RESUMEN
BACKGROUND: Magnetic resonance imaging (MRI) is often used to assess for disk displacement after manipulation, but limited information about the true incidence of iatrogenic herniations exists. Preliminary data must be obtained concerning the size of different types of displacement to further assess this relationship. The reliability of chiropractic radiologists in assessing disks, and a comparison of measuring devices should be evaluated. OBJECTIVE: To identify average measurements for normal and displaced disks and to assess the reliability of measurements by chiropractic radiologists. STUDY DESIGN: Intraobserver and interobserver reliability study assessing cervical disk displacement on MRI scans. METHODS: Three evaluators assessed the disks on 106 MRI scans. Six categories were assessed and compared. Thirty-seven scans were reassessed for intraobserver comparisons. Interobserver and intraobserver variations and measurement-device correlations were determined. RESULTS: Interexaminer measurement reliability for the 2 devices was 0.80 to 0.84. Intraexaminer reliability ranged from 0.58 to 0.94. Interexaminer and intraexaminer agreement for the presence of disk displacement was 86% (kappa = 0.69) and 78% to 85% (kappa = 0.50-0.67), respectively; for the presence of osteophytes, 92% (kappa = 0.54) and 86% to 95% (kappa = 0.60-0.80); and for the classification of disk displacements, 76% (kappa = 0.53) and 73% to 80% (kappa 0.44-0.61). Distinguishing between normal versus bulged disks demonstrated the greatest classification disagreement. Clear size differences between the types of disk displacement were noted. The ruler and digitizer correlation coefficient was 0.96. CONCLUSIONS: Interexaminer and intraexaminer agreement were good to very good concerning measurements and fair to good concerning disk assessments. Different disk displacement types demonstrated obvious mean size differences. No significant mean difference in measurements between the ruler and the digitizer was noted.
Asunto(s)
Vértebras Cervicales/anatomía & histología , Vértebras Cervicales/patología , Desplazamiento del Disco Intervertebral/diagnóstico , Imagen por Resonancia Magnética/instrumentación , Manipulación Espinal/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Femenino , Humanos , Desplazamiento del Disco Intervertebral/patología , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
BACKGROUND: Magnetic resonance imaging is often used to assess for disk displacement after manipulation, but limited information about the true incidence of iatrogenic herniations exists. To design a study that evaluates for a causal relationship, preliminary data must be obtained relating to the size of different types of disk displacement. The reliability of chiropractic radiologists in assessing disks and a comparison of different measuring devices should also be evaluated. OBJECTIVE: To identify average measurements for normal and displaced disks and to assess the reliability of measurements by chiropractic radiologists. STUDY DESIGN: Intraobserver and interobserver reliability study assessing disk displacement on magnetic resonance scans. METHODS: Three evaluators assessed the disks on 122 magnetic resonance scans from two imaging centers. Six categories were graded, and digitizer and ruler measurements were compared. Forty-four scans were reassessed for intraobserver agreement. Intraobserver and interobserver variations were measured with intraclass correlation coefficient and kappa statistical analysis. Measurement device correlation was assessed with Pearson's r. RESULTS: Clear size differences between different types of disk displacement were noted. Interexaminer measurement reliability was 0.78 to 0.84. Agreement concerning the presence of disk displacement was 85% (kappa = 0.68), and the classification of disk displacements was 76% (kappa = 0.60). Intraexaminer measurement reliability was 0.40 to 0.49. Intraexaminer agreement concerning the presence of disk displacement was 76% (kappa = 0.52), and the classification of disk displacements was 62% to 69% (kappa = 0.38 to 0.46). Normal versus bulged disk distinctions demonstrated the most disagreement. The ruler and digitizer correlation coefficient was 0.968. CONCLUSIONS: Different disk types demonstrated distinct size averages. Interexaminer agreement was good concerning disk assessment and measurements. Intraexaminer agreement was lower than expected. A millimetric ruler is an acceptable alternative to digital measurement devices.
Asunto(s)
Quiropráctica/estadística & datos numéricos , Desplazamiento del Disco Intervertebral/patología , Vértebras Lumbares/patología , Imagen por Resonancia Magnética , Manipulación Espinal/efectos adversos , Adulto , California , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/etiología , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética/instrumentación , Masculino , Variaciones Dependientes del Observador , Radiografía , Reproducibilidad de los Resultados , Estudios Retrospectivos , WashingtónRESUMEN
Intraosseous hemangioma is a slow-growing primary benign neoplasm of capillary, cavernous, or venous origin. The most common type is the cavernous hemangioma, composed of large thin-walled vessels and sinuses lined by endothelial cells. Although found in any bone, hemangioma is most common in the vertebrae, where it represents 2-3% of all radiographically detectable spinal tumors. Most spinal hemangiomas are solitary, asymptomatic lesions of the vertebral body, with 10-15% showing concomitant involvement of the posterior elements. Rarely, the lesion is located to the posterior arch. An unusual case of an expanding vertebral hemangioma isolated to the posterior elements of T9 is presented.
Asunto(s)
Hemangioma/complicaciones , Neoplasias de la Columna Vertebral/complicaciones , Estenosis Espinal/etiología , Adulto , Femenino , Hemangioma/diagnóstico por imagen , Hemangioma/cirugía , Humanos , Radiografía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugíaRESUMEN
A case of radiation induced osteonecrosis resulting in a fracture of the scapula in a 76-yr-old female patient with a history of breast carcinoma is presented. Diagnostic imaging, laboratory recommendations and clinical findings are discussed along with an algorithm for the safe management of patients with a history of cancer and musculoskeletal complaints. This case demonstrates the necessity of a thorough investigation of musculoskeletal complaints in patients with previous bone-seeking carcinomas.
Asunto(s)
Fracturas Espontáneas/etiología , Osteorradionecrosis/complicaciones , Escápula/efectos de la radiación , Anciano , Femenino , Fracturas Espontáneas/diagnóstico por imagen , Humanos , Cintigrafía , Escápula/lesiones , Tomografía Computarizada por Rayos XRESUMEN
A case of atypical brachydactyly is reported with clinical and radiographic findings. A differential diagnosis is discussed. In light of the lack of corrective surgical techniques, conservative management is considered, including genetic consultation to prevent the deformity in future generations.
Asunto(s)
Deformidades Congénitas del Pie , Deformidades Congénitas de la Mano , Preescolar , Epífisis/diagnóstico por imagen , Femenino , Humanos , RadiografíaRESUMEN
A case of unilateral Sprengel's deformity with an associated omovertebral bone is presented. A review of proposed mechanisms of development is included in the discussion of this rare anomaly. The condition is largely one of cosmetic deformity rather than signs and symptoms. The significance of identifying it's presence lies in uncovering the many less obvious, but more potentially serious, anomalies that may be associated with it. Conservative management is discussed.