A radiological study of vertebral and rib malformations in children with myelomeningocele

Postmortem radiographs from 112 infants with thoracolumbosacral or lumbosacral myelomeningoceles were surveyed for associated vertebral and rib malformations. Sixty-four exhibited a variety of anomalies including hemivertebrae, fused vertebral bodies, fused vertebral arches, fused ribs, absence of ribs and absence of vertebral bodies. Anomalies were commonly associated with the cranial end of a dysraphic spina bifida region; in addition hemivertebrae and rib fusion exhibited peak incidences centred around the seventh cervical and fourth thoracic vertebra respectively. Fusion of vertebral arch elements increased in frequency throughout the thoracic region towards T10. The twelfth pair of ribs were absent in 20% of cases. Apparent absence of vertebral bodies from the caudal end of the vertebral column was seen in 24% of the radiographs.     

Color Doppler sonography in penetrating injuries of the neck.

PURPOSETo determine whether color Doppler sonography can be a sensitive alternative to screening arteriography for identifying arterial injury in patients with penetrating traumatic neck injuries.METHODSFifty-two patients admitted to our trauma center with penetrating neck injuries (gunshot wounds and lacerations) were examined prospectively with color Doppler sonography, and findings were compared with the results of angiography (n = 44), with findings at surgery (n = 4), and with clinical status (n = 4).RESULTSColor Doppler sonography correctly detected all serious injuries of the carotid arteries (n = 6; 5 diagnosed at angiography and 1 at surgery) and all injuries of the vertebral arteries (n = 4; all diagnosed at angiography). Sonography missed 1 instance of reversible narrowing of the internal and external carotid arteries and did not show 2 normal vertebral arteries.CONCLUSIONColor Doppler sonography was as accurate as angiography in screening clinically stable patients with zone II or III injuries and no signs of active bleeding. Our initial results suggest that in the future, sonography may be used as a screening examination for arterial lesions in patients with penetrating neck injuries.     

Intracranial abnormalities in infants treated with extracorporeal membrane oxygenation: update on sonographic and CT findings.

PURPOSETo determine the frequency of intracranial lesions in infants treated with extracorporeal membrane oxygenation (ECMO), to evaluate trends in frequency during an 8-year period, and to determine which infants are at highest risk for intracranial injury.METHODSDaily sonograms were obtained in 386 infants during treatment with ECMO. Cranial CT scans were acquired after decannulation in 286 of 322 survivors. Abnormalities were classified as major or minor and hemorrhagic or nonhemorrhagic. Results were correlated with infant demographic data.RESULTSIntracranial abnormalities were detected in 203 (52%) of the 386 infants; 73 (19%) hemorrhagic, 86 (22%) nonhemorrhagic, and 44 (11%) combined lesions. Eighty-two lesions (21%) were classified as major. Forty-six (94%) of 49 major hemorrhages were identified at sonography. CT contributed additional information in 73% of neonates with intracranial abnormalities, of which 17 were major lesions not identified at sonography. The frequency of intracranial hemorrhage was increased in infants who were septic or premature or weighed less than 2.5 kg. An increase in time spent on ECMO bypass increased the risk for nonhemorrhagic injury. During an 8-year period, the frequency of hemorrhagic and major nonhemorrhagic lesions remained constant, whereas minor nonhemorrhagic abnormalities increased significantly.CONCLUSIONInfants treated with ECMO continue to be at high risk for cerebrovascular injury. Although daily sonograms are useful in identifying major hemorrhages, follow-up CT scans are crucial for accurate evaluation of intracranial abnormalities.     

