Abdominal Pain ; diagnosis ; diagnostic imaging ; Back Pain ; diagnosis ; diagnostic imaging ; Humans ; Male ; Pancreatitis ; diagnosis ; diagnostic imaging ; Radiography ; Recurrence ; Young Adult

Low back pain and gait disturbance began at 6 months of pregnancy in a twenty-eight years old female patient. She could not walk by herself after delivery because of severe pain and limitation of motion on pelvis. Irregular bony destruction on right sacroiliac joint and rotation of pelvis demonstrated on plain radiography. Tuberculosis was confirmed by CT guided needle biopsy. Back pain developing during pregnancy and after delivery can by overlooked as osteitis condensans ilii or nonspecific back pain. Tuberculous sacroilitis should be suspected for the patient with severe pelvic pain and bony destruction on sacroiliac joint, and with rotation of pelvis after delivery. Early diagnosis and proper treatment by anti-tuberculous medication could obtain satisfactory functional outcome. We have described an unusual case of tuberculous sacroiliitis associated with pregnancy in a 28 years old female patient and her clinical presentation, radiological features and outcome of medical treatment are discussed.
Adult ; Back Pain ; Biopsy, Needle ; Early Diagnosis ; Female ; Gait ; Humans ; Low Back Pain ; Osteitis ; Pelvic Pain ; Pelvis ; Pregnancy* ; Radiography ; Sacroiliac Joint ; Sacroiliitis ; Tuberculosis

BACKGROUNDDiscography is a gold standard for the diagnosis of the low back pain (LBP), but it has potential dangers for the development of discitis, cerebral spinal fluid leakage, retroperitoneal bleeding, acute new back pain and the tremendous radiation exposure to the patient. Using "evidence-based radiology" methods, the comparative roles of high intensity zone (HIZ) in diagnosing discogenic LBP were evaluated.

METHODSA focused clinical question was designed and a Pubmed and manual search were performed to identify the role of HIZ on MRI T2WI compared with discography. The studies retrieved were assessed for validity and strength. Sensitivity, specificity, likelihood ratios (LRs) and graphs of conditional probability were evaluated from the best current study by evidence-based radiology.

RESULTSBest evidence was retrieved in ten articles from 1992 to 2007. The best evidence level was 1b and the strength of the evidence included: sensitivity 0.63 (0.51, 0.76), specificity 0.97 (0.92, 1.00), positive predictive value 0.95, negative predictive value 0.72, positive LRs 18.37 and negative LRs 0.38. The gold standard of discogenic LBP is the provocative discography.

CONCLUSIONSFor suspected discogenic LBP, HIZ is limited for the diagnosis if HIZ is positive, which suggests further discography. In contrast HIZ is a good test for diagnosis if HIZ is negative, which indicates the disease can be excluded.

Humans ; Intervertebral Disc ; diagnostic imaging ; Low Back Pain ; diagnosis ; diagnostic imaging ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Radiography

OBJECTIVE: To investigate the diagnostic value of magnetic resonance imaging (MRI) in early detection of sacroiliitis, to identify risk factors of early sacroiliitis, and to propose a diagnostic algorithm for early ankylosing spondylitis (AS). METHOD: Twenty-nine consecutive patients with inflammatory back pain (IBP) and unclear sacroiliitis (unilateral grade 2> or=sacroiliitis in plain radiography (PR) based on modified New York criteria) were studied. Clinical features of spondyloarthropathy, HLA B27 positivity, and MR image set of the sacroiliac (SI) joints were obtained. Two radiologists interpreted MR images independently to diagnose definite sacroiliitis. An association between sacroiliitis in MRI and each clinical and laboratory feature was assessed with linear logistic regression analysis. Post-test probability was determined with sensitivity/specificity of clinical and laboratory features. RESULTS: MRI showed definite sacroiliitis in sixteen patients. The most frequently noted finding was erosion and high signal intensity lesion within the joint cavity in gadolinium enhanced T1-weighted images. Unilateral grade 2> or =sacroiliitis in PR was the only significant risk factor of definite sacroiliitis in MRI. When unclear sacroiliitis in PR, more than one clinical feature of spondyloarthropathy, and HLA B27 were found, probability of AS was 83% in a proposed diagnostic algorithm. CONCLUSION: MRI of the SI joints can detect sacroiliitis in more than half of patients with IBP and unclear sacroiliitis in PR. Unilateral grade 2> or =sacroiliitis in PR was a risk factor of definite sacroiliitis in MRI. A diagnostic algorithm for early detection of AS is proposed.
Back Pain ; Early Diagnosis* ; Gadolinium ; Humans ; Joints ; Logistic Models ; Magnetic Resonance Imaging* ; Radiography ; Risk Factors ; Sacroiliitis* ; Spondylarthropathies ; Spondylitis, Ankylosing

