[en] Scoliosis may be a spinal manifestation of underlying disease and although most cases of scoliosis are idiopathic, imaging plays a very important role in determining the underlying aetiology and in monitoring the changes of the deformity that take place with growth. As a clinical problem scoliosis may present directly to the radiology department through a primary healthcare referral, or it may be referred from the paediatric, orthopaedic, spinal and neurosurgical hospital services. Growth affects all types of scoliosis irrespective of cause. There are no reliable predetermined algorithmic steps in the management of scoliosis, and treatment decisions require the inclusion of multiple extrinsic (e.g age, menarche) and intrinsic (curve magnitude, vertebral anomaly) factors. It is important to remember that most of what is known about curve behaviour and its progression applies to idiopathic scoliosis, and it is inappropriate to apply these criteria to the other specific types of scoliosis. It is imperative that radiation techniques are used judiciously to minimize the radiation burden. Although magnetic resonance imaging (MRI) has had a significant impact in the understanding of the scoliotic deformity, it is still evolving and it may well eventually play a very important role in uncovering the underlying aetiology of 'idiopathic' scoliosis. Cassar-Pullicino, V.N. and Eisenstein, S.M. (2002)

[en] AIM: To demonstrate the use of MRI with Gadolinium-DTPA enhancement in the diagnosis of giant cisterna chyli. MATERIALS AND METHODS: The study consisted of contrast enhanced MRI with ultrasound and CT correlation in three patients with a giant cisterna chyli. An analysis of the morphology, location and post-contrast MR signal characteristics in relation to time was performed. RESULTS: Cisterna chyli has a characteristic lobulated morphology and location but the unenhanced MRI appearances are not specific. The post-Gadolinium-DTPA MRI appearances are critically dependent on the time elapsed after injection of contrast medium. Within the first 5 min, there is no enhancement at all, but by 10 min there is early layering of contrast medium evident, which by 30 min produces a clear fluid-fluid level. Delayed images at 4-5 h demonstrate a uniform enhancement of the cisternal contents producing a homogeneous intermediate signal. All of these features are best visualized on T1 fast saturation sequences. CONCLUSION: MRI with Gadolinium-DTPA enhancement is valuable in confirming the nature of the lymphatic ducts in the retroperitoneal space and helps to differentiate these normal structures from alternative lesions such as lymphadenopathy and tumour recurrence. Lee, K.C.Y., Cassar-Pullicino, V.N. (2000)

[en] AIM: To study the temporal evolution of high intensity zones (HIZ) on MRI in patients with degenerative disease of the lumbar spine, and to evaluate whether any correlation exist between such evolution and in patient's symptoms. MATERIALS AND METHODS: HIZs in the MRI of 56 patients were included in the study. Each Patient had an initial and a follow-up scan performed at various time intervals. Scans were assessed for any change in HIZs by two observers (D. M. and I. W. M.). Patients' symptoms were assessed for by visual analogue score (VAS), the Oswestry Questionnaire Score (OQS) and patients' subjective assessment of change in symptoms. Any MRI feature, apart from HIZs, which could independently explain a patient's change in symptoms, was considered to be a confounding factor. Data were analysed separately in the whole group as well as in the group without confounding factors. RESULTS: On follow-up MRI, HIZs were found to have resolved in 17 lumbar disc levels (26.6%), improved in 9 (14%), worsened in 12 (18.8%) and remained unchanged in 26 (40.6%) at lumbar disc levels. Chi-square testing did not demonstrate any correlation between HIZ changes and evolution of patients' subjective symptoms (p=0.26 for the whole group; p=0.07 for the group without confounding factors). Similar lack of meaningful relationship was noted between HIZ changes and the VAS and OQS scores. CONCLUSION: We conclude that HIZs either do not change or improve spontaneously in a large proportion of cases over a period of time. Furthermore, there is no statistical correlation between HIZ changes and change in a patient's symptoms

[en] Although the rare complication of squamous cell carcinoma in chronic osteomyelitis is well known, benign squamous epithelial proliferation can also occur, causing osteolysis and fracture. The radiological and correlated pathological features of osteolysis from this benign complication of chronic osteomyelitis are presented