CT angiographic evaluation of the V3 vertebral artery course in cases of occipitalized atlas,a study of 25 cases

ObjectivesTo study the relationship of the 3rd segment of the vertebral artery to the posterior arch of the atlas in patients with occipitalized atlas, using CT angiography.MethodsA retrospective study of 25 cases with complete or partially occipitalized atlas who underwent CT angiography evaluation. Fifty vertebral arteries were analyzed in relation to the respective/related half of the posterior arch of the atlas.ResultsOut of 50 vertebral arteries, 35 (70%) were anomalous; 31 (62%) traversed though bony canal between the fused occiput and atlas, and 4 (8%) coursed between C1 and C2 (C2 segmental type of vertebral artery). Except one, all anomalous vertebral arteries were associated with a fused corresponding side of posterior arch of atlas.ConclusionThe V3 portion of the vertebral artery assumes an anomalous course at the craniovertebral junction in most cases of occipitalized atlas, and this is strongly determined by the fusion status of the posterior arch of the atlas. Aberrations in its course are still seen despite expectations based on this fusion status. Preprocedural CT Angiography provides accurate information of its course to prevent iatrogenic VA injuries.Advances in knowledgeCT Angiography should be performed before any procedures at the craniovertebral junction in cases of occipitalized atlas to prevent iatrogenic, potentially catastrophic injuries to vertebral artery due to its anomalous course in most of these cases. There are very few such studies in the literature, none in radiology literature. We also describe some rare cases, including a case never described in any literature.     

Spinal imaging features in Japanese patients with Marfan syndrome: a case-control study

Purpose

The purpose of our study was to evaluate the morphology of the lumbosacral spine, i.e. the dura and vertebral body shape, of Japanese patients with Marfan syndrome (MFS) by comparing it with sex- and age-matched controls.

Materials and methods

Spinal MR or CT images of 32 MFS patients and 32 controls were retrospectively reviewed. The anteroposterior dural sac diameter (DSD), anteroposterior vertebral body diameter (VBD), and vertebral body height (VBH) were measured from L1 to S1 levels and the dural sac ratio [DSR = (DSD/VBD)] and vertebral body aspect ratio [VAR = (VBH/VBD)] were calculated.

Results

At each level, mean DSD and DSR were significantly higher in MFS patients; VBD was not. The cutoff values for DSR to differentiate between MFS patients and the controls were 0.59, 0.46, 0.42, 0.45, 0.47, and 0.47 from the level of L1 to S1. At a sensitivity of 93.8 % and a specificity of 84.4 % the cutoff value at S1 was most diagnostic. In MFS patients VAR was significantly higher at L3 and L4.

Conclusion

Our cutoff value for DSR >0.47 at S1 may help to identify MFS in the Japanese population. A square-like appearance of the L3 and L4 vertebral bodies is a supplementary finding in MFS patients.     

Parallel and spiral flow patterns of vertebral artery contributions to the basilar artery.

PURPOSETo demonstrate that the in vivo flow from individual vertebral arteries can be imaged and tracked in the basilar artery by use of saturation planes with three-dimensional time of flight MR angiography.METHODSTwenty volunteers were studied with intracranial three-dimensional time of flight angiography MR. The MR angiography was repeated with saturation of the individual vertebral arteries. Flow voids and signal intensity within the basilar and posterior cerebral arteries were evaluated for flow patterns.RESULTSOf 15 volunteers with a "normal" vertebrobasilar anatomy, 80% demonstrated a pattern of flow within the basilar artery in which the contributing vertebral components remained ipisilateral. This pattern was called "parallel." A "spiral" pattern of rotation of the contributing vertebral components was found in 20% of studies. The inflow to the posterior cerebral arteries could be identified from specific vertebral contributions and was related to the size-dominance of the vertebral artery.CONCLUSIONThere is nonadmixture of vertebral artery flows of variable duration within the basilar artery; at least two patterns of flow can be described within the basilar artery. The method presented is a simple technique for determining vertebral artery flow components with routine software and without secondary data manipulation.     