No abstract available.
Adolescent ; Back Pain/diagnosis/*etiology/surgery ; Decompression, Surgical ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Osteoblastoma/*complications/pathology/radiography/surgery ; Pain Measurement ; Radiotherapy, Adjuvant ; Spinal Neoplasms/*complications/pathology/radiography/surgery ; *Thoracic Vertebrae/pathology/radiography/surgery ; Tomography, X-Ray Computed ; Treatment Outcome

A giant vertebral notochordal rest is a newly described, benign entity that is easily confused with a vertebral chordoma. As microscopic notochordal rests are rarely found in adult autopsies, the finding of a macroscopic vertebral lesion is a new entity with only seven previously presented cases. We report here radiological findings, including diffusion weighted images, of a patient with a giant notochordal remnant confined to the L5 vertebra, with an emphasis on its distinction from a chordoma.
Chordoma/*diagnosis ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging/methods ; Female ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/pathology/radiography ; Magnetic Resonance Imaging/*methods ; Middle Aged ; Notochord/*pathology/radiography ; Physical Therapy Modalities ; Spinal Neoplasms/*diagnosis/therapy ; Tomography, X-Ray Computed

BACKGROUND: The prediction of lumbar back muscle degeneration is important because chronic low back pain and spino-pelvic imbalance have been known to be related to it. However, gender difference should be considered because there are different quality and volume of muscles between genders. The purpose of this study was to search for clinical and radiological factors to predict the degree of lumbar back muscle degeneration according to gender difference. METHODS: We reviewed 112 patients (44 men and 68 women) with spinal stenosis who underwent a decompressive surgery between 1 January 2009 and 31 December 2011. Degrees of lumbar back muscle degeneration were classified into three categories by the fatty infiltration at each L3-4 disc level on the axial view of T1 magnetic resonance imaging (MRI). Age, sex, bone marrow density score, and body mass index (BMI) were obtained from chart reviews. Lumbar lordosis, sacral slope, pelvic tilt (PT), and pelvic incidence were calculated with lumbar spine standing lateral radiographs. The degrees of spinal stenosis and facet arthropathy were checked with MRI. Student t-test, chi-square test, or Fisher exact test were used to compare clinical and radiological parameters between genders. Analysis of variance (ANOVA) and linear regression analysis were used to search for a relationship between lumbar back muscle degeneration and possible predictive factors in each gender group. RESULTS: Many clinical and radiological parameters were different according to gender. The age, BMI, and PT in the female group (p = 0.013, 0.001, and 0.019, respectively) and the PT in the men group (p = 0.018) were predictive factors to be correlated with lumbar back muscle degeneration. CONCLUSIONS: The PT was the important predictive factor for lumbar back muscle degeneration in both, the male and the female group. However, age and BMI were predictive factors in the female group only.
Aged ; Back Muscles/*pathology/physiopathology/radiography ; Chronic Disease ; Decompression, Surgical ; Female ; Humans ; Low Back Pain/*diagnosis/physiopathology/surgery ; Lumbosacral Region ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postural Balance ; Posture ; Predictive Value of Tests ; Retrospective Studies ; Spinal Stenosis/*diagnosis/physiopathology/surgery

OBJECTIVETo explore the diagnostic value of lumbar disc imagery applied for patients with discogenic lumbodynias and the outcome of lumbar fusion and the significance of the imagery technique in choosing the joints and sections for fusion.

METHODSThe lumbar imagery technique was applied for 35 patients who suffered from discogenic lumbodynias, involving 74 discs. All the cases got MRI and CT scanning. The results of the imagery and MRI were observed and induced pains were recorded. According to the imagery results, 20 out of the 35 patients received lumbar fusion and were followed up.

