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Study Quality
1. Timmann D, Diener HC. Coordination and ataxia. In: Goetz C, ed. Textbook of Clinical Neurology. 3rd ed: Saunders; 2007. Review/Other-Dx N/A Book chapter. N/A 4
2. Gilman S, Gelb DJ. Disorders of the Cerebellum. In: Griggs RC, Joynt RJ, eds. Baker’s Clinical Neurology: Lippincott Williams & Wilkins; 2003 Review/Other-Dx N/A Book chapter. N/A 4
3. Melo TP, Bogousslavsky J, Moulin T, Nader J, Regli F. Thalamic ataxia. J Neurol. 1992;239(6):331-337. Observational-Dx 17 patients To study hemiataxia as a manifestation of thalamic infarction. Recovery was good, and in all patients the sensory and motor disturbances improved or cleared before the hemiataxia. All patients had an infarct involving the lateral part of the thalamus (thalamogeniculate territory in 16, tuberothalamic territory in 1), also affecting the posterior limb of the internal capsule (PLIC) in 7 patients. Hemiataxia seemed linked to involvement of the caudal part of the ventral lateral nucleus of the thalamus or the immediately adjacent medial part of the PLIC. 3
4. Expert Panel on Neurologic Imaging:, Salmela MB, Mortazavi S, et al. ACR Appropriateness Criteria Cerebrovascular Disease. J. Am. Coll. Radiol.. 14(5S):S34-S61, 2017 May. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for cerebrovascular disease. No results stated in abstract. 4
5. Shetty VS, Reis MN, Aulino JM, et al. ACR Appropriateness Criteria Head Trauma. J. Am. Coll. Radiol.. 13(6):668-79, 2016 Jun. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for head trauma. No results stated in abstract. 4
6. American College of Radiology. ACR Appropriateness Criteria®: Suspected Spine Trauma. Available at: Review/Other-Dx N/A To provide evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
7. Roth CJ, Angevine PD, Aulino JM, et al. ACR Appropriateness Criteria Myelopathy. J. Am. Coll. Radiol.. 13(1):38-44, 2016 Jan. Review/Other-Tx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for myelopathy No results stated in abstract. 4
8. American College of Radiology. ACR Appropriateness Criteria®: Hearing Loss and/or Vertigo. Available at: Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for Hearing Loss and/or Vertigo. No abstract available. 4
9. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Available at: Review/Other-Dx N/A To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. No abstract available. 4
10. Terry JB, Rosenberg RN. Frontal lobe ataxia. Surg Neurol. 1995; 44(6):583-588. Review/Other-Dx 1 patient Case report on a patient with large bilateral, medial-orbital, frontal lobe lesion who manifested gait impairment and dysarthria. Lesion is defined by MRI and PET. Disruption of the frontopontocerebellar pathway, originating from Brodman’s area 10 in the frontal cortex, is the likely mechanism for frontal ataxia. 4
11. Deluca C, Moretto G, Di Matteo A, et al. Ataxia in posterior circulation stroke: clinical-MRI correlations. J Neurol Sci. 2011;300(1-2):39-46. Review/Other-Dx 94 patients Our aim was to prospectively investigate functional localizations in the cerebellar system (hemispheres and peduncles) by quantifying ataxia severity in patients with PC strokes. Gait ataxia was present in 95.7%, limb ataxia in 76.1%, dysarthria in 56.5% and nystagmus in 65.2% of patients. Gait ataxia frequency did not differ between the patterns, but was significantly more severe in the CH/CP pattern than in either picaCH (P=0.0059) or CP (P=0.0065) pattern. Limb ataxia was significantly less frequent (P<0.001) and less severe (P<0.001) in picaCH pattern than other patterns. Dysarthria was less frequent in picaCH pattern than in other patterns (P=0.018) and less severe than in scaCH (P=0.0043) or CP (P=0.0047) pattern. No differences in nystagmus frequency or severity were observed across all four patterns. 4