Characterizing the Location of Spinal and Vertebral Levels in the Human Cervical Spinal Cord

BACKGROUND AND PURPOSE:Advanced MR imaging techniques are critical to understanding the pathophysiology of conditions involving the spinal cord. We provide a novel, quantitative solution to map vertebral and spinal cord levels accounting for anatomic variability within the human spinal cord. For the first time, we report a population distribution of the segmental anatomy of the cervical spinal cord that has direct implications for the interpretation of advanced imaging studies most often conducted across groups of subjects.MATERIALS AND METHODS:Twenty healthy volunteers underwent a T2-weighted, 3T MRI of the cervical spinal cord. Two experts marked the C3–C8 cervical nerve rootlets, C3–C7 vertebral bodies, and pontomedullary junction. A semiautomated algorithm was used to locate the centerline of the spinal cord and measure rostral-caudal distances from a fixed point in the brain stem, the pontomedullary junction, to each of the spinal rootlets and vertebral bodies. Distances to each location were compared across subjects. Six volunteers had 2 additional scans in neck flexion and extension to measure the effects of patient positioning in the scanner.RESULTS:We demonstrated that substantial variation exists in the rostral-caudal position of spinal cord segments among individuals and that prior methods of predicting spinal segments are imprecise. We also show that neck flexion or extension has little effect on the relative location of vertebral-versus-spinal levels.CONCLUSIONS:Accounting for spinal level variation is lacking in existing imaging studies. Future studies should account for this variation for accurate interpretation of the neuroanatomic origin of acquired MR signals.

Advanced MR imaging techniques of the human spinal cord are critical to understanding the pathophysiology of conditions such as traumatic injury, degenerative spondylosis, or neuroinflammatory conditions such as multiple sclerosis. These techniques provide the opportunity to assess subclinical changes in spinal cord structure and function. For example, diffusion tensor imaging and magnetization transfer can be used to follow the integrity of white matter tracts in specific regions of the human spinal cord¹; fMRI can be used to track the spinal response to a particular stimulus, reflecting the integrity of specific functional circuits.² Recently, the microstructure of the corticospinal motor pathway was mapped; imaging characteristics of this map correlated with clinical function.³ The ultimate goal of early detection of subclinical recovery or deterioration should be to personalize treatment strategies in both the acute and chronic phases of injury.A prerequisite to accurate interpretation of advanced imaging data is appreciating the neuroanatomic origin of the acquired signal. An imaging atlas brings prior spatial knowledge to an imaging dataset. Advanced brain imaging has benefited from the design and improvement of brain atlases that allow registration of various functional and structural imaging studies.^4,5 Atlases of the spinal cord are not as developed. Despite recent initiatives for creating a generic template of the spinal cord,⁶ most previous templates have been created by individual research groups to meet the objectives of specific studies. For example, manually segmented templates have been created on the basis of specific anatomic information of the nerve rootlet position.² Perhaps most common is to infer neuroanatomic positions within the spinal cord by counting the adjacent vertebral bodies and stating that, for example, the C6 spinal cord segment is adjacent to the C5 vertebral body.⁷ This latter approach coincides with widely accepted neuroanatomy textbooks, but the error associated with vertebral body measurements to predict the immediate caudal spinal cord segment has not been investigated. The diversity of human anatomy offers 2 principal sources of variability: 1) intersubject differences in spinal column anatomy, and 2) intersubject differences in spinal cord segments relative to a fixed point in the brain stem. The work presented here considers these 2 sources of diversity across a cohort of healthy individuals and presents a unique solution, a “spinal level map,” which can be applied in advanced MR imaging assessment of the human cervical cord.In this work, we impart a neuroanatomic context to single-subject high-resolution images of the cervical spine by delineating the location of vertebral bodies and spinal cord segments down the central axis of the spinal cord. Thus, we account for the personal anatomy of single subjects. Using expert markings as ground truth data, we report the distribution of vertebral and spinal cord segments across our cohort of 20 subjects. To the best of our knowledge, this is the first article that presents a quantitative, accurate solution to delineate the anatomic variability of the human cervical spinal cord. We anticipate that this approach will dramatically enhance the accuracy of quantitative MR imaging–based assessment of the normal and diseased spinal cord.     

Sonographic characteristics of the cavum velum interpositum.

