Magnetic Resonance Imaging Examinations of Gluteal Decubitus Ulcers in Spinal Cord Injury Patients

Abstract

The purpose of our study was to use magnetic resonance imaging (MRI) to determine deep changes in soft tissues and bones underlying decubitus ulcers which occur in spinal cord injury (SCI) patients. By diagnosing these deep changes adjacent to decubitus ulcers, MRI can facilitate proper clinical management and prevent contraindicated surgery. MRI evaluation was performed on 37 male SCI patients for a total of 44 diagnostic studies. The studies were evaluated by the following criteria: 1) the presence of an adjacent fluid collection, 2) bone involvement raising the possibility of osteomyelitis and 3) heterotopic bone formation. Results demonstrated 11 patients (29.7 percent) with fluid collection in the deep soft tissues underlying the decubitus ulcer and eight patients (21.6 percent) with abnormal adjacent bone marrow signal. Four patients (10.8 percent) had heterotopic bone formation near the ulcer. We conclude that MRI is helpful in determining the depth and extent of soft tissue involvement underlying decubitus ulcers including underlying fluid collections, heterotopic bone formation and evidence of adjacent bone marrow edema. This is beneficial in planning proper therapy. (J Spinal Cord Med 1996; 19:5–8.)     

Magnetic Resonance Imaging of Pressure Sores in Spinal Cord Injured Patients: Accuracy in Predicting Osteomyelitis

Objective:

Identify key magnetic resonance imaging (MRI) features that have a significant correlation with osteomyelitis of pressure ulcers in spinal injury patients.

Design:

Retrospective review study.

Participants:

Adult patients admitted to the National Spinal Injuries Centre with spinal cord injury (SCI) and signs of pressure ulceration investigated with MRI.

Methods:

Analysis of MRI examinations and clinical records collected over a 4-year period. Images were independently assessed by 2 experienced radiologists for osteomyelitis based on assigned predictive indicators including cortical bone erosion, soft tissue edema, deep collections, heterotopic new bone, hip effusion, and abnormal signal change of the marrow.

Results:

Thirty-seven patients underwent 41 MRI scans. The prevalence of osteomyelitis was highly correlated with cortical bone erosion (r = 0.84) and abnormal bone marrow changes on T1-weighted images (r = 0.82).     

Efficacy and Safety of Terazosin to Improve Voiding in Spinal Cord Injury Patients

Abstract

A total of 28 male spinal cord injury (SCI) patients were enrolled in an open label study to evaluate the efficacy and safety of terazosin to improve voiding. All patients were started on 1 mg daily dose at bedtime. The dosage was gradually increased to 1–2 mg twice daily, depending upon patient tolerance and a minimum acceptable systolic blood pressure of 90 mm Hg. Urodynamic evaluation was done in 24 patients prior to and one week after a maximum tolerated dose was established for at least 48 hours. The maximum dose varied from 1 to 5 mg daily. Subjective improvement in voiding was noticed in 50 percent of patients. Objective assessment with urodynamics showed a mean drop in maximum voiding pressure of 35 cm H2O (range 9–65 cm H2O) in only 42 percent of patients. Subjective improvement in voiding occurred in 14 of 17 patients with absent detrusor sphincter dyssynergia. The drug was discontinued in three patients with side effects of syncope in one patient, lethargy in another and body rash in the third. Because the tolerance dose of terazosin is variable and the therapeutic response is unpredictable, urodynamic monitoring is recommended to accomplish a useful outcome. (J Spinal Cord Med; 18:236–239)     

Etiology of Lumbosacral Radiculoplexopathy: Sacral Insufficiency Fracture on Magnetic Resonance Imaging

HSS Journal ® - Sacral insufficiency fracture (SIF) can cause lumbosacral radiculoplexopathy (LSRP) and is probably under-recognized. Symptoms may include nonspecific lumbar spine or buttock...     

Magnetic Resonance Imaging Data in the Evaluation of Effects of Functional Electrical Stimulation on Knee Joints of Adolescents with Spinal Cord Injury

Abstract

Diagnostic imaging, consisting of roentgenograms and magnetic resonance images (MRIs), was performed as part of an evaluation of the effects of a functional electrical stimulation (FES) program on the knee joints of 29 adolescents with spinal cord injuries following implantation of fine-wire intramuscular electrodes in their lower extremity muscles. The subjects underwent a regimen consisting of stimulated exercise, standing and/or walking. The effects of FES on knee joints were prospectively studied by reviewing diagnostic imaging data. Evaluation of MRIs and plain radiographs showed no evidence of knee joint pathology secondary to FES exercise or weight bearing. In fact, based on follow-up of MRI scan, many of the joints improved following participation in the program. The MRI data supported the clinical examination of the knee joints of these children. Clinical examination appears adequate for screening for potential knee joint problems.     

Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS) is a common entrapment syndrome whose diagnosis can be difficult. We compared preoperative magnetic resonance imaging (MRI) and operative findings in 23 consecutive TTS patients (28 sides) whose mean age was 74.5 years. The 1.5T MRI sequence was 3D T2* fat suppression. We compared the MRI findings with surgical records and intraoperative videos to evaluate them. MRI- and surgical findings revealed that a ganglion was involved on one side (3.6%), and the other 27 sides were diagnosed with idiopathic TTS. MRI visualized the nerve compression point on 23 sides (82.1%) but failed to reveal details required for surgical planning. During surgery of the other five sides (17.9%), three involved varices, and on one side each, there was connective tissue entrapment or nerve compression due to small vascular branch strangulation. MRI studies were useful for nerve compression due to a mass lesion or idiopathic factors. Although MRI revealed the compression site, it failed to identify the specific involvement of varices and small vessel branches and the presence of connective tissue entrapment.     

Spinal Hydatid Cyst Mimicking Arachnoid Cyst on Magnetic Resonance Imaging

Abstract

Background: Primary spinal hydatid cysts are uncommon and account for 1% of all cases of hydatid disease. Echinococcus granulosus is most often responsible for the cyst hydatid. Intradural, extramedullary involvement is rare. When the cysts do not demonstrate typical magnetic resonance imaging findings, the differential diagnosis is more complex.

Method: Case report.

Findings: An isolated primary hydatid cyst of the spine in a 35-year-old man that appeared to be an arachnoid cyst on preoperative radiographic examination.

Conclusion: Hydatid cysts that lack the typical radiographic appearance may be mistaken for arachnoid cysts. Misdiagnosis has serious implications for surgical intervention and long-term care.     

The Value of Sympathetic Skin Response Recordings in the Assessment of the Vesicourethral Autonomic Nervous Dysfunction in Spinal Cord Injured Patients

Purpose

We assessed the degree of sparing of the descending sympathetic spinal tract and correlated these findings with bladder neck function in spinal cord injured patients.

Materials and Methods

Sympathetic skin responses of the right hand and foot were recorded and compared to the urodynamic findings in 27 spinal cord injured patients.

Results

All tetraplegic and paraplegic patients with a lesion above the T6 level who presented with bladder neck dyssynergia associated with autonomic hyperreflexia had abnormal sympathetic skin responses in the right hand and foot. All patients with a lesion below the T6 and above the T12 levels with an abnormal sympathetic skin response in the right foot also had bladder neck dyssynergia.

Conclusions

Evidence is presented that the integrity of the descending sympathetic spinal tract is necessary for a synergic function of the vesicourethral complex and that sympathetic skin responses are of value in the diagnosis of bladder neck dyssynergia. For lesions below the T12 level other investigative methods to exclude bladder neck dyssynergia are necessary.     

Outcome of Transanal Irrigation for Bowel Dysfunction in Patients With Spinal Cord Injury

Background/Objective:     

磁共振成像在复发性肛瘘中的应用价值

为探讨磁共振成像（magneticresonanceimaging,MRI）在复发性肛瘘中的应用价值,回顾40例复发性肛瘘患者的MRI表现,总结分析其内口位置特点、瘘管走行形态以及肛提肌侵犯范围等。MRI采用Philips1．5T超导型磁共振扫描机,软体线圈,检查体位为仰卧位。采用横断：TIWI自旋回波（SE）序列,T2WI快速自旋回波（FSE）序列,T2WI脂肪抑制（FAT—SAT）序列。冠状及斜冠状位：T2WIFSE序列。层厚5ram,间隔lmm。结果显示,40例复发性肛瘘患者均为高位肛瘘,手术证实均存在内口,其中38例术中所见与MRI表现一致,该38例患者内口均位于肛窦附近（32例存在1个内口,6例存在2个内口）;另2例MRI检查各序列及断面均未显示内口。瘘管长度7．0～16．0cm（其中走行平直23例,走行迂曲17例）;瘘管宽度0．8～3．0cm。瘘管走行于肌间者32例,走行于肛提肌内者8例。本组患者瘘管壁均不规则,其厚度为0．3～1．0cm。瘘管存在支管者11例;内盲瘘1例。瘘管仅侵犯耻骨直肠肌者4例,仅侵犯髂骨尾骨肌者9例,耻骨直肠肌及髂骨尾骨肌同时受侵27例;并发瘘管组织癌变1例。结果表明,MRI能准确显示内口的位置、瘘管走行及肛提肌受侵范围、程度,在复发性肛瘘术前检查中具有重要作用。     

腰骶神经根囊肿的临床诊断和治疗探讨

目的：探讨腰骶神经根囊肿的临床诊断及治疗方法。方法：27例神经根囊肿患者，男17例，女10例，年龄42～65岁，平均53．6岁。其中有7例保守治疗，20例行手术治疗。手术中13例行囊肿大部分切除，残余部分缝合包绕囊内神经根；7例行囊肿大部分切除后用骶棘肌填塞交通孔。并对腰骶神经根囊肿的临床表现以及CT、脊髓造影、MRI等影像学资料进行分析。结果：CT扫描可见椎体后缘凹陷性压迹9例。脊髓造影显示神经根有囊状充盈11例。MRI显示囊肿在Tl加权像呈低信号，T2加权像呈高信号，信号与脑脊液一致。结论：MRI对本病诊断和鉴别诊断具有重要的临床价值；对保守治疗无效者，应行椎板开窗减压和囊肿摘除术。