Pernicious anemia (PA) is an autoimmune disease characterized by atrophic gastritis and deficiency in intrinsic factor leading to impairment of vitamin B12 absorption in the ileum. Anemia is commonly found in rheumatoid arthritis (RA); however, PA is rarely found in RA. There are few reports describing patients with both conditions; none in Korea to date. We report on a case of a 46-year-old female who presented with hypesthesia and general weakness. She was previously diagnosed as seropositive RA with myelodysplastic syndrome. She had severely impaired sensation, especially for vibration and proprioception in all limbs. Subacute combined degeneration was observed on her magnetic resonance imaging and serum vitamin B12 level was very low. Further exam results were consistent with PA and her symptoms improved with cobalamin injection. This case demonstrates that PA should be considered in RA patients presenting with both central nervous system manifestations and anemia.
Absorption ; Anemia ; Anemia, Pernicious* ; Arthritis, Rheumatoid* ; Autoimmune Diseases ; Central Nervous System* ; Extremities ; Female ; Gastritis, Atrophic ; Humans ; Hypesthesia ; Ileum ; Intrinsic Factor ; Korea ; Magnetic Resonance Imaging ; Middle Aged ; Myelodysplastic Syndromes ; Proprioception ; Subacute Combined Degeneration ; Vibration ; Vitamin B 12

Purpose: To determine the effect of axial T2-weighted images (T2WIs) scanning order on the central canal, lateral recess, and related anatomical structures in the lumbar spine. Materials and Methods: After Institutional Review Board approval and informed consent, 45 patients with low back pain (22 males and 23 females, aged between 20–83 years with median age of 60 years) underwent lumbar spine magnetic resonance examination in the supine position on a 1.5 tesla scanner. Axial T2WIs were acquired both before and after the sagittal scans (pre- and post-sagittal axial T2WIs). Two radiologists assessed the grades of the central canal and lateral recess stenosis (CCS and LRS) at the L3/4, L4/5, and L5/S1 levels. The cross-sectional areas of spinal canal (SCCSA), dural sac (DSCSA), free cerebrospinal fluid (FCSA), and ligamentum flavum (LFCSA) were measured twice from a single representative image at each disc level using a threshold-based semiautomated method. The effect of time on the CCS and LRS grades as well as cross-sectional areas was evaluated using a generalized estimating equation. Results: Time had no significant effect on the CCS and LRS grades across the three disc levels (p = 0.178 for CCS, p = 0.383 for right LRS, p = 0.378 for left LRS). However, time significantly affected the DSCSA (p < 0.001), FCSA (p < 0.001), and LFCSA (p = 0.014), but not the SCCSA (p = 0.082). The DSCSA and FCSA were larger and the LFCSA was smaller on post-sagittal axial T2WIs than on pre-sagittal axial T2WIs; estimated differences were 2.9 mm 2 (2.3%) for DSCSA, 3.0 mm 2 (3.7%) for FCSA, and -2.4 mm 2 (-1.7%) for LFCSA. Conclusion The scanning order of axial T2WIs did not affect the CCS or LRS grades.However, the DSCSA, FCSA, and LFCSA in post-sagittal axial T2WIs showed significant differences compared to that of pre-sagittal axial T2WIs, although the relative percentage differences were less than 5%.

Purpose: To determine the effect of axial T2-weighted images (T2WIs) scanning order on the central canal, lateral recess, and related anatomical structures in the lumbar spine. Materials and Methods: After Institutional Review Board approval and informed consent, 45 patients with low back pain (22 males and 23 females, aged between 20–83 years with median age of 60 years) underwent lumbar spine magnetic resonance examination in the supine position on a 1.5 tesla scanner. Axial T2WIs were acquired both before and after the sagittal scans (pre- and post-sagittal axial T2WIs). Two radiologists assessed the grades of the central canal and lateral recess stenosis (CCS and LRS) at the L3/4, L4/5, and L5/S1 levels. The cross-sectional areas of spinal canal (SCCSA), dural sac (DSCSA), free cerebrospinal fluid (FCSA), and ligamentum flavum (LFCSA) were measured twice from a single representative image at each disc level using a threshold-based semiautomated method. The effect of time on the CCS and LRS grades as well as cross-sectional areas was evaluated using a generalized estimating equation. Results: Time had no significant effect on the CCS and LRS grades across the three disc levels (p = 0.178 for CCS, p = 0.383 for right LRS, p = 0.378 for left LRS). However, time significantly affected the DSCSA (p < 0.001), FCSA (p < 0.001), and LFCSA (p = 0.014), but not the SCCSA (p = 0.082). The DSCSA and FCSA were larger and the LFCSA was smaller on post-sagittal axial T2WIs than on pre-sagittal axial T2WIs; estimated differences were 2.9 mm 2 (2.3%) for DSCSA, 3.0 mm 2 (3.7%) for FCSA, and -2.4 mm 2 (-1.7%) for LFCSA. Conclusion The scanning order of axial T2WIs did not affect the CCS or LRS grades.However, the DSCSA, FCSA, and LFCSA in post-sagittal axial T2WIs showed significant differences compared to that of pre-sagittal axial T2WIs, although the relative percentage differences were less than 5%.

