| 1. |
- Hebelka, Hanna, 1977, et al.
(author)
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Axial Loading during MRI Induces Lumbar Foraminal Area Changes and Has the Potential to Improve Diagnostics of Nerve Root Compromise
- 2022
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In: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 11:8
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Journal article (peer-reviewed)abstract
- Lumbar foraminal stenosis is a common cause of lumbar radiculopathy and conventionally assessed with magnetic resonance imaging (MRI) in supine-positioned patients. An MRI acquired during spine loading may unmask pathology not otherwise revealed in a relaxed position. Therefore, we investigated how spine loading during MRI affects lumbar foramina. In 89 low-back pain patients’ lumbar, MRIs were performed in a relaxed supine position and during axial loading using a Dynawell® compression device. The smallest area of all intervertebral foramina at levels L3/L4–L5/S1 (534 foramina) was determined using a freehand polygonal tool in parasagittal T2-weighted sequences. The grading system described by Lee et al. was also used to qualitatively assess foraminal stenosis. Overall, a mean reduction of 2.2% (mean −0.89 cm2 and −0.87 cm2, respectively) was observed (p = 0.002), however for individual foramina large variations, with up to about 50% increase or decrease, were seen. Stratified for lumbar level, an area reduction was found for L3/L4 and L4/L5 foramina (mean change −0.03 cm2; p = 0.036; and −0.03 cm2; p = 0.004, respectively) but not for L5/S1. When comparing the measured area changes to qualitative foraminal grading, 22% of the foramina with a measured area decrease were evaluated with a higher grading. Thus, detailed information on foraminal appearance and nerve root affection can be obtained using this method.
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| 2. |
- Hutchins, John, et al.
(author)
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A systematic review of validated classification systems for cervical and lumbar spinal foraminal stenosis based on magnetic resonance imaging.
- 2022
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In: European spine journal. - : Springer Science and Business Media LLC. - 1432-0932 .- 0940-6719. ; 31:6, s. 1358-1369
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Journal article (peer-reviewed)abstract
- Foraminal stenosis is commonly investigated with radiological methods in patients with radiating pain in extremities. However, there is a lack of consensus regarding the methodology to assess compression of the nerve roots. This systematic review was performed to identify validated classification systems for foraminal stenosis in the lumbar and cervical spine based on magnetic resonance imaging (MRI).A systematic search was conducted according to the PRISMA guidelines. The search included Cochrane, Embase, Medline and PubMed databases going back 30years and up to September 2021. Three categories of words were used in different variations; foraminal stenosis, MRI and scoring. For inclusion, at least one word from each category had to be present. Articles suggesting classification systems or reporting on their validation were selected for inclusion.A total of 823 articles were identified and all abstracts were reviewed. Subsequently, a full-text review of 64 articles was performed and finally 14 articles were included. A total of three validated classification systems were found for the cervical and lumbar spine. The remaining 11 articles reported on validation or suggested modifications of the classification systems.The three classification systems demonstrated moderate to good reliability and have all been shown feasible in the clinical setting. There is however a need for further studies testing the validity of these classifications in relation to both clinical findings and to surgical outcome data.
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| 3. |
- Hutchins, John, et al.
(author)
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Cervical Foraminal Changes in Patients with Intermittent Arm Radiculopathy Studied with a New MRI-Compatible Compression Device
- 2023
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In: Journal of Clinical Medicine. - 2077-0383. ; 12:20
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Journal article (peer-reviewed)abstract
- Diagnosing cervical foraminal stenosis with intermittent arm radiculopathy is challenging due to discrepancies between MRI findings and symptoms. This can be attributed to the fact that MRI images are often obtained in a relaxed supine position. This study aims to evaluate the feasibility of the Dynamic MRI Compression System (DMRICS) and to assess possible changes in cervical foramina, with both quantitative measurements and qualitative grading systems, with MRI during a simulated Spurling test. Ten patients (five women and five men, ages 29-45) with previously confirmed cervical foraminal stenosis underwent MRI scans using DMRICS. MRI images were acquired in both relaxed and provoked states. A radiologist assessed 30 foramina (C4-C7) on the symptomatic side in both patient positions. Quantitative and qualitative measures were performed, including the numeric rating scale (NRS) and the Park and Kim grading systems. The provoked state induced concordant neck and arm pain in 9 of 10 patients. Significant shifts in Park and Kim foraminal gradings were noted: 13 of 27 Park gradings and 9 of 27 Kim gradings escalated post provocation. No quantitative changes were observed. This pilot study indicates that the DMRICS device has the potential to improve diagnostic accuracy for cervical radiculopathy, demonstrating induced cervical foraminal changes during a simulated Spurling test while performing MRI.
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| 4. |
- Hutchins, John, et al.
