Degenerative disease of the spine: How to relate clinical symptoms to radiological findings

Degenerative disease of the spine (DDS) is one of the most common pathological conditions in humans. The clinical presentation of DDS is highly variable, ranging from mild pain to severe neurological symptoms. When more severe clinical symptoms are present, it is necessary to use imaging methods, such as magnetic resonance imaging (MRI), to confirm the diagnosis and establish the extent of the disease in order to determine proper treatment. There are several MRI changes which, based on clinicoradiological studies, are believed to be potential sources of pain and other clinical symptoms in DDS, including compression of the nerve root or spinal cord by disc herniations or osteophytes, recent ("active") disc herniation, Modic type 1 degenerative changes of the vertebral bodies, degenerative changes of the vertebral endplates (erosive intervertebral osteochondrosis), marked degenerative changes of the facet joints and ligamenta flava, degenerative spinal canal stenosis, degenerative spondylolisthesis, and Baastrup's disease. The authors analyzed the relationship of the MRI findings mentioned above with clinical symptoms of DDS, as well as the differentiation between DDS and nondegenerative diseases, which can manifest with similar clinical signs. The role of contrast-enhanced MRI and advanced MR techniques (e.g., high field MRI, functional MRI and MR spectroscopy) was also discussed. To establish an appropriate treatment for DDS, it is important to emphasize in the MRI report specific changes, which might be the cause of the pain and other clinical signs, as well as to rule out nondegenerative lesions, especially neoplasms, infections and rheumatoid disorders.

MRI Protocol for Pituitary Assessment in Children with Growth or Puberty Disorders-Is Gadolinium Contrast Administration Actually Needed?

The aim of this study was to assess the diagnostic value of non-contrast pituitary MRI in children with growth or puberty disorders (GPDs) and to determine the criteria indicating the necessity to perform post-contrast examination. A retrospective study included re-analysis of 567 contrast-enhanced pituitary MRIs of children treated in a tertiary reference center. Two sets of sequences were created from each MRI examination: Set 1, including common sequences without contrast administration, and Set 2, which included common pre- and post-contrast sequences (conventional MRI examination). The differences in the visibility of pituitary lesions between pairs of sets were statistically analyzed. The overall frequency of Rathke’s cleft cysts was 11.6%, ectopic posterior pituitary 3.5%, and microadenomas 0.9%. Lesions visible without contrast administration accounted for 85% of cases. Lesions not visible before and diagnosed only after contrast injection accounted for only 0.18% of all patients. Statistical analysis showed the advantage of the antero-posterior (AP) pituitary dimension over the other criteria in determining the appropriateness of using contrast in pituitary MRIs. The AP dimension was the most significant factor in logistic regression analysis: OR = 2.23, 95% CI, 1.35–3.71, p-value = 0.002, and in ROC analysis: AUC: 72.9% with a cut-off value of 7.5 mm, with sensitivity/specificity rates of 69.2%/73.5%. In most cases, the use of gadolinium-based contrast agent (GBCA) in pituitary MRI in children with GPD is unnecessary. The advantages of GBCA omission include shortening the time of MRI examination and of general anesthesia; saving time for other examinations, thus increasing the availability of MRI for waiting children; and acceleration in their further clinical management.

The Impact of Common Epidemiological Factors on Gray and White Matter Volumes in Magnetic Resonance Imaging-Is Prevention of Brain Degeneration Possible?

Introduction: The aim of the study was to evaluate the impact of multiple risk factors (age, diabetes, hypertension, hyperlipidemia, BMI, smoking, alcohol) on the gray and white matter volumes as well as on the burden of white matter hyperintensities (WMH).

Material and Methods: The study group consisted of 554 subjects (age range: 50–69 yrs, F/M: 367/187) recruited from the larger cohort of the Polish fraction of the Prospective Urban Rural Epidemiological (PURE) study. The participants answered questionnaires about their lifestyle, underwent physical and psychological examination (MoCA test), laboratory blood tests followed by brain MRI. Volumetric measurements of the total gray matter (GMvol), total white matter (WMvol) and WHM (WMHvol) normalized to the total intracranial volume were performed using the Computational Anatomy Toolbox 12 (CAT12) and Statistical Parametric Maps 12 (SPM12) based on 3D T1-weighted sequence. The influence of risk factors was assessed using multiple regression analysis before and after correction for multiple comparisons.

Results: Older age was associated with lower GMvol and WMvol, and higher WMHvol (p < 0.001). Smaller GMvol volume was associated with higher WMHvol (p < 0.001). Higher WMHvol was associated with hypertension (p = 0.01) and less significantly with hyperlipidemia (only before correction p = 0.03). Diabetes, abnormal BMI, smoking and alcohol intake did not have any significant impact on GMvol, WMvol or WMHvol (p > 0.05). MoCA score was not influenced by any of the factors.

Conclusions: Gray matter loss is strongly associated with the accumulation of WMH which seems to be potentially preventable by maintaining normal blood pressure and cholesterol levels.