Cauda equina syndrome in ankylosing spondylitis: a case report and review of the literature

Summary The cauda equina syndrome (CES) is an infrequently recognised and poorly understood complication of ankylosing spondylitis (AS). We report a case of CES with enlarged caudal sac and multiple posterior arachnoid diverticula eroding the laminae and spinous processes of the lumbosacral vertebrae in a patient with long-standing AS. The diagnosis was established using computerised tomography (CT) and magnetic resonance imaging (MRI).     

Coexistence of spinal arteriovenous malformation and ankylosing spondylitis — Are they related?

Summary A 50-year-old man with long standing ankylosing spondylitis developed cauda equina syndrome, which was found to be coexistent with a spinal arterio-venous maliformation. Paraplegia ensued following an acute exacerbation of back pain along with an attack of uveitis. Vasculitis changes were found on resected abnormal vessels.     

Vestibular syndrome in multiple myeloma: Role of magnetic resonance imaging

Summary The authors report a case of multiple myeloma involving the temporal bone and responsible for a vestibular syndrome associated with hypoacusis. The lesion was best visualised by magnetic resonance imaging.     

Cauda equina syndrome complicating ankylosing spondylitis: use of electromyography and computerised tomography in diagnosis.

A case of the cauda equina syndrome complicating ankylosing spondylitis (AS) is described. An unusual feature of this case was the relapsing and remitting nature of the condition, but there is sufficient evidence to explain the clinical picture on the basis of a recurrent intraspinal inflammatory process. The clinical and radiological features are similar to those of a further 28 reported in the literature. An electromyogram (EMG) proved important in defining the extent of neurological involvement. Computerised tomography (CT) showed marked laminar erosion and no bony exit foramen encroachment. We believe that the clinical diagnosis of this condition can be adequately confirmed with plain radiology, EMG, and CT scan.     

Combination of transverse myelitis and arachnoiditis in cauda equina syndrome of long-standing ankylosing spondylitis: MRI features and its role in clinical management

The cauda equina syndrome (CES) is a rare neurological complication of ankylosing spondylitis (AS). Imaging diagnosis of CES in long-standing AS patients (CES-AS) using myelography, computed tomography (CT), and magnetic resonance imaging (MRI) were reported in the literature. They, however, demonstrate only the chronic abnormalities of CES-AS, i.e., dural ectasia, dorsal dural diverticula, and selective bone erosion at the posterior elements of the vertebrae. To our knowledge, imaging features of acute intradural inflammation in CES-AS were not described. We report a patient of CES-AS in whom MRI disclosed acute transverse myelitis and arachnoiditis along the lower spinal cord, and discuss the pathogenesis of CES-AS and the role of MRI in clinical management.     

Coexistence of diffuse idiopathic skeletal hyperostosis and ankylosing spondylitis

Summary To the best of our knowledge, only two patients with concurrent diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) have been reported so far. Here we present 3 patients in whom clinical and radiological findings indicative of DISH and AS coexisted. Two of these cases exhibited HLA B27. Although the presence of sacroiliitis would appear to exclude DISH, calcification and ossification of the anterior common vertebral ligament (ACVL) confirmed diagnosis of the latter disease.     

Early-stage hip involvement in patients with ankylosing spondylitis: A Chinese study based on magnetic resonance imaging

Objectives: To evaluate the clinical characteristics and identify potential factors of the early-stage hip involvement in patients with ankylosing spondylitis (AS) based on the magnetic resonance imaging (MRI).

Methods: A cross-sectional retrospective study of 655 consecutive patients was performed. Patients with hip pain or limited hip function but lacking definitive evidence of hip involvement on radiography underwent hip MRI. Based on the results of the imaging tests, the patients were classified into three categories: (1) no hip involvement; (2) early-stage hip involvement according to MRI but not radiography; (3) advanced-stage hip involvement according to a Bath Ankylosing Spondylitis Radiology Index-hip score ≥2.

