- High Prevalence of Spinal Cord Cavernous Malformations in the Familial Cerebral Cavernous Malformations Type 1 Cohort
With prospective imaging to screen the spinal cord, the authors found SCCMs in 21 of 29 familial CCM1 patients, a prevalence of 72.4%. They conclude that the study demonstrates that SCCMs are indeed a common finding in patients with familial CCM and supports the idea of familial CCM syndrome as a progressive systemic disease that affects the entire central nervous system. They found an expected positive correlation of number of SCCMs with both patient age and number of intracranial CCMs. They also found a high prevalence of vertebral intraosseous vascular malformations (69%), including atypical (T1 hypointense) intraosseous vascular malformation in approximately 38% of the patients who underwent MR imaging screening.
- Counterpoint: Conventional Fluoroscopy-Guided Selective Cervical Nerve Root Block—A Safe, Effective, and Efficient Modality in the Hands of an Experienced Proceduralist
Two-hundred fifty-four conventional fluoroscopy-guided selective cervical nerve root blocks were performed via an anterolateral approach with an average fluoroscopy time of 24.3 seconds for all cases. There were no aborted procedures and no major or permanent complications. There were 14 minor complications; 12 of these were periprocedural and resolved by the 2-week follow-up visit. One-hundred eighty-five patients (75.2%) reported pain improvement of >50% from baseline at 15 minutes postinjection. The authors conclude that this study confirms that conventional fluoroscopy is as safe and effective as CT for the guidance of selective cervical nerve root block when using a meticulous technique and a nonparticulate steroid and performed by an experienced proceduralist.
- Sensitivity of the Inhomogeneous Magnetization Transfer Imaging Technique to Spinal Cord Damage in Multiple Sclerosis
Anatomic images covering the cervical spinal cord from the C1 to C6 levels and DTI, magnetization transfer/inhomogeneous magnetization transfer images at the C2/C5 levels were acquired in 19 patients with MS and 19 paired healthy controls. Anatomic images were segmented in spinal cord GM and WM, both manually and using the AMU40 atlases. MS lesions were manually delineated. MR imaging metrics were analyzed within normal-appearing and lesion regions in anterolateral and posterolateral WM and compared using Wilcoxon rank tests and z scores. The use of a multiparametric MR imaging protocol combined with an automatic template-based GM/WM segmentation approach in the current study outlined a higher sensitivity of the ihMT technique toward spinal cord pathophysiologic changes in MS compared with atrophy measurements, DTI, and conventional MT. The authors also conclude that the clinical correlations between ihMTR and functional impairment observed in patients with MS also argue for its potential clinical relevance, paving the way for future longitudinal multicentric clinical trials in MS.
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