12. Deluca C, Moretto G, Di Matteo A, et al. Hemi- and monoataxia in cerebellar hemispheres and peduncles stroke lesions: topographical correlations. Cerebellum. 11(4):917-24, 2012 Dec. Observational-Dx 70 patients To assess the topographical correlations of hemi- and monoataxia in 70 patients with posterior circulation stroke in order to better define clinical syndromes useful to localize the lesion within the cerebellar system but also to deepen the insight within the somatotopy of the cerebellar system. Hemiataxia was present in (47/70; 67.1%) and monoataxia in (23/70; 32.9%) of patients. Monoataxia involved the upper limb in (19/70; 27.1%) and the lower limb in (4/70; 5.7%) of patients. Limb ataxia usually localized the lesion ipsilaterally (picaCH, scaCH, CH/CP, and CP patterns involving the medulla and sometimes the pons) (53/70; 75.7%), but it might be due also to contralateral (CP pattern involving the pons or midbrain) (16/70; 22.9%) or bilateral lesions (1/70). 3
13. Ye BS, Kim YD, Nam HS, Lee HS, Nam CM, Heo JH. Clinical manifestations of cerebellar infarction according to specific lobular involvement. Cerebellum. 2010; 9(4):571-579. Observational-Dx 66 consecutive patients Analysis of patients with isolated cerebellar infarctions demonstrated on DWI MRI. The most common symptoms in patients with isolated cerebellar infarctions were vertigo (87%) and lateropulsion (82%). Isolated vertigo or lateropulsion without any other symptoms was present in 38% of patients. On the other hand, limb ataxia was a presenting symptom in only 40% of the patients. Lateropulsion, vertigo, and nystagmus were more common in patients with a lesion in the caudal vermis. Logistic regression analysis showed that lesions in the posterior paravermis or nodulus were independently associated with lateropulsion. Lesions in the nodulus were associated with contralateral pulsion, and involvement of the culmen was associated with ipsilateral pulsion and isolated lateropulsion without vertigo. Nystagmus was associated with lesions in the pyramis lobule, while lesions of the anterior paravermis were associated with dysarthria and limb ataxia. Results showed that the cerebellar lobules are responsible for producing specific symptoms in cerebellar stroke patients. 3
14. Luijckx GJ, Boiten J, Lodder J, Heuts-van Raak L, Wilmink J. Isolated hemiataxia after supratentorial brain infarction. J Neurol Neurosurg Psychiatry. 1994; 57(6):742-744. Review/Other-Dx 3 patients Describe hemiataxia in association with infarction involving the posterior limb of the internal capsule. Hemiataxia can occur in association with isolated supratentorial infarction involving the posterior limb of the internal capsule. 4
15. Kim JS, Lee JH, Im JH, Lee MC. Syndromes of pontine base infarction. A clinical-radiological correlation study. Stroke. 1995; 26(6):950-955. Review/Other-Dx 37 patients Report the clinical-imaging correlation of lacunar infarction involving the base of the pons. Study suggested large lesions involving the paramedian caudal or middle pons correlate with severe hemiparesis, whereas lesions of similar size located in the paramedian rostral pons tended to produce dysarthria-clumsy hand syndrome. In pontine lacunar infarction various manifestations of ataxia are frequent, but they are less common than sensory-motor alteration. 4
16. Jagoda AS, Bazarian JJ, Bruns JJ Jr, et al. Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 52(6):714-48, 2008 Dec. Review/Other-Dx N/A To provide evidence-based recommendations on select issues in the management of adult patients with mTBI in the acute setting. No abstract available. 4
17. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 343(2):100-5, 2000 Jul 13. Observational-Dx 1st phase – 520 consecutive patients; 2nd phase – 909 consecutive patients Prospective study to derive and validate a set of clinical criteria that could be used to identify patients with MHI in whom CT could be forgone. The study was conducted in two phases at a large, inner-city, level 1 trauma center. Of the 520 patients in the first phase, 36 (6.9%) had positive scans. All patients with positive CT scans had one or more of 7 findings: headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure. Among the 909 patients in the second phase, 57 (6.3%) had positive scans. In this group of patients, the sensitivity of the 7 findings combined was 100% (95% CI, 95% to 100%). All patients with positive CT scans had at least one of the findings. For the evaluation of patients with MHI, the use of CT can be safely limited to those who have certain clinical findings. 3
18. Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 357(9266):1391-6, 2001 May 05. Observational-Dx 3,121 consecutive patients Prospective cohort multicenter study to develop a highly sensitive clinical decision rule for use of CT in patients with minor head injuries. A CT head rule was derived which consists of 5 high-risk factors (failure to reach GCS (G of 15 within 2 h, suspected open skull fracture, any sign of basal skull fracture, vomiting >2 episodes, or age >65 years) and two additional medium-risk factors (amnesia before impact >30 min and dangerous mechanism of injury). The high-risk factors were 100% sensitive (95% CI, 92%-100%) for predicting need for neurological intervention, and would require only 32% of patients to undergo CT. The medium-risk factors were 98.4% sensitive (95% CI, 96%-99%) and 49.6% specific for predicting clinically important brain injury, and would require only 54% of patients to undergo CT. 3
19. Juliano AF, Ginat DT, Moonis G. Imaging Review of the Temporal Bone: Part II. Traumatic, Postoperative, and Noninflammatory Nonneoplastic Conditions. [Review]. Radiology. 276(3):655-72, 2015 Sep. Review/Other-Dx N/A To discuss about the anatomy of the temporal bone as well as inflammatory and neoplastic processes in the temporal bone region. No results stated in abstract. 4
20. Biffl WL, Cothren CC, Moore EE, et al. Western Trauma Association critical decisions in trauma: screening for and treatment of blunt cerebrovascular injuries. [Review] [38 refs]. J Trauma. 67(6):1150-3, 2009 Dec. Review/Other-Tx N/A N/A No results stated in abstract. 4
21. Bromberg WJ, Collier BC, Diebel LN, et al. Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma. 68(2):471-7, 2010 Feb. Review/Other-Dx 68 articles EBM guideline for the screening, diagnosis, and treatment of BCVI by the Eastern Association for the Surgery of Trauma organization Practice Management Guidelines committee. The East Practice Management Guidelines Committee suggests guidelines that should be safe and efficacious for the screening, diagnosis, and treatment of BCVI. Risk factors for screening are identified, screening modalities are reviewed indicating that although angiography remains the gold standard, multi-planar (=8 slice) CTA may be equivalent, and treatment algorithms are evaluated. It is noted that change in the diagnosis and management of this injury constellation is rapid due to technological advancement and the difficulties inherent in performing randomized prospective trials in this patient population. 4
22. Amyot F, Arciniegas DB, Brazaitis MP, et al. A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury. J Neurotrauma 2015;32:1693-721. Review/Other-Dx N/A To review the effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury. No results stated in abstract. 4
23. Patel SG, Collie DA, Wardlaw JM, et al. Outcome, observer reliability, and patient preferences if CTA, MRA, or Doppler ultrasound were used, individually or together, instead of digital subtraction angiography before carotid endarterectomy. J Neurol Neurosurg Psychiatry. 2002;73(1):21-28. Observational-Dx 67 patients To evaluate the accuracy of routinely available non-invasive tests (spiral computed tomographic angiography (CTA), time of flight magnetic resonance angiography (MRA), and colour Doppler ultrasound (DUS)), individually and together, compared with intra-arterial digital subtraction angiography (DSA) in patients with symptomatic tight carotid stenosis; and to assess the effect of substituting non-invasive tests for DSA on outcome, interobserver variability, and patient preference. 67 patients were included (34 had all four imaging procedures). DUS, CTA, and MRA all agreed with DSA in the diagnosis of operable v non-operable disease in about 80% of patients. CTA tended to underestimate (sensitivity 0.65, specificity 1.0), MRA to overestimate (sensitivity 1.0, specificity 0.57), and DUS to agree most closely with (sensitivity 0.85, specificity 0.71) the degree of stenosis as shown by DSA. When using any two of the three non-invasive tests in combination, adding the third if the first two disagreed would result in very few misdiagnoses (about 6%). MRA had similar interobserver variability to CTA (both worse than DSA). Patients preferred CTA over MRA and DSA. 1