Purpose: To determine the effect of axial T2-weighted images (T2WIs) scanning order on the central canal, lateral recess, and related anatomical structures in the lumbar spine. Materials and Methods: After Institutional Review Board approval and informed consent, 45 patients with low back pain (22 males and 23 females, aged between 20–83 years with median age of 60 years) underwent lumbar spine magnetic resonance examination in the supine position on a 1.5 tesla scanner. Axial T2WIs were acquired both before and after the sagittal scans (pre- and post-sagittal axial T2WIs). Two radiologists assessed the grades of the central canal and lateral recess stenosis (CCS and LRS) at the L3/4, L4/5, and L5/S1 levels. The cross-sectional areas of spinal canal (SCCSA), dural sac (DSCSA), free cerebrospinal fluid (FCSA), and ligamentum flavum (LFCSA) were measured twice from a single representative image at each disc level using a threshold-based semiautomated method. The effect of time on the CCS and LRS grades as well as cross-sectional areas was evaluated using a generalized estimating equation. Results: Time had no significant effect on the CCS and LRS grades across the three disc levels (p = 0.178 for CCS, p = 0.383 for right LRS, p = 0.378 for left LRS). However, time significantly affected the DSCSA (p < 0.001), FCSA (p < 0.001), and LFCSA (p = 0.014), but not the SCCSA (p = 0.082). The DSCSA and FCSA were larger and the LFCSA was smaller on post-sagittal axial T2WIs than on pre-sagittal axial T2WIs; estimated differences were 2.9 mm 2 (2.3%) for DSCSA, 3.0 mm 2 (3.7%) for FCSA, and -2.4 mm 2 (-1.7%) for LFCSA. Conclusion The scanning order of axial T2WIs did not affect the CCS or LRS grades.However, the DSCSA, FCSA, and LFCSA in post-sagittal axial T2WIs showed significant differences compared to that of pre-sagittal axial T2WIs, although the relative percentage differences were less than 5%.

Purpose: To determine the effect of axial T2-weighted images (T2WIs) scanning order on the central canal, lateral recess, and related anatomical structures in the lumbar spine. Materials and Methods: After Institutional Review Board approval and informed consent, 45 patients with low back pain (22 males and 23 females, aged between 20–83 years with median age of 60 years) underwent lumbar spine magnetic resonance examination in the supine position on a 1.5 tesla scanner. Axial T2WIs were acquired both before and after the sagittal scans (pre- and post-sagittal axial T2WIs). Two radiologists assessed the grades of the central canal and lateral recess stenosis (CCS and LRS) at the L3/4, L4/5, and L5/S1 levels. The cross-sectional areas of spinal canal (SCCSA), dural sac (DSCSA), free cerebrospinal fluid (FCSA), and ligamentum flavum (LFCSA) were measured twice from a single representative image at each disc level using a threshold-based semiautomated method. The effect of time on the CCS and LRS grades as well as cross-sectional areas was evaluated using a generalized estimating equation. Results: Time had no significant effect on the CCS and LRS grades across the three disc levels (p = 0.178 for CCS, p = 0.383 for right LRS, p = 0.378 for left LRS). However, time significantly affected the DSCSA (p < 0.001), FCSA (p < 0.001), and LFCSA (p = 0.014), but not the SCCSA (p = 0.082). The DSCSA and FCSA were larger and the LFCSA was smaller on post-sagittal axial T2WIs than on pre-sagittal axial T2WIs; estimated differences were 2.9 mm 2 (2.3%) for DSCSA, 3.0 mm 2 (3.7%) for FCSA, and -2.4 mm 2 (-1.7%) for LFCSA. Conclusion The scanning order of axial T2WIs did not affect the CCS or LRS grades.However, the DSCSA, FCSA, and LFCSA in post-sagittal axial T2WIs showed significant differences compared to that of pre-sagittal axial T2WIs, although the relative percentage differences were less than 5%.

