Scoliosis circa 2000: radiologic imaging perspective

Plain film imaging remains important for the diagnosis and surveillance of scoliosis, as well as for the detection of complications after surgery. New means of treating scoliosis have become established and should be understood by the radiologist. To the well-known postoperative complications, including pneumothorax, pneumonia, and gastrointestinal obstruction, are added new specific potential problems with the new surgical methodology.     

Spinal osteoblastoma: relationship between paravertebral muscle abnormalities and scoliosis

 Objective. To illustrate the variety of paravertebral muscle abnormalities as seen on computed tomography (CT) or magnetic resonance imaging (MRI) in association with spinal osteoblastomas and correlate the findings with the presence of scoliosis. Design. In a retrospective study the clinical notes, plain radiographic, CT and/or MRI features were reviewed for the presence of scoliosis and paravertebral muscle abnormality (either inflammation or atrophy). Patients. Twelve patients (7 male, 5 female) with a mean age of 17 years were studied. Three lesions occurred in the cervical spine, five in the thoracic spine and four in the lumbar spine. Results and conclusions. Nine patients had scoliosis. All patients with a thoracic or lumbar lesion and scoliosis (n=8) had an associated abnormality of the paravertebral muscles (usually atrophy with fatty replacement). One patient with a lumbar lesion and no scoliosis had normal paravertebral muscles. One patient with a cervical lesion had thoracic scoliosis but no muscle abnormality in the cervical region, while two patients with cervical lesions and no scoliosis showed muscle abnormalities. The results support the clinical hypothesis that scoliosis in patients with spinal osteoblastoma is due to paravertebral muscle spasm, although this would not appear to be the case for cervical lesions.     

Scoliosis in cystic fibrosis — An appraisal

An unusually high prevalence (10%) of scoliosis is described in a series of 151 patients aged four years and older with cystic fibrosis. The scolioses were of the late onset (juvenile and adolescent) type, being typically thoracic with the curve convex to the right, although there was no significant preference for either sex. No direct relationship was found between the spinal curvature and the severity or distribution of the lung disease, although the worse scolioses tended to occur in patients with relatively severe pulmonary involvement. There was no evidence of metabolic bone disease as a predisposing cause. Some indication of a familial tendency towards scoliosis was apparent, and a genetic or constitutional basis is postulated with an unknown precipitating factor.     

Imaging in scoliosis: what,why and how?

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.     

MR imaging features of brain stem hypoplasia in familial horizontal gaze palsy and scoliosis

We report the case of a child with horizontal gaze palsy, pendular nystagmus, and discrete thoracolumbar scoliosis. MR imaging of the brain depicted pons hypoplasia with an absence of the facial colliculi, hypoplasia, butterfly configuration of the medulla, and the presence of a deep midline pontine cleft (split pons sign). These MR imaging findings suggest familial horizontal gaze palsy with progressive kyphoscoliosis, a rare congenital disorder. To the best of our knowledge, MR imaging findings of only 4 similar cases, with or without progressive idiopathic scoliosis, have been reported. We discuss the pathogenesis substratum of this entity. Early recognition of this rare entity is important if supportive therapeutic measures in progressive scoliosis are to be applied.     

脊柱椎体单纯性和病理性压缩骨折的磁共振成像

椎体压缩性骨折在临床上并不少见，病因有骨质疏松、外伤所致的单纯性椎体压缩与病理性压缩骨折。对不同病因引起的椎体压缩性骨折，治疗原则和方法有极大的区别，因此病因的鉴别对临床诊断和治疗有非常重要的意义。本文比较了单纯性和病理性脊柱压缩骨折的不同影像诊断方法及常规磁共振上两者的不同表现与鉴别点，同时详细介绍了磁共振的新技术——弥散技术在鉴别单纯性和病理性脊柱压缩骨折的应用。     

磁共振三点定位技术在脊柱侧弯中的应用

目的　探讨MRI 3点定位 ( 3PPS)技术在脊柱侧弯中的应用价值。方法　对 12例普通X线平片显示脊柱侧弯的患者 ,应用MRI 3PPS扫描技术 ,采用自旋回波T1WI及T2 WI序列 ,完成在 1幅图像上显示整个脊柱及椎管内脊髓全貌。结果　 12例中1例失败 ,其余 11例均可在 1幅图像上完整显示扭曲的脊柱及椎管内脊髓的全貌 ,了解脊柱侧弯的程度、椎体骨质异常及椎管内脊髓受压变形等改变。结论　磁共振 3PPS技术的应用 ,大大提高了对脊柱畸形诊断的直观性和准确性 ,对手术治疗有极大的指导作用     