[en] Sacral insufficiency fractures are a well recognised cause for low back, buttock and groin pain in the elderly. However, over a 4 year period, four patients have presented with symptoms of cauda equina syndrome, who were found on investigation to have acute sacral insufficiency fracture without any other aetiological spinal abnormality. Four patients who presented to the spinal surgeons of our institution with symptoms of cauda equina syndrome were referred for spinal MR. Sagittal and axial T1 and T2 weighted turbo spin echo sequences of the lower thoracic and lumbar spine were performed on all patients. Subsequent studies included MR of the sacrum supplemented where appropriate by CT and technetium MDP bone scintigraphy. No evidence of a compressive lesion of the lower thoracic or lumbar spine was present in any of the four patients. Dedicated MR examination of the sacrum in these patients revealed unilateral acute insufficiency fractures involving zone 1 from S1 to S3 extending from the sacro-iliac joint to the lateral margin of the sacral foramen. There was no evidence of compression of the sacral nerve roots. The possible mechanism for the symptomatic presentation is discussed. Sacral insufficiency fractures should be excluded in elderly or osteoporotic patients presenting with cauda equina syndrome who have no evidence of compression in the thoraco-lumbar MR studies. (orig.)

[en] Objective. Multilevel spinal injury is well recognised. Previous studies reviewing the radiographs of spinal injury patients have shown an incidence of 15.2% of unsuspected spinal injury. It is recognised that magnetic resonance imaging (MRI) can identify injuries that are not demonstrated on radiographs. The objective of this study was to determine the incidence and significance of spinal injuries using MRI in comparison with radiographs.Design and patients. The radiographs and MR images of 110 acute spinal injury patients were reviewed independently of each other and the findings were then correlated to determine any unsuspected injury.Results. MRI detected vertebral body bone bruises (microtrabecular bone injury) in 41.8% of spinal injury patients which were not seen on radiographs. These bone bruises were best appreciated on sagittal short tau inversion recovery MR sequences and seen at contiguous and non-contiguous levels in relation to the primary injury.Conclusion. This level of incidence of bone bruises has not previously been appreciated. We recommend that patients undergoing MRI for an injured segment of the spine are better assessed by MRI of the entire spine at the same time to exclude further injury. (orig.)

[en] To examine factors which affect local recurrence of osteoid osteomas treated with percutaneous CT-guided radiofrequency thermocoagulation. A prospective study was carried out on 45 patients with osteoid osteoma who underwent percutaneous radiofrequency thermocoagulation with a minimum follow-up of 12 months There were seven local recurrences (16%); all occurred within the first year. Local recurrence was significantly related to a non-diaphyseal location (P<0.01). There was no significant relationship (P=0.05) between local recurrence and age of the patient, duration of symptoms, previous treatment, size of the lesion, positive biopsy, radiofrequency generator used or the number of needle positions. There were no complications. Osteoid osteomas in a non-diaphyseal location are statistically more likely to recur than those in a diaphyseal location when treated with CT-guided percutaneous radiofrequency thermocoagulation. This relationship between local recurrence and location has not been previously reported. (orig.)

[en] Intra-articular ganglion cysts of the cruciate ligaments are associated with non-specific clinical signs and symptoms. Familiarity with the MR appearances in particular is important to make an accurate diagnosis, exclude associated abnormalities, and avoid misdiagnosis. (orig.)

[en] Tumoral lesions related to Paget's disease may be classified as malignant, benign or pseudotumoral. While sarcomatous degeneration is the most feared complication, awareness of benign and pseudotumoral lesions is essential for assisting in accurate histological interpretation of the biopsy sample, which may avoid unnecessary repeat biopsies. We present the first case of a juxta-articular subperiosteal ganglion associated with Paget's disease, with classic imaging characteristics, especially on CT examination. The well-defined soft tissue mass at the medial aspect of the obturator rim, adjacent to a small fracture in pagetic quadrilateral plate, showed an ossified rim and internal gas lucencies, these being the hallmarks of a juxta-articular subperiosteal ganglion. On MRI, the lesion was of intermediate signal intensity on T1-weighted sequences, increased signal intensity on T2-weighted sequences, with rim enhancement after gadolinium contrast injection and preservation of fatty marrow signal of the underlying pagetic bone. Identification of the entity avoided an unnecessary biopsy or surgical intervention. (orig.)

[en] Paget's disease (PD) is a chronic metabolically active bone disease, characterized by a disturbance in bone modelling and remodelling due to an increase in osteoblastic and osteoclastic activity. The vertebra is the second most commonly affected site. This article reviews the various spinal pathomechanisms and osseous dynamics involved in producing the varied imaging appearances and their clinical relevance. Advanced imaging of osseous, articular and bone marrow manifestations of PD in all the vertebral components are presented. Pagetic changes often result in clinical symptoms including back pain, spinal stenosis and neural dysfunction. Various pathological complications due to PD involvement result in these clinical symptoms. Recognition of the imaging manifestations of spinal PD and the potential complications that cause the clinical symptoms enables accurate assessment of patients prior to appropriate management. (orig.)