Results: One hundred and sixty-eight patients had early-stage hip involvement and 103 patients had advanced-stage hip involvement. Multivariate logistic regression analysis indicated that younger age at onset, worse BASMI score, and more active inflammation in the sacroiliac joints were associated with the occurrence of early-stage hip involvement.

Conclusion: Negative plain radiography results cannot be used to rule out hip involvement. MRI was superior to radiography for the detection of early-stage hip involvement. Susceptible AS patients with symptoms or risk factors for hip involvement should undergo hip MRI to test for lesions in the early stage.     

Dickkopf-1 in ankylosing spondylitis: Relation to spinal dysmobility and radiographic findings

Back groundDickkopf-1 (DKK-1) is an inhibitory molecule that regulates Wnt pathway, which is critically important in osteoblastic new bone formation, therefore it may play a role in the process of new bone formation in Ankylosing Spondylitis (AS).Aim of the workTo measure serum level of DKK-1 in AS patients and study the relation between these levels with disease activity, spinal dysmobility and radiographic findings.Patients and methodsThirty AS patients as well as 20 healthy subjects as a control group were included in this study. DKK-1 serum levels were measured using ELISA technique, disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, radiographic assessment by Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-s) and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS).ResultsDKK-1 was not correlated to ESR, CRP or BASDAI (p > 0.05) and was negatively correlated to BASRI-s and mSASSS (p < 0.001), though DKK-1 serum level was unexpectedly higher in patients versus control (p < 0.001). On comparing HLA-B27 positive and HLA-B27 negative patients, there were a significant increase in BASRI-s and mSASSS and decrease in DKK-1 level in those with positive HLA-B27 (p < 0.05). On comparing patients received anti TNF therapy and those not received anti TNF therapy, there was no significant difference in DKK-1 level (p > 0.05).ConclusionOur finding suggests dysfunction of DKK-1 in patient with AS.     

Discovertebral lesion in ankylosing spondylitis: differential diagnosis with discitis by magnetic resonance imaging

 Ankylosing spondylitis (AS) is occasionally accompanied by erosive changes in the vertebral endplate at one or more restricted levels (Andersson lesions). The radiographic findings of this lesion are similar to those of bacterial discitis, and a differential diagnosis between them is often difficult. These diseases must be diagnosed correctly because they require different treatments. In order to evaluate the prevalence of Andersson lesions in the Japanese population, we examined 31 cases of AS which were treated in our department, and Andersson lesions were found in three (9.7%) of them. All these three cases developed Andersson lesions in the earlier phase of the AS, and differentiating the lesions from bacterial discitis was difficult. The details of these three cases are reviewed, and the importance of differentiating between Andersson lesions and bacterial discitis is discussed. Plain radiographs showed no clear difference between these conditions, but magnetic resonance imaging (MRI) was found to be more efficient. Received: February 5, 2001 / Accepted: September 27, 2001     

An epidemiological survey of the signs and symptoms of ankylosing spondylitis

Summary An epidemiological survey of ankylosing spondylitis (AS) was performed in Tromsø, Northern Norway. Altogether 27 cases of AS were found, and the symptoms and signs of these subjects were compared to those of persons with back pain but not suffering from AS (NON-AS). The symptoms which differentiated best between AS and NON-AS were: back pain which awakened the subject at night and made him leave the bed, back pain not relieved by lying down but improved by exercise, back pain of 3 months duration or more and morning stiffness lasting 0.5 hours or more. Reduced lateral mobility of the lumbar spine, a total spinal extension of 20° or less and a total spinal flexion of 40° or less were signs of acceptable value for the diagnosis of AS. Clinical criteria for the diagnosis of AS, to be used both in the clinical management of patients with back complaints and in population surveys of AS are suggested.     

