| 11. |
- Ekedahl, Harald, et al.
(författare)
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Accuracy of Clinical Tests in Detecting Disk Herniation and Nerve Root Compression in Subjects With Lumbar Radicular Symptoms
- 2018
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993. ; 99:4, s. 726-735
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate the accuracy of 3 commonly used neurodynamic tests (slump test, straight-leg raise [SLR] test, femoral neurodynamic test) and 2 clinical assessments to determine radiculopathy (radiculopathy I, 1 neurologic sign; radiculopathy II, 2 neurologic signs corresponding to 1 specific nerve root) in detecting magnetic resonance imaging (MRI) findings (extrusion, subarticular nerve root compression, and foraminal nerve root compression). Design: Validity study. Setting: Secondary care. Participants: We included subjects (N=99; mean age, 58y; 54% women) referred for epidural steroid injection because of lumbar radicular symptoms who had positive clinical and MRI findings. Positive clinical findings included the slump test (n=67), SLR test (n=50), femoral neurodynamic test (n=7), radiculopathy I (n=70), and radiculopathy II (n=33). Positive MRI findings included extrusion (n=27), subarticular nerve compression (n=14), and foraminal nerve compression (n=25). Interventions: Not applicable. Main Outcome Measures: Accuracy of clinical tests in detecting MRI findings was evaluated using sensitivity, specificity, and receiver operating characteristics analysis with area under the curve (AUC). Results: The slump test had the highest sensitivity in detecting extrusion (.78) and subarticular nerve compression (1.00), but the respective specificity was low (.36 and.38). Radiculopathy I was most sensitive in detecting foraminal nerve compression (.80) but with low specificity (.34). Only 1 assessment had a concurrent high sensitivity and specificity (ie, radiculopathy II) in detecting subarticular nerve compression (.71 and.73, respectively). The AUC for all tests in detecting extrusion, subarticular nerve compression, and foraminal nerve compression showed ranges of.48 to.60,.63 to.82, and.33 to.57, respectively. Conclusions: In general, the investigated neurodynamic tests or assessments for radiculopathy lacked diagnostic accuracy. The slump test was the most sensitive test, while radiculopathy II was the most specific test. Most interestingly, no relationship was found between any neurodynamic test and foraminal nerve compression (foraminal stenosis) as visualized on MRI.
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| 12. |
- Ekedahl, Harald, et al.
(författare)
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The 1-Year Results of Lumbar Transforaminal Epidural Steroid Injection in Patients with Chronic Unilateral Radicular Pain : The Relation to MRI Findings and Clinical Features
- 2017
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Ingår i: American Journal of Physical Medicine and Rehabilitation. - 0894-9115. ; 96:9, s. 654-662
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In patients with chronic radicular pain, we aimed to evaluate subgroup differences in 1-yr response to transforaminal epidural steroid injection. DESIGN: In this longitudinal cohort study of 100 subjects, 170 transforaminal epidural steroid injections were performed for 1 yr. The sample was stratified by type of disc herniation (protrusion n = 57, extrusion n = 27), by location of disc herniation (central/subarticular n = 60, foraminal n = 24), by grade of nerve root compression (low-grade compression n = 61, high-grade subarticular nerve compression n = 14, high-grade foraminal nerve compression n = 25), and by positive Slump test (n = 67). Treatment response was evaluated by visual analogue scale leg pain and self-reported disability (Oswestry Disability Index). Logistic regression was used to analyze the predictive value of baseline characteristics including the stratified subgroups. RESULTS: High-grade subarticular nerve compression predicted the 1-yr improvement in both visual analogue scale leg pain (P = 0.046) and Oswestry Disability Index (P = 0.027). Low age (P < 0.001), short duration of leg pain (P = 0.015), and central/subarticular disc herniation (P = 0.017) predicted improvement in Oswestry Disability Index. CONCLUSIONS: In patients treated with one or several transforaminal epidural steroid injections due to chronic lumbar radicular pain, clinical findings failed to predict the 1-yr treatment response. Low age, short duration of leg pain, central/subarticular disc herniation, and high-grade subarticular nerve compression predicted a favorable 1-yr response to transforaminal epidural steroid injection.
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| 13. |
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| 14. |
- Håkansson, Claes, et al.
(författare)
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Inter-modality assessment of medial temporal lobe atrophy in a non-demented population: application of a visual rating scale template across radiologists with varying clinical experience
- 2022
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Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 32, s. 1127-1134
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To assess inter-modality agreement and accuracy for medial temporal lobe atrophy (MTA) ratings across radiologists with varying clinical experience in a non-demented population. Methods Four raters (two junior radiologists and two senior neuroradiologists) rated MTA on CT and MRI scans using Scheltens' MTA scale. Ratings were compared to a consensus rating by two experienced neuroradiologists for estimation of true positive and negative rates (TPR and TNR) and over- and underestimation of MTA. Inter-modality agreement expressed as Cohen's kappa (dichotomized data), Cohen's kappa(w), and two-way mixed, single measures, consistency ICC (ordinal data) were determined. Adequate agreement was defined as kappa/kappa(w) >= 0.80 and ICC >= 0.80 (significance level at 95% CI >= 0.65). Results Forty-nine subjects (median age 72 years, 27% abnormal MTA) with cognitive impairment were included. Only junior radiologists achieved adequate agreement expressed as Cohen's kappa. All raters achieved adequate agreement expressed as Cohen's kappa(w) and ICC. True positive rates varied from 69 to 100% and TNR varied from 85 to 100%. No under- or overestimation of MTA was observed. Ratings did not differ between radiologists. Conclusion We conclude that radiologists with varying experience achieve adequate inter-modality agreement and similar accuracy when Scheltens' MTA scale is used to rate MTA on a non-demented population. However, TPR varied between radiologists which could be attributed to rating style differences.
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| 15. |
- Kahlon, Babar, et al.
(författare)
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Is aqueductal stroke volume, measured with cine phase-contrast magnetic resonance imaging scans useful in predicting outcome of shunt surgery in suspected normal pressure hydrocephalus?
- 2007
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Ingår i: Neurosurgery. - 0148-396X. ; 60:1, s. 124-129
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate clinical usefulness of cerebrospinal fluid stroke volume (SV) assessed in the cerebral aqueduct, via cine phase-contrast magnetic resonance imaging, for predicting outcome after shunt surgery in suspected normal pressure hydrocephalus. METHODS: Thirty-eight patients with suspected normal pressure hydrocephalus were included. SV was assessed using cine phase-contrast magnetic resonance imaging, and kept blinded until postoperative follow-up after 7 +/- 5.8 months (mean the results were standard deviation). Selection to surgery was based on a positive lumbar infusion test or cerebrospinal fluid tap test, and outcome was evaluated with objective tests. RESULTS: Six patients were excluded from SV measurements because of technical difficulties. Eight patients were not operated (negative lumbar infusion test and cerebrospinal fluid tap test). SV in the not operated patients (mean, 66 +/- 53 mu l) did not differ from the operated patients (95 +/- 78 mu l; P = 0.335). Operated patients showed statistically significant improvements in walk (P = 0.020), reaction time (P = 0.006), and memory (P = 0.001) tests. Patients were divided into three groups according to SV range: low (0-50 mu l), middle (51 - 100 mu l), and high (> 100 mu l). No statistically significant (P > 0.05) improvements in any of the objective tests were found in any of the SV the different SV ranges. The numbers of individually improved patients were similar in ranges: six out of seven in the low, nine out of nine in the middle, and five out of eight in the high range. Weak correlations were found between SV and the initial pulse,amplitude (R-s = 0.043; P = 0.014) as well as the plateau pulse amplitude (R-s = 0.043; P = 4) as measured with the lumbar infusion test. CONCLUSION: The data from this Study show no evidence that cine phase-contrast magnetic resonance imaging measurements of SV in the cerebral aqueduct are useful for selecting patients with normal pressure hydrocephalus symptoms to shunt surgery.
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| 16. |
- Karlberg, Mikael, et al.
(författare)
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Acute vestibular neuritis visualized by 3-T magnetic resonance imaging with high-dose gadolinium.
- 2004
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Ingår i: Archives of Otolaryngology - Head and Neck Surgery. - 1538-361X. ; 130:2, s. 229-232
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Tidskriftsartikel (refereegranskat)abstract
- Sudden idiopathic unilateral loss of vestibular function without other signs or symptoms is called acute vestibular neuritis. It has been suggested that reactivation of human herpes simplex virus 1 could cause vestibular neuritis, Bell palsy, and sudden unilateral hearing loss. Enhancement of the facial nerve on gadolinium-enhanced magnetic resonance imaging (MRI) is a common finding in Bell palsy, but enhancement of the vestibular nerve has never been reported in acute vestibular neuritis. We present 2 consecutive cases of acute vestibular neuritis where high-field-strength MRI (3.0 T) with high-dose (0.3 mmol/kg of body weight) gadolinium–pentetic acid showed isolated enhancement of the vestibular nerve on the affected side only. These findings support the hypothesis of a viral and inflammatory cause of acute vestibular neuritis and might have implications for its treatment.
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| 17. |
- Karlberg, Mikael, et al.
(författare)
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Mondini-like malformation mimicking otosclerosis and superior semicircular canal dehiscence.
- 2006
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Ingår i: Journal of Laryngology and Otology. - 1748-5460. ; 120:5, s. 419-422
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Tidskriftsartikel (refereegranskat)abstract
- In 2003, it was reported that superior semicircular canal dehiscence can mimic otosclerosis because of low-frequency bone conduction hearing gain and dissipation of air-conducted acoustic energy through the dehiscence. We report the case of a 17-year-old girl with left-sided combined hearing loss thought to be due to otosclerosis. Bone conduction thresholds were -10 dB at 250 and 500 Hz and she had a 40 dB air bone gap at 250 Hz. When a tuning fork was placed at her ankle she heard it in her left ear. Acoustic reflexes and vestibular evoked myogenic potentials could be elicited bilaterally. Imaging of the temporal bones showed no otosclerosis, superior semicircular canal dehiscence or large vestibular aqueduct, but a left-sided, Mondini-like dysplasia of the cochlea with a modiolar deficiency could be seen. Mondini-like cochlear dysplasia should be added to the causes of inner-ear conductive hearing loss.
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| 18. |
- Sundgren, P, et al.
(författare)
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Paragangliomas of the spinal canal
- 1999
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Ingår i: Neuroradiology. - : Springer Science and Business Media LLC. - 1432-1920 .- 0028-3940. ; 41:10, s. 788-794
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Tidskriftsartikel (refereegranskat)abstract
- We report the clinical MRI and histopathological features of five consecutive cases of spinal paraganglioma. Three intradural tumours were found in the typical location (two at the L4, one at the S2 level); one intradural extramedullary tumour arose at an unusual level, from the ventral C2 root, and one extradural tumour growing along the L5 nerve root sheath had an aggressive growth pattern with early, local paraspinal recurrence and, eventually, intradural metastatic spread. This type of growth pattern has not been described previously. Paragangliomas of the spinal canal are more common than previously thought and can be located anywhere along the spine, although the lumbosacral level is the most common. Their appearance on MRI can not distinguish them from other tumours in the spinal canal. Even though paragangliomas in general are benign and slowly growing their growth pattern can vary and be more aggressive, to the point of metastatic spread.
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