BACKGROUND AND PURPOSEDifferential considerations for pineal region CSF collections include both true cysts and normal cystlike anatomic variations. Our purpose was to determine the sonographic characteristics of pineal region fluid spaces that reflect the presence of a normal persistent cavum velum interpositum (CVI).METHODSEighteen neonates and infants who had sonographic findings of "cysts" in the pineal region were examined prospectively with conventional sonography and color Doppler sonography to evaluate the shape of the fluid collection and its anatomic relationship with the color-coded internal cerebral veins. Subsequent MR images were obtained in eight of these infants to determine the exact nature of the cystlike collections.RESULTSThe cystlike spaces in the pineal region were of an inverted helmet shape in 14 subjects and roundish in four. All were situated inferior or slightly anteroinferior to the splenium of the corpus callosum and 2.5 to 4 mm away from the quadrigeminal plate. The internal cerebral veins were either inferior (n = 12) or inferolateral (n = 6) to the cystlike spaces at sonography. Subsequent MR studies confirmed eight of these cystlike spaces to be the posterior portion of the CVI.CONCLUSIONThe CVI may appear as a cyst in the pineal region on neonatal sonograms. Usually, it has a characteristic inverted helmet shape and is situated beneath the fornices and above the internal cerebral veins.     

Wertigkeit der diffusionsgewichteten MRT in der Beurteilung von Knochenmarkveränderungen bei Wirbelkörpermetastasen

Aim of the study. The aim of the study was the evaluation of the diffusion coefficient (ADC) of vertebral metastasis and regular vertebral bodies with diffusion weighted MRI (DWI). DWI evaluates the tissue-specific molecular diffusion of protons. In tissues with high cell densities (neoplasm) a decreased ADC can be expected due to restricted diffusion according to an exaggerated amount of intra- and intercellular membranes (i. e. diffusion barriers). Methods. In 5 breast cancer patients the ADC of both known vertebral metastases and of adjacent regular vertebral bodies were measured with DWI (1.0 T; Phased-Array-Body-Coil; b: 880 and 440 s/mm²). Results. The ADC of regular vertebral bodies (1.3±0.23×10^–,3s/mm²) was significantly (p≤0.0002) higher than in vertebral metastases (0.39±0.11×10^–3s/mm²). Conclusions. These data demonstrate that the ADC can be reliably measured in vertebral bodies. The quantitative evaluation of the ADC in vertebral bodies seems to be an objective and comparable parameter for differentiating malign from benign vertebral tissue.     

Ultrasonographic evaluation of vertebral venous valves

To date, vertebral venous valves have not been studied clinically or by sonography. This report reveals that these valves could be studied noninvasively by using sonographic techniques. Real-time sonography clearly showed the opening and closing of the two cusps of vertebral venous valves at the junction of the vertebral vein and the brachiocephalic vein, which move synchronously with the internal jugular venous valves. This is the first time the vertebral venous valves have been studied by using clinical sonography. This might provide a new point of view for evaluating the clinical significance of vertebral venous valves.     

Echography in hip dysplasia in neonates and infants. Echographic anatomy, technic and case material

The value of hip joint sonography in newborns and unweaned infants is the latest development in the diagnosis of hip dysplasia. Knowledge of the sonographic anatomy makes accurate examination and staging according to Graf's tables possible. Since sonography is non-invasive it can be used for screening and check-up, thus reducing the use of radiography. A personal series of 250 patients is presented.     

Proton MR spectroscopy of brain abnormalities in neonates born to HIV-positive mothers.