Advances in computed tomography and magnetic resonance imaging of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. Imaging is important for establishing a diagnosis of HCC and early diagnosis is imperative as several potentially curative treatments are available when HCC is small. Hepatocarcinogenesis occurs in a stepwise manner on a background of chronic liver disease or cirrhosis wherein multiple genes are altered resulting in a range of cirrhosis-associated nodules. This progression is related to increased cellularity, neovascularity and size of the nodule. An understanding of the stepwise progression may aid in early diagnosis. Dynamic and multiphase contrast-enhanced computed tomography and magnetic resonance imaging still form the cornerstone in the diagnosis of HCC. An overview of the current diagnostic standards of HCC in accordance to the more common practicing guidelines and their differences will be reviewed. Ancillary features contribute to diagnostic confidence and has been incorporated into the more recent Liver Imaging Reporting and Data System. The use of hepatocyte-specific contrast agents is increasing and gradually changing the standard of diagnosis of HCC; the most significant benefit being the lack of uptake in the hepatocyte phase in the earlier stages of HCC progression. An outline of supplementary techniques in the imaging of HCC will also be reviewed.     

Demonstration of calf abnormalities by magnetic resonance imaging in polyarteritis nodosa

Summary A 36-year-old Caucasian woman presenting with persisting painful calves after a flu-like illness was diagnosed as having polyarteritis nodosa. Magnetic resonance imaging of the lower legs showed abnormal signal intensity of the outer muscle groups with sparing of the central located muscles. The good clinical response to oral prednisone was supported by improvement of MRI.     

Volvulus of the gall bladder diagnosed by ultrasonography, computed tomography, coronal magnetic resonance imaging and magnetic resonance cholangio-pancreatography

A 54-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Upon physical examination the vital signs of the patient were within normal ranges. Ultrasonography and computed tomography (CT) examination of the abdomen was obtained, which demonstrated a large dilatated cystic structure, measuring approximately 68.6 mm x 48.6 mm, with marked distension and inflammation. Additionally, the enhanced CT was characterized by the non-enhanced wall of the gallbladder. As the third examination in this study, magnetic resonance imaging (MRI), namely coronal MRI and magnetic resonance cholangio-pancreatography (MRCP), were performed. The MRCP demonstrated a dilatation of the gallbladder but detected no neck of the gallbladder. Simple cholecystectomy was performed. Macroscopic findings included a distended and gangrenous gallbladder, and closer examination revealed a counterclockwise torsion of 360 degrees on the gallbladder mesentery. Coronal MRI and MRCP showing characteristic radiography may be useful in making a definitive diagnosis.     

Epicardial Fat: Definition,Measurements and Systematic Review of Main Outcomes

Epicardial fat (EF) is a visceral fat deposit, located between the heart and thepericardium, which shares many of the pathophysiological properties of other visceralfat deposits, It also potentially causes local inflammation and likely has directeffects on coronary atherosclerosis. Echocardiography, computed tomography andmagnetic resonance imaging have been used to evaluate EF, but variations betweenmethodologies limit the comparability between these modalities.We performed a systematic review of the literature finding associations of EF withmetabolic syndrome and coronary artery disease. The summarization of theseassociations is limited by the heterogeneity of the methods used and the populationsstudied, where most of the subjects were at high cardiovascular disease risk.EF is also associated with other known factors, such as obesity, diabetes mellitus,age and hypertension, which makes the interpretation of its role as an independentrisk marker intricate. Based on these data, we conclude that EF is a visceral fatdeposit with potential implications in coronary artery disease. We describe thereference values of EF for the different imaging modalities, even though these havenot yet been validated for clinical use. It is still necessary to better definenormal reference values and the risk associated with EF to further evaluate its rolein cardiovascular and metabolic risk assessment in relation to other criteriacurrently used.     