(author)
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MRI evaluation of foraminal changes in the cervical spine with assistance of a novel compression device
- 2023
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In: Scientific Reports. - 2045-2322. ; 13:1
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Journal article (peer-reviewed)abstract
- Standard supine Magnetic Resonance Imaging (MRI) does not acquire images in a position where most patients with intermittent arm radiculopathy have symptoms. The aim of this study was to test the feasibility of a new compression device and to evaluate image quality and foraminal properties during a Spurling test under MRI acquisition. Ten asymptomatic individuals were included in the study (6 men and 4 women; age range 27 to 55 years). First, the subjects were positioned in the cervical compression device in a 3 T MRI scanner, and a volume T2 weighted (T2w) sequence was acquired in a relaxed supine position (3 min). Thereafter, the position and compressive forces on the patient's neck (provocation position) were changed by maneuvering the device from the control room, with the aim to simulate a Spurling test, causing a mild foraminal compression, followed by a repeated image acquisition (3 min). A radiologist measured the blinded investigations evaluating cervical lordosis (C3-C7), foraminal area on oblique sagittal images and foraminal cross-distance in the axial plane. A total of three levels (C4-C7) were measured on the right side on each individual. Measurements were compared between the compressed and relaxed state. Reliability tests for inter- and intraclass correlation were performed. The device was feasible to use and well tolerated by all investigated individuals. Images of adequate quality was obtained in all patients. A significant increase (mean 9.4, p = 0.013) in the cervical lordosis and a decreased foraminal cross-distance (mean 32%, p < 0.001) was found, during the simulated Spurling test. The area change on oblique sagittal images did not reach a statistically significant change. The reliability tests on the quantitative measures demonstrated excellent intraobserver reliability and moderate to good interobserver reliability. Applying an individualized provocation test on the cervical spine, which simulates a Spurling test, during MRI acquisition was feasible with the novel device and provided images of satisfactory quality. MRI images acquired with and without compression showed changes in cervical lordosis and foraminal cross distance indicating the possibility of detecting changes of the foraminal properties. As a next step, the method is to be tested on symptomatic patients.
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| 5. |
- Olefeldt, David, et al.
(author)
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The Boreal-Arctic Wetland and Lake Dataset (BAWLD)
- 2021
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In: Earth System Science Data. - : Copernicus Gesellschaft MBH. - 1866-3508 .- 1866-3516. ; 13:11, s. 5127-5149
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Journal article (peer-reviewed)abstract
- Methane emissions from boreal and arctic wetlands, lakes, and rivers are expected to increase in response to warming and associated permafrost thaw. However, the lack of appropriate land cover datasets for scaling field-measured methane emissions to circumpolar scales has contributed to a large uncertainty for our understanding of present-day and future methane emissions. Here we present the BorealArctic Wetland and Lake Dataset (BAWLD), a land cover dataset based on an expert assessment, extrapolated using random forest modelling from available spatial datasets of climate, topography, soils, permafrost conditions, vegetation, wetlands, and surface water extents and dynamics. In BAWLD, we estimate the fractional coverage of five wetland, seven lake, and three river classes within 0.5 x 0.5 degrees grid cells that cover the northern boreal and tundra biomes (17 % of the global land surface). Land cover classes were defined using criteria that ensured distinct methane emissions among classes, as indicated by a co-developed comprehensive dataset of methane flux observations. In BAWLD, wetlands occupied 3.2 x 10(6) km(2) (14 % of domain) with a 95 % confidence interval between 2.8 and 3.8 x 10(6) km(2). Bog, fen, and permafrost bog were the most abundant wetland classes, covering similar to 28 % each of the total wetland area, while the highest-methane-emitting marsh and tundra wetland classes occupied 5 % and 12 %, respectively. Lakes, defined to include all lentic open-water ecosystems regardless of size, covered 1.4 x 10(6) km(2) (6 % of domain). Low-methane-emitting large lakes (>10 km(2)) and glacial lakes jointly represented 78 % of the total lake area, while high-emitting peatland and yedoma lakes covered 18 % and 4 %, respectively. Small (<0.1 km(2)) glacial, peatland, and yedoma lakes combined covered 17 % of the total lake area but contributed disproportionally to the overall spatial uncertainty in lake area with a 95 % confidence interval between 0.15 and 0.38 x 10(6) km(2). Rivers and streams were estimated to cover 0.12 x 10(6) km(2) (0.5 % of domain), of which 8 % was associated with high-methane-emitting headwaters that drain organic-rich landscapes. Distinct combinations of spatially co-occurring wetland and lake classes were identified across the BAWLD domain, allowing for the mapping of "wetscapes" that have characteristic methane emission magnitudes and sensitivities to climate change at regional scales. With BAWLD, we provide a dataset which avoids double-accounting of wetland, lake, and river extents and which includes confidence intervals for each land cover class. As such, BAWLD will be suitable for many hydrological and biogeochemical modelling and upscaling efforts for the northern boreal and arctic region, in particular those aimed at improving assessments of current and future methane emissions.
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