METHODS 419 MRIs from two prospective multicenter studies were examined. Images were assessed for the presence, levels, and location of cord signal changes and compared with clinical data (signs/symptoms, mJOA, Nurick). Inter-rater reliability for signal changes was calculated. Signal changes were also evaluated for prediction of 2-year post-operative outcome using 2 approaches: (1) Hirabayashi recovery ratio, (2) a dichotomized mJOA score of <16 and = 16 at 2-years representing a suboptimal and optimal neurological outcome, respectively. RESULTS >MRIs were categorized by signal change: no signal change (28.9%), T2 hyperintensity-only (T2-only, 51.8%), and T2-hyperintensity and T1-hypointensity (T1+T2, 19.3%). T2-hyperintensity was present at multiple levels in 27% of patients overall. There was moderate/substantial agreement (Kappa: 0.60) for T2-hyperintensity, and fair agreement for T1-hypointensity (Kappa: 0.31) identification among 3 raters. Baseline severity increased from no signal change to T2-only to T2+T1 (P < 0.0001), and there was an incremental increase in the frequency of signs/symptoms. The presence of T1-hypointensity correlated with reduced recovery ratio (P = 0.03) and likelihood of an optimal surgical outcome (P = 0.005). Greater number of T2-hyperintensity levels was also associated with worse baseline severity (P < 0.0001) and recovery ratio (P = 0.001). CONCLUSION This is the largest study of DCM patients to show an increasing stepwise impairment from no signal change to T2-hypertensity to T1-hypointensity. While T2-hyperintensity alone does not predict outcomes, T1-hypointensity indicates more permanent injury, portending decreased functional recovery. Multilevel T2-hyperintensity suggests additional tissue injury, correlating with worse impairment and recovery potential.

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The Relationship Between MRI Signal Intensity Changes, Clinical Presentation, and Surgical Outcome in Degenerative Cervical Myelopathy

Spine ◽

10.1097/brs.0000000000002234 ◽

2017 ◽

Vol 42 (24) ◽

pp. 1851-1858 ◽

Cited By ~ 21

Author(s):

Aria Nouri ◽

Allan R. Martin ◽

So Kato ◽

Hamed Reihani-Kermani ◽

Lauren E. Riehm ◽

...

Keyword(s):

Cervical Myelopathy ◽

Surgical Outcome ◽

Signal Intensity ◽

Clinical Presentation ◽

Intensity Changes ◽

Degenerative Cervical Myelopathy ◽

The Relationship

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Falcotentorial meningioma: surgical outcome in 14 patients

Journal of Neurosurgery ◽

10.3171/jns.2006.104.1.47 ◽

2006 ◽

Vol 104 (1) ◽

pp. 47-53 ◽

Cited By ~ 21

Author(s):

Takeo Goto ◽

Kenji Ohata ◽

Michiharu Morino ◽

Toshihiro Takami ◽

Naohiro Tsuyuguchi ◽

...

Keyword(s):

Surgical Outcome ◽

Tumor Location ◽

Magnetic Resonance Images ◽

Fisher Exact Test ◽

Vein Of Galen ◽

Exact Test ◽

Anatomical Relationship ◽

Surgical Difficulty ◽

Relationship Of ◽

The Relationship

Object The authors evaluated their surgical experience over 20 years with 14 treated falcotentorial meningiomas. Methods In the past 20 years, 14 patients with falcotentorial junction meningiomas were surgically treated. There were seven men and seven women, whose ages ranged from 34 to 79 years. On the basis of neuroimaging studies, the authors analyzed the influence of the anatomical relationship of the tumor to the vein of Galen, patency of the vein of Galen, tumor size, and the signal intensities on the magnetic resonance images to determine possible difficulties that might be encountered during surgery and to prognosticate the outcome of surgery. Depending on the relationship with the vein of Galen, tumors were labeled as either a superior or an inferior type. All tumors were resected via an occipital transtentorial approach. The surgical outcome in eight patients was excellent; in the remaining six patients, it was fair. Of the prognostic factors, tumor location especially seemed to be the most important (p < 0.01, Fisher exact test). The outcome associated with the inferior type of tumor was significantly less optimal probably due to the relationship to the deep veins and the brainstem. In this series, the occlusion of deep veins did not significantly influence outcome. Conclusions Classification of the tumor location by preoperative neuroimaging studies can be helpful in estimating the surgical difficulty that might be encountered in treating the falcotentorial junction meningioma.

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01-2 The relationship of mammographic density to surgical outcome and histologic findings in patients with ductal carcinoma in situ

Academic Radiology ◽

10.1016/s1076-6332(00)80251-2 ◽

2000 ◽

Vol 7 (11) ◽

pp. 1038

Keyword(s):

Mammographic Density ◽

Ductal Carcinoma In Situ ◽

Surgical Outcome ◽

Carcinoma In Situ ◽

Ductal Carcinoma ◽

Relationship Of ◽

The Relationship

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The relationship of the scleractinian corals to the rugose corals

Paleobiology ◽

10.1017/s0094837300025707 ◽

1980 ◽

Vol 6 (02) ◽

pp. 146-160 ◽

Cited By ~ 29

Author(s):

William A. Oliver

Keyword(s):

