Comparison of computerized tomography with magnetic resonance imaging (MRI) in the evaluation of encephalic ventricular volume

Cella media distance in human brain in relation to age and gender

AIMS

To determine whether simple linear measurements can be used as an accurate and reproducible replacement of the volumetric ones.

METHODS

We measured the cella media distance (CM1) and the distance between the right and left human brain surfaces (CM2)--measured along the CM1 line--in the groups of women (F) and men (M) who were divided according to diagnoses into three subgroups (F1-3 and M1-3). Examinations were carried out under standardized conditions: axial serial CT (Computed Tomography) images, in 4 mm layers (333 patients). Measured values were detected by Osiris Software. Recorded values were statistically analysed.

RESULTS

We found very highly significant (subgroups M1, M3), and significant (subgroups F1, F2, F3, M2) associations between the cella media distance and the decade of age. There were only non-significant differences in CM1 distances between men and women and between the diagnoses groups as well. Correlation between cella media distance and volume of lateral ventricles was greater in men in both, subgroup M1 (r = 0.659, P < 0.0001) and in a mixed group where all the three male subgroups M1-3 were combined into one group (r = 0.675, P < 0.0001). Among women the correlation was lower, however still significant (r = 0.357, P < 0.0001 for F1 and r = 0.465, P < 0.0001 for F1-3).

CONCLUSIONS

The cella media distance is much better predictor of brain lateral ventricular volume in men than in women.

The effects of side-posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects

STUDY DESIGN

A blinded, randomized controlled trial was conducted.

OBJECTIVE

To test the hypothesis that chiropractic side-posture manipulation (adjusting) of the lumbar spine separates (gaps) the zygapophysial (Z) joints.

SUMMARY OF BACKGROUND DATA

Spinal adjusting is thought to gap the Z joints, yet no studies have conclusively validated this hypothesis, and some investigators have reported that the lumbar Z joints do not gap during rotation.

METHODS

For this study, 64 healthy student volunteers (32 men and 32 women) ages 22 to 30 years with no history of significant low back pain were randomized into four groups of 8 men and 8 women each. Interventions included lumbar side-posture spinal adjusting (manipulation) and side-posture positioning. Anterior to posterior measurements of the Z joints from MRI scans taken before and after side-posture spinal adjusting and before and after side-posture positioning were compared.

RESULTS

Observers performing the measurements were blinded as to group and first and second scans. Reliability of the measurements was established. Differences were found between the groups (F = 24.15; P < 0.000, analysis of variance). Side-posture positioning showed greater gapping than the control condition (mean difference, 1.18; P < 0.000); side-posture adjusting showed greater gapping than the control condition (mean difference, 1.89; P < 0.000), and side-posture adjusting showed greater gapping than side-posture positioning (mean difference, 0.71; P = 0.047).

CONCLUSIONS

Spinal adjusting produced increased separation (gapping) of the Z joints. Side-posture positioning also produced gapping, but less than that seen with lumbar side-posture adjusting. This study helps to increase understanding about the mechanism of action for spinal manipulation.

Effects of side-posture positioning and side-posture adjusting on the lumbar zygapophysial joints as evaluated by magnetic resonance imaging: a before and after study with randomization

OBJECTIVE

To test the a priori hypothesis that one of the positive mechanisms of action of chiropractic side-posture manipulation (adjusting) of the lumbar spine is to separate, or gap, the zygapophysial (Z) joints.

DESIGN

Before and after study with randomization.

SETTING

Chiropractic college clinic and magnetic resonance imaging (MRI) facility.

PARTICIPANTS

Sixteen healthy student volunteers (8 men and 8 women) ages 22 to 29 years with no history of significant low back pain. Nineteen volunteers were screened, with 3 disqualified from the study. Subjects were randomized into 4 groups, each with 2 men and 2 women.

INTERVENTIONS

Lumbar side-posture spinal adjusting (manipulation) and side-posture positioning.

MAIN OUTCOME MEASURES

Comparison of anterior to posterior measurements of the Z joints from MRI scans taken before and after side-posture spinal adjusting and before and after side-posture positioning, and a rigorous subjective evaluation protocol of the Z joints by 3 radiologists blinded to the randomized groups.

MAIN RESULTS

Observers making measurements were blinded to what group subjects were placed in and whether they were measuring first or second scans; radiologists were blinded to what group subjects were assigned. Differences were found between the groups. Those receiving side-posture spinal adjusting and remaining in side posture showed the greatest increase in gapping (0.7 mm vs 0.0 mm for controls).

CONCLUSIONS

Lumbar side-posture spinal adjusting produced increased separation (gapping) of the zygapophysial joints. Side-posture positioning also produced gapping, but less than that seen with lumbar side-posture adjusting. A larger clinical trial should be performed to further define the results of this study.

Age-related changes in intracranial compartment volumes in normal adults assessed by magnetic resonance imaging

Magnetic resonance (MR) image-based computerized segmentation was used to measure various intracranial compartments in 49 normal volunteers ranging in age from 24 to 80 years to determine age-related changes in brain, ventricular, and extraventricular cerebrospinal fluid (CSF) volumes. The total intracranial volume (sum of brain, ventricular, and extraventricular CSF) averaged 1469 +/- 102 cm3 in men and 1289 +/- 111 cm3 in women. The difference was attributable primarily to brain volume, which accounted for 88.6% of the respective intracranial volumes in both sexes, but was significantly larger in men (1302 +/- 112 cm3) than in women (1143 +/- 105 cm3). In both, the cranial CSF volume averaged 11.4%. Total intracranial volume did not change with age, although the normalized brain volume of both men and women began to decrease after the age of 40 years. This decrease was best reflected by expansion of the extraventricular CSF volume which, after the age of 50 years, was more marked in men than in women. The volume of the cranial CSF, as determined by MR image-based computerized segmentation, is considerably larger than traditionally accepted and resides mostly extraventricularly. Expansion of CSF volume with age provides a good index of brain shrinkage although evolving changes and growth of the head with age tend to confound the results.

Evaluation of encephalic ventricular volume from the magnetic resonance imaging scans of thirty-eight human subjects

Accurate volume determination of the encephalic ventricles is of importance in several clinical conditions, including Alzheimer's presenile dementia, schizophrenia, and benign intracranial hypertension. Previous studies have investigated the accuracy with which magnetic resonance imaging (MRI) can be used in clinical practice to evaluate the encephalic ventricles. However, adequate evaluation of pathological conditions depends on a sufficient amount of morphometric data from normal subjects. To begin establishing this data base for "normal" subjects, we evaluated the MRI scans of 38 subjects found to have no apparent pathology and calculated the ventricular volume in each case by using methods previously developed in our laboratory. The results were then compared with published volumes determined from studies that used either ventricular casts or computerized tomographic scans. The average total ventricular volume for all 38 subjects was 17.4 cm3, while that for males was 16.3 cm3 and that for females was 18.0 cm3. A small but significant correlation was found between age of subject and ventricular volume, with ventricular size increasing with age.