PURPOSETo examine the sensitivity of proton MR spectroscopy for detecting early central nervous system abnormalities in neonates born to human immunodeficiency virus (HIV)-positive mothers.METHODSAsleep, unsedated, and continuously monitored by electrocardiography, 10 newborns, 5 with HIV-positive and 5 with HIV-negative mothers, were studied within the first 10 days of life in a 1.5-T scanner. After T1- and T2-weighted images were obtained, proton spectra were performed using voxels of interest (3.4 cm3) in the deep parietooccipital white matter. Peaks were identified as N-acetyl-aspartate (2.0 ppm), creatine and phosphocreatine (3.0 ppm), choline (3.2 ppm), and inositol (3.5 ppm). Peak areas were used to calculate metabolic ratios: N-acetyl-aspartate to creatine, inositol to creatine, and creatine to choline.RESULTSAll newborns of HIV-positive mothers had abnormal proton spectra compared with control infants; a nonspecific amino acid peak in the 2.1- to 2.6-ppm area was elevated, broad, and overlapping the N-acetyl-aspartate peak in all the HIV-exposed newborns and in only 1 of the 5 control newborns. The choline-to-creatine ratio was higher in HIV-exposed newborns at 2.3 +/- 0.4 (normal term, 0.9 +/- 0.3), as was the N-acetyl-aspartate-to-creatine ratio at 2.6 +/- 0.9 (for control subjects, 1.2 +/- 0.4). MR images from these brain regions were all considered normal. Because acquired immunodeficiency syndrome develops in only a small fraction of neonates born to HIV-seropositive mothers, the above spectral abnormalities found in all our subjects may result from indirect effects of HIV, such as intrauterine growth retardation.CONCLUSIONSThese findings indicate that proton MR spectroscopy might play an important role in detecting early central nervous system complications in newborns of HIV-seropositive mothers.     

Assessment of the bone mineral density in the lumbar vertebrae of newborns by quantitative computed tomography

 Objective. To assess the true mineral density (BMD, in g/cm³) of the lumbar spine in newborns. Design and patients. A post-mortem analysis of five infants with gestational ages ranging from 35 to 40 weeks, and birth weights from 2765 to 3200 g, was conducted using dual-energy quantitative computed tomography (QCT; Siemens Somatom DR). A 2 or 4 mm thick slice was obtained for each lumbar vertebra from L1 to L4. The density measured in these vertebrae was corrected by reference to a solid phantom (Osteo-CT) measured simultaneously. A three-dimensional image of the spine (Elscint CT Twin), as well as a photomicrograph of histological preparation from L2 vertebra, were also obtained in another term baby for comparison with the CT results. Results and conclusions. In the range of values studied, the vertebral densities were not dependent on birth weight. BMD values measured in L2, L3 and L4 were not significantly different, but were 10% lower than in L1 in four of five infants. The spatial resolution of the QCT protocol used (0.4 mm) did not permit the differentiation of trabecular and cortical bone, and the vertebral bodies appeared very homogeneous and dense, with a mean density value of 210±30 mg Ca/cm³, which is 2.5 times higher than the mean maximum value found in young normal adults. These preliminary results highlight the potential of QCT in neonatology. Special protocols will, however, need to be developed for in vivo measurements in this particular paediatric field.     

Facet Joint Signal Change on MRI at Levels of Acute/Subacute Lumbar Compression Fractures

BACKGROUND AND PURPOSE:The prevalence of facet joint signal change in acute/subacute lumbar vertebral body compression fractures is unknown. We hypothesized that facet joint signal change on MR imaging is more common in facet joints associated with an acute/subacute lumbar compression fracture than those associated with normal vertebral bodies or ones that have a chronic compression fracture.MATERIALS AND METHODS:Three neuroradiologists and a neuroradiology fellow retrospectively graded facet joint inflammatory change on MR imaging in 900 facet joints in 75 patients with at least 1 painful osteoporotic lumbar compression fracture. Facet joint signal change was assessed on T2-weighted images with chemical fat-saturation, STIR images, and/or gadolinium-enhanced T1-weighted images with chemical fat-saturation. Each facet joint from the T12/L1 to L5/S1 level was assessed individually. An overall facet joint signal-change score, which is a composite measure of the grade of signal change for all 4 facet joints associated with a given lumbar vertebral level, was devised, and statistical significance was assessed via Wilcoxon rank sum tests.RESULTS:The overall facet joint signal-change scores were significantly higher at vertebral body levels affected by an acute/subacute compression fracture compared with control levels, which were associated with either normal bodies or chronic compression fractures.CONCLUSIONS:Our findings suggest an association between facet joint signal change on MR imaging and acute/subacute lumbar vertebral body compression fractures.