Critical Points ◽

Scleractinian Corals ◽

Convincing Evidence ◽

Early Triassic ◽

Rugose Corals ◽

History Of ◽

The Subject ◽

Relationship Of ◽

The Relationship ◽

Biologic Factors

The Mesozoic-Cenozoic coral Order Scleractinia has been suggested to have originated or evolved (1) by direct descent from the Paleozoic Order Rugosa or (2) by the development of a skeleton in members of one of the anemone groups that probably have existed throughout Phanerozoic time. In spite of much work on the subject, advocates of the direct descent hypothesis have failed to find convincing evidence of this relationship. Critical points are:(1) Rugosan septal insertion is serial; Scleractinian insertion is cyclic; no intermediate stages have been demonstrated. Apparent intermediates are Scleractinia having bilateral cyclic insertion or teratological Rugosa.(2) There is convincing evidence that the skeletons of many Rugosa were calcitic and none are known to be or to have been aragonitic. In contrast, the skeletons of all living Scleractinia are aragonitic and there is evidence that fossil Scleractinia were aragonitic also. The mineralogic difference is almost certainly due to intrinsic biologic factors.(3) No early Triassic corals of either group are known. This fact is not compelling (by itself) but is important in connection with points 1 and 2, because, given direct descent, both changes took place during this only stage in the history of the two groups in which there are no known corals.

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Skeletal elements of crinoid echinoderms: High-resolution structural and microanalytical results

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100074768 ◽

1983 ◽

Vol 41 ◽

pp. 194-195

Author(s):

D. F. Blake ◽

L. F. Allard ◽

D. R. Peacor

Keyword(s):

High Resolution ◽

Marine Invertebrates ◽

Sea Urchins ◽

Structural Features ◽

Sea Stars ◽

High Resolution Tem ◽

Relationship Of ◽

The Relationship ◽

Insight Into

Echinodermata is a phylum of marine invertebrates which has been extant since Cambrian time (c.a. 500 m.y. before the present). Modern examples of echinoderms include sea urchins, sea stars, and sea lilies (crinoids). The endoskeletons of echinoderms are composed of plates or ossicles (Fig. 1) which are with few exceptions, porous, single crystals of high-magnesian calcite. Despite their single crystal nature, fracture surfaces do not exhibit the near-perfect {10.4} cleavage characteristic of inorganic calcite. This paradoxical mix of biogenic and inorganic features has prompted much recent work on echinoderm skeletal crystallography. Furthermore, fossil echinoderm hard parts comprise a volumetrically significant portion of some marine limestones sequences. The ultrastructural and microchemical characterization of modern skeletal material should lend insight into: 1). The nature of the biogenic processes involved, for example, the relationship of Mg heterogeneity to morphological and structural features in modern echinoderm material, and 2). The nature of the diagenetic changes undergone by their ancient, fossilized counterparts. In this study, high resolution TEM (HRTEM), high voltage TEM (HVTEM), and STEM microanalysis are used to characterize tha ultrastructural and microchemical composition of skeletal elements of the modern crinoid Neocrinus blakei.

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Studies on Leukemogenic and Sarcomagenic Viruses

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100067777 ◽

1970 ◽

Vol 28 ◽

pp. 156-157

Author(s):

Leon Dmochowski

Keyword(s):

Electron Microscopy ◽

Electron Microscope ◽

Morphological Properties ◽

Mode Of Development ◽

Relationship Of ◽

The Relationship

Electron microscopy has proved to be an invaluable discipline in studies on the relationship of viruses to the origin of leukemia, sarcoma, and other types of tumors in animals and man. The successful cell-free transmission of leukemia and sarcoma in mice, rats, hamsters, and cats, interpreted as due to a virus or viruses, was proved to be due to a virus on the basis of electron microscope studies. These studies demonstrated that all the types of neoplasia in animals of the species examined are produced by a virus of certain characteristic morphological properties similar, if not identical, in the mode of development in all types of neoplasia in animals, as shown in Fig. 1.

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The relationship of IGE receptor topography to signaling activity in RBL-2H3 mast cells

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100085484 ◽

1991 ◽

Vol 49 ◽

pp. 236-237

Author(s):

J.R. Pfeiffer ◽

J.C. Seagrave ◽

C. Wofsy ◽

J.M. Oliver

Keyword(s):

Mast Cells ◽

Protein A ◽

Scattered Electron ◽

Ige Receptor ◽

Receptor Complexes ◽

Ige Binding ◽

Electron Imaging ◽

Small Clusters ◽

Relationship Of ◽

The Relationship

In RBL-2H3 rat leukemic mast cells, crosslinking IgE-receptor complexes with anti-IgE antibody leads to degranulation. Receptor crosslinking also stimulates the redistribution of receptors on the cell surface, a process that can be observed by labeling the anti-IgE with 15 nm protein A-gold particles as described in Stump et al. (1989), followed by back-scattered electron imaging (BEI) in the scanning electron microscope. We report that anti-IgE binding stimulates the redistribution of IgE-receptor complexes at 37“C from a dispersed topography (singlets and doublets; S/D) to distributions dominated sequentially by short chains, small clusters and large aggregates of crosslinked receptors. These patterns can be observed (Figure 1), quantified (Figure 2) and analyzed statistically. Cells incubated with 1 μg/ml anti-IgE, a concentration that stimulates maximum net secretion, redistribute receptors as far as chains and small clusters during a 15 min incubation period. At 3 and 10 μg/ml anti-IgE, net secretion is reduced and the majority of receptors redistribute rapidly into clusters and large aggregates.

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