A case of multiple intra-abdominal splenosis with computed tomography and magnetic resonance imaging correlative findings

Hepatic splenosis refers to heterotopic auto- transplantation and implantation of splenic tissue resulting from the spillage of cells from the spleen after splenic trauma or splenectomy. The true incidence of splenosis is unknown, because this entity is usually an incidental finding at surgery. Splenic implants are usually multiple, and can be localized anywhere in the peritoneal cavity. Splenic implants in the peritoneal cavity may be confused with renal tumors, abdominal lymphomas and endometriosis. We describe computed tomography （CT） and magnetic resonance imaging （MRI） findings in a rare case of multiple intra-abdominal splenosis located along the hepatic surface and adjacent to the upper pole of the right kidney, mimicking a renal neoplasm.     

Evaluation of internal consistency and re-test reliability of Bath ankylosing spondylitis indices in a large cohort of adult and juvenile spondylitis patients in Taiwan

The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G) have been recommended for evaluating function and disability in patients with ankylosing spondylitis (AS). The aim of this study was to develop a Chinese version of the BASDAI, BASFI, and BAS-G and assess their reliability and validity. The Chinese version was obtained after a translation and back-translation process. A total of 447 patients with adult and juvenile AS were assessed using these three instruments. Reliability was tested by internal consistency and test-retest reliability. Internal consistency of the instrument was given as Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation coefficient. To assess the sensitivity to change, 153 patients were included in an 8-week follow-up study. In our analysis, the reliability of these three instruments-the BASDAI, BASFI, and BAS-G-for a 24-h test-retest showed acceptable intraclass correlation coefficients (0.92-0.94). Our Chinese versions of the BASDAI, BASFI, and BAS-G also showed 0.87, 0.94, and 0.90, respectively, with Cronbach's alpha coefficient, indicating good reliability. For sensitivity to change in 8-week follow-up, all three instruments showed 5.0 to 5.4% changes. Our Chinese versions of the BASDAI, BASFI, and BAS-G showed adequate reliability, validity, and responsiveness to clinical change. Thus, disease activity and functional status in Chinese-speaking patients with AS may be adequately evaluated with these versions of the original instruments.     

Preoperative staging of rectal carcinoma by computed tomography and 0.15T magnetic resonance imaging

A prospective study was done on 34 patients using magnetic resonance imaging (MRI) and computed tomography (CT) preoperatively to stage patients with known rectal carcinoma. The study was done to determine the accuracy and clinical usefulness of CT and MRI. The Thoeni staging method was used. Twenty-four of 30 cases were staged correctly by CT. Sixteen of 27 were staged correctly by MRI. CT detected lymph node metastases in six of 15 cases with one false-positive. MRI detected lymph node metastases in two of 15 patients with one false-positive. CT was the preferred examination, and was useful in some cases. These cases included patients with small tumors who were considered for local excision and patients with extensive disease who were candidates for preoperative or intraoperative radiation treatment. MRI demonstrated extensive disease, as did CT in our later cases. Read at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985.     

卒中后抑郁患者的局部一致性降低:静息态功能磁共振成像研究

目的 探讨卒中后抑郁(post-stroke depression,PSD)患者静息态脑功能磁共振成像(functional magnetic resonance imaging,fMRI)特征.方法 分别对13例PSD患者以及无PSD卒中患者进行静息态fMRI扫描,采用局部一致性(regional homogeneity,ReHo)作为指标,分析PSD患者脑功能.结果 与对照组相比,PSD组患者左侧额中回、右侧额上回、右侧额中回、右侧扣带前回、右侧扣带后回、左侧岛叶、左侧尾状核和左侧海马的ReHo值显著降低.结论 PSD患者存在静息态神经环路功能异常,提示在临床治疗过程中需要重视卒中患者的情绪状态.     

HLA-B27 negative ankylosing spondylitis and hidradenitis suppurativa: Report of a case

Summary The association between hidradenitis suppurativa and joint involvement is well recognized. We describe a 63-year-old man with a severe HLA-B27 negative ankylosing spondylitis associated with hidradenitis suppurativa. We are not aware of any reports of such an association in the literature.