The exact source of pain from osteoporotic vertebral compression fractures and the mechanism of pain relief with vertebral augmentation remain unknown. There is recent evidence that pain associated with vertebral compression fractures can arise from the posterior elements, presumably from increased strain on facet joints.^1,2 Microscopically, facet joint capsules are richly imbued with receptors sensitive to stretch or inflammation.³While most literature indicates that chronic morphologic changes of facet joints are not predictive of facet joint pain,⁴ there is evidence that facet joint inflammation manifest as bone scan activity, facet joint hyperintensity on fat-suppressed T2-weighted MR imaging, or facet joint enhancement on gadolinium-enhanced MR imaging is predictive.^5,6 MR imaging evidence of facet joint signal change, defined as T2 hyperintensity or enhancement on fat-suppressed images, adjacent to compression fractures has not been characterized to date, to our knowledge. We hypothesized that evidence of facet joint signal change on MR imaging is more common in facet joints associated with an acute/subacute lumbar compression fracture than in facet joints adjacent to vertebral bodies that are either normal or have a chronic compression fracture.     

Lumbar spine in Marfan syndrome

Lumbar spine radiographs of 28 patients with Marfan syndrome and a gender and age-matched control group were evaluated for scoliosis and morphologic changes of the L2, L3, and L4 vertebrae. No patient or control subject had any serious low back problems. The Marfan patients showed a high incidence of scoliosis (64%). The incidence of lumbosacral transitional vertebra was also high (18%). The end plates of the vertebral bodies in the Marfan patients were more biconcave than in the control group. In addition, the transverse processes were longer in relation to the vertebral body width in the Marfan group than in the controls. These findings indicate that biconcave vertebral bodies can be added to the list of skeletal manifestations of the Marfan syndrome, and Marfan syndrome to the list of differential diagnoses for biconcave vertebrae (codfish vertebrae).     

In Not Only Vertebroplasty but Also Kyphoplasty,the Resolution of Vertebral Deformities Depends on Vertebral Mobility

BACKGROUND AND PURPOSE:It has not been clarified whether the postoperative resolution of vertebral deformities achieved by KP are superior to those achieved by VP. We compared the outcomes of KP and VP, taking into account the presence of vertebral mobility, to determine whether the balloon inflation in KP may contribute to postoperative resolution of the vertebral deformities in patients with VCFs.MATERIALS AND METHODS:The subjects had 34 vertebral bodies treated by VP, and 43 vertebral bodies treated by KP. In all patients, preoperative dynamic imaging was performed to assess the presence of vertebral mobility. First, the vertebral height restoration and kyphotic change were compared between the VP and KP groups. Then, the patients were further divided into 2 groups on the basis of the presence of vertebral mobility, and they were compared within and between the VP and KP groups in relation to the presence of vertebral mobility.RESULTS:Overall, no significant differences were observed in either the vertebral height restoration or kyphotic change between the VP and KP groups (P > .20). Preoperative dynamic imaging identified 19 vertebral bodies each with vertebral mobility in the VP (56%) and KP groups (44%) (P = .21). Within the VP and KP groups, the vertebral height restoration and kyphotic changes were significantly better in patients with vertebral mobility than in those without (P < .01). There were no significant differences between the 2 treatment groups after adjustment for the presence of vertebral mobility (P > .30).CONCLUSIONS:In both the VP and KP groups, the vertebral height restoration and kyphotic change largely depended on the preoperative vertebral mobility. The use of the balloon itself contributed little to resolution of the vertebral deformities.

Balloon kyphoplasty is now considered as minimally invasive and effective as conventional percutaneous vertebroplasty for rapid pain relief in patients with painful vertebral compression fractures resistant to conservative treatment.^1–9 KP is a treatment procedure that was developed with the expectation that it would provide better resolution of vertebral deformities than VP because of the insertion and inflation of a balloon within the collapsed vertebral body. Although some reports show that the postoperative height restoration and kyphotic changes achieved by KP are significantly superior to those achieved by VP,^10–13 others report scarce differences in these outcomes between balloon KP and VP,^14–16 and no consensus has yet been reached. It has been reported that the presence of vertebral mobility associated with pseudoarthrosis of the fractured vertebral bodies greatly influences the postoperative height restoration and kyphotic changes after conventional VP^17–20; however, the influence of vertebral mobility on the outcomes of KP has been studied very little.²¹ The present study aimed at comparing the postoperative height restoration and kyphotic changes between patients with VCFs undergoing VP and KP, according to the presence or absence of preoperative vertebral mobility.     