Imaging features of spinal osteoid osteoma with emphasis on MRI findings

A retrospective evaluation of the imaging of 13 patients with a diagnosis of osteoid osteoma (OO) of the spine was undertaken. Available imaging included radiographs (n=10), computed tomography (CT) (n=13), bone scintigraphy (n=5) and magnetic resonance imaging (MRI) (n=13). MRI features evaluated were pattern of neural arch and vertebral body oedema and the presence of an identifiable nidus. MRI features were correlated with other available imaging. There were seven males and six females with an age range of 8–59 years. On radiographs, scoliosis was present in ten and a sclerotic pedicle in nine patients. Focal increased uptake on bone scintigraphy consistent with OO was seen in all five patients where scintigraphy was available. On CT, a nidus was identified in all patients and reactive sclerosis was seen in 12. MRI demonstrated the nidus in eight patients and unilateral neural arch oedema with anterior extension to involve the ipsilateral posterolateral vertebral body in 11. When MRI is performed in the evaluation of back pain, the presence of unilateral neural arch oedema extending to involve the posterolateral vertebral body raises the possibility of spinal OO and should prompt CT to confirm the presence of a nidus.     

Spinal curves and scoliosis

Scoliosis, an abnormal side-to-side curve of the spine with associated vertebral rotation, affects as many as 4% of all adolescents. Several different categories of scoliosis exist, and treatment can range from observation and follow-up to bracing and surgical correction. This article discusses special imaging series for scoliosis and emphasizes the need for proper radiation protection techniques for patients with scoliosis, most of whom are girls in their early to mid-teens.     

Resolution of Ga-67 citrate uptake in the left neck mass of Hodgkin's disease and reversion of double scoliosis of cervical-thoracic and lower lumbar vertebrae

A 6-yr-old boy underwent a total body Ga-67 citrate imaging study because of a large mass of Hodgkin's lymphoma in the left neck and the left anterior chest wall region. The images showed intense uptake in the left neck extending anteroinferiorly to the left upper chest wall corresponding to the left neck and chest region. In addition, there was mild cervical-upper thoracic scoliosis with convexity to the right and mild scoliosis of the lower lumbar scoliosis with concavity to the left. After three cycles of chemotherapy, in the follow-up Ga-67 citrate total body images seven months after his first Ga-67 citrate imaging, the intense uptake in the left neck and the left upper chest wall had been resolved and the scoliosis of the cervical-thoracic and lower lumbar spine had also been reversed to normal. This case shows that a Ga-67 citrate imaging study is useful for first diagnosis and subsequent monitoring of the therapeutic effects in a follow-up imaging. Also Ga-67 citrate imaging provided evidence that the scoliosis had been reversed.     

Childhood scoliosis: MR imaging

The spinal cords of 28 scoliosis patients between the ages of 1 month and 17 years were examined with magnetic resonance (MR) imaging. Complete visualization was obtained in all cases. In 15 patients (53%) neuropathologic abnormalities demonstrated by MR imaging significantly affected their clinical course, including tethered cords (n = 7), syringomyelia (n = 5), Arnold-Chiari I malformation (n = 4), spinal cord tumors (n = 2), Arnold-Chiari II malformation (n = 3), and diastematomyelia (n = 1). The advantages of MR imaging in the evaluation of the scoliotic spine in children include a high sensitivity for the occult conditions associated with scoliosis, good anatomic demonstration of the cord, and absence of bone artifacts. MR imaging is recommended as a primary imaging modality in scoliosis, following conventional radiography.     

Imaging in spinal trauma

Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given.     

Imaging in scoliosis from the orthopaedic surgeon's point of view

For treating patients with scoliosis orthopaedic surgeons need diagnostic imaging procedures in order to provide answers about a possible underlying disease, choice of treatment, and prognosis. Once treatment is instituted, imaging is also critical for monitoring changes of the deformity so as to optimize therapy. The combined effort of orthopaedic surgeons and radiologists helps detect treatable causes of scoliosis at an early stage, define the need and timing for surgery, and ensure that every precaution is taken to minimize the risks of surgery. Neurosurgical causes, with particular reference to spinal cord tumours and syringomyelia, need to be addressed before scoliosis surgery can be contemplated.     

Scoliosis imaging: An analysis of radiation risk in the CT scan projection radiograph and a comparison with projection radiography and EOS

IntroductionScoliosis is defined as a deformity of the spine with lateral curvature in the coronal plane. It requires regular X-ray imaging to monitor the progress of the disorder, therefore scoliotic patients are frequently exposed to radiation. It is important to lower the risk from these exposures for young patients. The aim of this work is to compare organ dose (OD) values resulting from Scan Projection Radiograph (SPR) mode in CT against projection radiography and EOS^® imaging system when assessing scoliosis.MethodsA dosimetry phantom was used to represent a 10-year old child. Thermoluminescent dosimetry detectors were used for measuring OD. The phantom was imaged with CT in SPR mode using 27 imaging parameters; projection radiography and EOS machines using local scoliosis imaging procedures. Imaging was performed in anteroposterior, posteroanterior and lateral positions.Results17 protocols delivered significantly lower radiation dose than projection radiography (p < 0.05). OD values from the CT SPR imaging protocols and projection radiography were statistically significant higher than the results from EOS. No statistically significant differences in OD were observed between 10 imaging protocols and those from projection radiography and EOS imaging protocols (p > 0.05).ConclusionEOS has the lowest dose. Where this technology is not available we suggest there is a potential for OD reduction in scoliosis imaging using CT SPR compared to projection radiography. Further work is required to investigate image quality in relation to the measurement of Cobb angle with CT SPR     

Anterior spinal artery stroke demonstrated by echo-planar DWI

Diffusion-weighted MR (DWI) is becoming an established method for the investigation of cerebral ischemia. Its value in spinal ischemia has to be demonstrated. We report on a patient presenting with postoperative paraparesis who underwent emergency MRI of the spine with echo-planar diffusion-weighted imaging which showed an area of hyperintensity corresponding to a decrease of diffusion as measured by the apparent diffusion coefficient. On follow-up imaging spinal stroke was confirmed. In conclusion, spinal echo-planar MR imaging can demonstrate ischemic changes despite strong echo-planar artifacts. It could become an important adjunct to the management of patients with suspected spinal ischemia.     

脊柱病变多层螺旋CT的应用价值

目的：探讨多层螺旋CT对于脊柱病变的诊断价值。方法：搜集脊柱病变患者18例，其中脊柱骨折7例，颈椎后纵韧带骨化2例，腰椎结核2例，特发性脊柱侧弯7例。所有患者经多层螺旋CT扫描，MIP、MPR／CPR、3D-SSD与4D-Angio重建，分析不同处理后图像的应用价值。结果：MRP／CPR应用简捷，可矢状、冠状观察骨性病变的部位与程度，但对于胸椎骨折或侧弯，由于受到肋骨重叠的显示而不适用于评价胸椎骨折；3D-SSD可观察骨性结构的破坏，但缺乏对椎管形态的显示，4维重建可清晰评价脊柱骨折与脊柱侧弯的所有相关表现，通过调节不同密度阈值可显示出椎管内形态，尤其适用观察骨折、侧弯的分类与椎管的状况。结论：多层螺旋CT可全脊柱扫描，其多种后处理技术的应用可全面评价脊柱病变，4维重建可清晰评价脊柱病变的所有相关表现，而MIP不适用于对脊柱的评价。     

Spine infection/inflammation

This article discusses the imaging of infectious and other inflammatory conditions that affect the spinal cord, spinal column, intradural spinal nerve roots, and spinal meninges with emphasis on magnetic resonance (MR) imaging. Inflammatory lesions of the spine are often indistinguishable on imaging and even on pathologic examination. However, infectious causes are treatable so it is important for the radiologist to make the diagnosis. The most common inflammatory and infectious conditions affecting the anatomic compartments of the spine are described, following an external to internal anatomic approach. Subsequently, several infectious pathogenic agents are discussed individually as they affect the spinal column and its contents.     

Spinal fusion-hardware construct: Basic concepts and imaging review

The interpretation of spinal images fixed with metallic hardware forms an increasing bulk of daily practice in a busy imaging department. Radiologists are required to be familiar with the instrumentation and operative options used in spinal fixation and fusion procedures, especially in his or her institute. This is critical in evaluating the position of implants and potential complications associated with the operative approaches and spinal fixation devices used. Thus, the radiologist can play an important role in patient care and outcome. This review outlines the advantages and disadvantages of commonly used imaging methods and reports on the best yield for each modality and how to overcome the problematic issues associated with the presence of metallic hardware during imaging. Baseline radiographs are essential as they are the baseline point for evaluation of future studies should patients develop symptoms suggesting possible complications. They may justify further imaging workup with computed tomography, magnetic resonance and/or nuclear medicine studies as the evaluation of a patient with a spinal implant involves a multi-modality approach. This review describes imaging features of potential complications associated with spinal fusion surgery as well as the instrumentation used. This basic knowledge aims to help radiologists approach everyday practice in clinical imaging.     

Evaluation of the cervical spine in the obtunded patient

Assessment of cervical spine stability in the posttraumatic obtunded patient can be difficult to accomplish with currently available imaging modalities. Dynamic fluoroscopy during passive flexion and extension has been proposed by some authors as a method for the evaluation of cervical spine stability. We present our experience with dynamic fluoroscopy, the general opinions of multiple trauma centers, and alternative methods for evaluating cervical spine stability in the obtunded patient. The potential risks and problems associated with each method are discussed.