RESULTSAmong 35 patients, the induced pains occurred at 22 discs in 20 patients (57.1%). All the 22 segments in 20 patients with positive reaction were given lumbar fusion. The follow-up time was 10 months to 2 years with an average of 15 months. Based on the renewed MacNab standard, the results were excellent in 13 cases,good in 4 cases, fair in 2 cases, bad in 1 case. Fifteen patients with negative reaction were given conservative treatment and pains disappeared completely in 5 patients, disappeared nearly in 7 patients, no changes or became worse in 3 patients. Six patients including 9 lumbar discs neighboring the fusion segments who were found no changes in MRI scan and no induced pains in lumbar discography, were not given fusion treatment. Meantime, 1 patient was given fusion treatment because his neighboring symptom-free discs getting more deteriorative resulted in the happen of serious symptoms.

CONCLUSIONLumbar imagery technique has its unique value in the diagnosis and selective treatment of lumbar-disc-related pains. Lumbar fusion of the intervertebral space causing pains can eliminate the suffering of patients. It is appropriate to select those deteriorating discs with symptoms in deciding the fusion segments.

Adult ; Female ; Humans ; Intervertebral Disc ; diagnostic imaging ; Low Back Pain ; diagnosis ; therapy ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography

OBJECTIVETo study correlation between high intensity zone (HIZ) of lumbar disc and positive pain response on lumbar discography for the diagnosis and treatment of discogenic low back pain.

METHODSThirty-seven cases with chronic low back pain without neurologic symptoms and lumbar disc herniation on CT scan underwent lumbar discography and MRI examination. X-ray and CT after discography with positive pain response were analyzed to correlate with HIZ on MRI.

RESULTSNinety-eight discs underwent discography in 37 patients. Twenty-one discs presented positive pain response; including 10 have HIZ (47.6%). Seventy-seven discs presented negative pain response; including 29 had HIZ (37.6%). The higher grade of annular disruption group had the higher proportion of HIZ on lumbar MRI. There was a positive correlation between HIZ and degree of annular disruption. However, there was no correlation between HIZ and positive pain response on lumbar discography.

CONCLUSIONSHIZ on lumbar MRI only can be a filtrated and suggestive image sign and can not replace discography in the diagnosis and treatment of discogenic low back pain.

Humans ; Intervertebral Disc ; diagnostic imaging ; Low Back Pain ; diagnosis ; diagnostic imaging ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Radiography ; Sensitivity and Specificity

OBJECTIVETo analyzed the relationship between lumbar endplate Modic area changes rate and low back pain by measuring MRI T2 sagittal image of lumbar endplate Modic area changes rate.

METHODSFrom December 2011 to June 2012,70 patients with low back pain in operation were evaluated on pain by VAS and function by JOA,and examined by MRI including 39 males and 31 females with an average age of (51.00 +/- 11.89) years ranging from 29 to 72 years old. Among them, 54 cases had lumbar endplate Modic changes involving 15 cases in types Modic I ,21 cases in type Modic II, 11 cases in type Modic III ,mixed type Modic in 7 cases (eliminated for too few cases). Modic area changes and corresponding vertebral area were measured on MRI T2 median sagittal. The areas of two ways were compared to yield the rate of changes for Modic, for multisegmental Modic changes to calculate the total ratios. A correlation was observed among JOA, VAS and the rate of Modic changes.

RESULTSThe correlation coefficient of change rate of Modic I with JOA score was r = -0.308, P = 0.048 < 0.05, there was a negative correlation;the correlation coefficient of change rate of Modic I with VAS scores was r = 0.428,P = 0.021 < 0.05, there was a positive correlation. The correlation coefficient of change rate of Modic II with JOA score was r = -0.375, P = 0.043 < 0.05, there was a negative correlation;the correlation coefficient of change rate of Modic II with VAS score was r = 0.352, P = 0.041 < 0.05, there was a positive correlation. The area change rate of Modic III had no significant correlation with low back pain degree (P > 0.05).

CONCLUSIONModic I and II area changes rate of of patients with low back pain is closely related to the degree of pain low back pain, Modic III area changes rate is not significant correlated to the degree of lower back pain.

Adult ; Aged ; Female ; Humans ; Low Back Pain ; diagnosis ; diagnostic imaging ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography