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

Avulsion fracture of the acromion is rare. It is difficult to diagnosis because there is little displacement and it occurs even without direct trauma. We experienced a case without direct trauma that was diagnosed with ultrasonography. A 55-year-old male patient visited our outpatient clinic with shoulder pain resulting from a significant stress at the trapezius muscle during lifting of a steel reinforcement. Simple radiography revealed a calcific deposit over the acromion rather than a fracture. Avulsion fracture was identified with ultrasonography. This is the first report demonstrating that ultrasonography has an advantage over radiographs in the diagnosis of an avulsion fracture of the acromion of the scapula.
Acromion* ; Ambulatory Care Facilities ; Diagnosis* ; Fractures, Bone ; Humans ; Lifting ; Male ; Middle Aged ; Radiography ; Scapula ; Shoulder Pain ; Steel ; Superficial Back Muscles ; Ultrasonography

In a group of 109 patients with low back pain, the electromyographic(EMG) findings were compared with computed tomographic (CT) findings. There were 64 (58.7%) patients who had abnormal EMG results combined with abnormal CT findings. 11 (10.1%) cases had abnormal EMG and normal CT findings, another 11 (10.1%) patients had abnormal CT and normal EMG findings. 33 patients underwent operation; nerve root compressions were confirmed in all those with abnormal EMG findings, and 32 of those with abnormal CT findings. Among 33 surgical cases, 24 (72.7%) patients had abnormal EMG findings in both paralumbar and lower extremity muscles. In 9 (27.3%) patients there was evidence of abnormal EMG findings in the paralumbar muscles only. Among 46 who had abnormal EMG findings in paralumbar and lower limb muscles, 44 (95.6%) patients had combined CT abnormalities, and in the remaining 2 patients, nerve root 'compression was confirmed by surgery in 1 case and by myelogram in the other. In 29 cases with abnormal EMG findings in the paralumbar muscles only, 20 (69.0%) patients had combined CT abnormalities. In comparing normal versus abnormal EMG findings of the paralumbar muscles only, a significantly higher percentage of abnormal CT results were found among the abnormal EMG findings. These results indicate that abnormal EMG findings in both the paralumbar and lower limb muscles, strongly suggests the presence of nerve root compression. In cases where there are abnormal EMG findings in the paralumbar muscles only, it is recommended that CT scan must be done for the correct diagnosis of low back pain.
Adolescent ; Adult ; Aged ; Back Pain/*diagnosis/*radiography ; Child ; Comparative Study ; *Electromyography ; Evaluation Studies ; Female ; Human ; Lumbosacral Region ; Male ; Middle Age ; *Tomography, X-Ray Computed

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