Essential hypertension and neurovascular compression at the ventrolateral medulla oblongata: MR evaluation.

PURPOSETo investigate, using MR imaging, neurovascular compression at the ventrolateral medulla oblongata in patients with essential hypertension.METHODSThirty-two patients with essential hypertension (57.6 +/- 7 years of age), 6 patients with secondary hypertension (56.7 +/- 10.3 years of age), and 18 control subjects (50.5 +/- 11 years of age) were evaluated. Transaxial three-dimensional fast low angle shot images were obtained (38/6/1 [repetition time/echo time/excitations]). The center of a 40-mm-thick slab (16 partitions) was placed at the pontomedullary junction. We evaluated the relationships between the upper ventrolateral medulla and the vertebral arteries and branches identified by their flow-related hyperintensities in each group.RESULTSIn the essential hypertension group, 29 (90.6%) of 32 cases showed neurovascular compression. Of those, 22 demonstrated neurovascular compression on the left side, 3 on both sides, and 4 on the right side. In the control group, 4 cases of 18 showed neurovascular compression. In the secondary hypertension group, 1 of 6 cases showed neurovascular compression. The rates of observed neurovascular compression between controls and essential hypertension group were statistically significant.CONCLUSIONWe found a close correlation between essential hypertension and neurovascular compression at the ventrolateral medulla oblongata on the left side. MR with a 3-D fast low-angle shot sequence has acceptable spatial resolution and depicts blood vessels simultaneously by flow-related phenomena.     

The feasibility study of US-MRI virtual navigation in the shoulder

PurposeThe aim of this study was to evaluate the feasibility of ultrasound sonography (US)–magnetic resonance imaging (MRI) virtual navigation in the shoulder.MethodsWe selected 10 healthy volunteers and 10 patients with supraspinatus tendinitis to fuse in the shoulder with a Virtual Navigator System. We selected five internal marks as follows: (1) ① acromion, ② the point of junction between the supraspinatus muscle and the tendon, ③ the point of the middle in the surface of the head of humerus in the plane of ②, ④ the point of attachment of the supraspinatus tendon in the great tuberosity of humerus, and ⑤ the point of the middle in the surface of the head of humerus in the plane of ④. To make three, four, and five marks in different combinations in the process of image fusion successively, it should be based on these points. The observed targets included coincidence, stability, and accuracy in the sonography and magnetic resonance images by two radiologists.ResultsThe supraspinatus tendon of the 10 volunteers and the lesions of 10 patients with supraspinatus tendinitis could be fused between the sonography image and the magnetic resonance image. The effect of the combination of ②+③+④+⑤ in the group with four-point internal marks was most satisfactory (P<.05).ConclusionThe process of the combination of ②+③+④+⑤ in the group with four-point internal marks is considered the best method, and the application of US-MRI virtual navigation is regarded feasible in the shoulder.     

Is ultrasound useful in detection and follow-up of gastric foreign bodies in children?

ObjectiveThe objective was to show potential value of ultrasound in detection and follow-up of gastric foreign bodies.Material and methodsMedical records of 18 children with gastric foreign bodies were evaluated retrospectively.ResultsThe following gastric foreign bodies were identified: eight coins, five button batteries, domino, lollipop stick, hairclip, screw nut, and small plastic cylinders. All were confirmed by ultrasound. The batteries, domino, and two coins were removed endoscopically, the screw nut was removed surgically, while the rest were recovered in the stool.ConclusionsUltrasound examination of water-filled stomach can be useful in diagnostic workup of gastric foreign bodies in children, especially radiolucent ones.