No abstract available.
Diabetes Mellitus* ; Humans ; Myositis* ; Renal Dialysis* ; Vasculitis

PURPOSE: The purpose of this study was to compare the grade of fatty degeneration and atrophy of rotator cuffs on immediate postoperative MRI to those on preoperative MRI in patients with rotator cuff tears. MATERIALS AND METHODS: Seventy patients were included in this study, who received arthroscopic rotator-cuff repair and underwent both preoperative magnetic resonance imaging (MRI) and immediate postoperative MRI in our institution. Fatty degeneration of rotator cuffs and the atrophy of supraspinatus muscles were evaluated with T1 oblique sagittal images in the Y-shaped view. Fatty degeneration was evaluated using a Goutallier classification system, and the atrophy of supraspinatus muscles was evaluated using a modified tangent sign and a visual occupation ratio. RESULTS: From 70 patients, a total of 100 tendons were repaired: 18, 69, and 13 tendons were treated for subscapularis, supraspinatus, and infraspinatus, respectively. The Goutallier grades (P = 0.012), modified tangent signs (P = 0.000), and visual occupation ratios (P = 0.000) of supraspinatus muscles were significantly decreased in immediate postoperative MRIs when compared to preoperative MRIs. In immediate postoperative MRIs, the Goutallier grades of supraspinatus muscles were decreased by one grade in 18.8% (n = 13) of the patients, and the atrophy of supraspinatus muscles was improved by one grade in 26.1% (n = 18) for modified tangent signs and 21.7% (n = 15) for visual occupation ratios. However, fatty infiltration by the Goutallier grades of subscapularis (P = 1.000) and infraspinatus (P = 0.157) muscles were not significantly changed after arthroscopic surgery. CONCLUSION: Immediate postoperative MRIs showed a significant improvement of fatty degeneration and muscle atrophy in supraspinatus muscles when compared to preoperative MRIs.
Arthroscopy ; Atrophy* ; Classification ; Humans ; Magnetic Resonance Imaging* ; Muscles ; Muscular Atrophy ; Occupations ; Rotator Cuff* ; Tears ; Tendons

OBJECTIVE: To evaluate T2 relaxation time change using axial T2 mapping in a rabbit degenerated disc model and determine the most correlated variable with histologic score among T2 relaxation time, disc height index, and Pfirrmann grade. MATERIALS AND METHODS: Degenerated disc model was made in 4 lumbar discs of 11 rabbits (n = 44) by percutaneous annular puncture with various severities of an injury. Lumbar spine lateral radiograph, MR T2 sagittal scan and MR axial T2 mapping were obtained at baseline and 2 weeks and 4 weeks after the injury in 7 rabbits and at baseline and 2 weeks, 4 weeks, and 6 weeks after the injury in 4 rabbits. Generalized estimating equations were used for a longitudinal analysis of changes in T2 relaxation time in degenerated disc model. T2 relaxation time, disc height index and Pfirrmann grade were correlated with the histologic scoring of disc degeneration using Spearman's rho test. RESULTS: There was a significant difference in T2 relaxation time between uninjured and injured discs after annular puncture. Progressive decrease in T2 relaxation time was observed in injured discs throughout the study period. Lower T2 relaxation time was observed in the more severely injured discs. T2 relaxation time showed the strongest inverse correlation with the histologic score among the variables investigated (r = -0.811, p < 0.001). CONCLUSION: T2 relaxation time measured with axial T2 mapping in degenerated discs is a potential method to assess disc degeneration.
Animals ; Disease Models, Animal ; Intervertebral Disc/injuries/*pathology ; Intervertebral Disc Degeneration/*pathology ; Lumbar Vertebrae/*pathology ; Magnetic Resonance Imaging/*methods ; Male ; Punctures ; Rabbits

No abstract available.
Arthritis, Rheumatoid* ; Humans

PURPOSE: The aim of this study was to characterize the brain ultrasonographic findings of late-onset circulatory dysfunction (LCD) due to adrenal insufficiency (AI) in preterm infants. METHODS: Among the 257 preterm infants born at <33 weeks of gestation between December 2009 and February 2014 at our institution, 35 preterm infants were diagnosed with AI. Brain ultrasonographic findings were retrospectively analyzed before and after LCD in 14 preterm infants, after exclusion of the other 21 infants with AI due to the following causes: death (n=2), early AI (n=5), sepsis (n=1), and patent ductus arteriosus (n=13). RESULTS: Fourteen of 257 infants (5.4%) were diagnosed with LCD due to AI. The age at LCD was a median of 18.5 days (range, 9 to 32 days). The last ultrasonographic findings before LCD occurred showed grade 1 periventricular echogenicity (PVE) in all 14 patients and germinal matrix hemorrhage (GMH) with focal cystic change in one patient. Ultrasonographic findings after LCD demonstrated no significant change in grade 1 PVE and no new lesions in eight (57%), grade 1 PVE with newly appearing GMH in three (21%), and increased PVE in three (21%) infants. Five infants (36%) showed new development (n=4) or increased size (n=1) of GMH. Two of three infants (14%) with increased PVE developed cystic periventricular leukomalacia (PVL) and rapid progression to macrocystic encephalomalacia. CONCLUSION: LCD due to AI may be associated with the late development of GMH, increased PVE after LCD, and cystic PVL with rapid progression to macrocystic encephalomalacia.
Adrenal Insufficiency* ; Brain* ; Ductus Arteriosus, Patent ; Encephalomalacia ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Leukomalacia, Periventricular ; Pregnancy ; Retrospective Studies ; Sepsis ; Ultrasonography