24. Villablanca JP, Nael K, Habibi R, Nael A, Laub G, Finn JP. 3 T contrast-enhanced magnetic resonance angiography for evaluation of the intracranial arteries: comparison with time-of-flight magnetic resonance angiography and multislice computed tomography angiography. Invest Radiol. 2006;41(11):799-805. Observational-Dx 12 patients (312 arterial segments examined) To prospectively evaluate the image quality and visualization of the intracranial arteries using high spatial resolution contrast-enhanced magnetic resonance angiography (CE-MRA) at 3 T and to perform intraindividual comparison with time-of-flight (TOF) MRA and multislice CT angiography (CTA). A total of 312 arterial segments were examined by CE-MRA, TOF-MRA, and CTA. The majority of intracranial arteries (87%) were visualized with diagnostic image quality on CE-MRA with a significant correlation to TOF (R values = 0.84; 95% confidence interval 0.79-0.86, P < 0.0001), and to CTA (R values = 0.74; 95% confidence interavl 0.68-0.78, P < 0.001). The image quality for small intracranial arteries, including the anterior-inferior cerebellar artery, the posterior communicating artery, and the M3 branch of the middle cerebral artery, was significantly lower on CE-MRA compared with TOF and CTA (P < 0.03). There was a significant correlation for the dimensional measurements of arterial diameters at CE-MRA with TOF (r = 0.88, 95% confidence interval 0.81-0.93), and CTA (r = 0.83, 95% confidence interval 0.73-0.90). 1
25. Westerlaan HE, van Dijk MJ, Jansen-van der Weide MC, et al. Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis--systematic review and meta-analysis. Radiology. 2011; 258(1):134-145. Meta-analysis 50 studies; 2 independent reviewers To calculate the sensitivity and specificity of CTA in the diagnosis of cerebral aneurysms in patients with acute SAH at presentation. For sensitivity, the selected studies showed moderate heterogeneity. For specificity, low heterogeneity was observed. The majority of the studies (n = 30) used a four-detector row CT scanner. The studies had good methodologic quality. Pooled sensitivity was 98% (95% CI: 97%, 99%), and pooled specificity was 100% (95% CI: 97%, 100%). Potential sources of variability among the studies were variations in the methodologic features (quality score), CT examination procedure (number of rows on the MDCT scanner), the standard of reference used, and the prevalence of ruptured intracranial aneurysms. There was evidence for publication bias, which may have led to overestimation of the diagnostic accuracy of CTA. M
26. Ben Hassen W, Machet A, Edjlali-Goujon M, et al. Imaging of cervical artery dissection. [Review]. Diagn Interv Imaging. 95(12):1151-61, 2014 Dec. Review/Other-Dx N/A To review Imaging of cervical artery dissection. No results stated in abstract 4
27. Fiebach J, Brandt T, Knauth M, Jansen O. [MRI with fat suppression in the visualization of wall hematoma in spontaneous dissection of the internal carotid artery]. Rofo 1999;171:290-3. Review/Other-Dx 13 patients To compare the different MR-examination techniques for the diagnosis of acute spontaneous internal carotid artery dissection. MR-angiography shows a narrowing of the vessel diameter in early examinations. During the subacute stage methemoglobin can obscure this finding. From the third day on fat suppressed T1-weighted images showed a hyperintense hematoma that strongly contrasted to the surrounding fatty tissue. Fat suppressed images showed a hyperintense hematoma up to 10 months after symptom onset while MRA and spin echo sequences did not. 4
28. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group.[Erratum appears in N Engl J Med 2001 Feb 8;344(6):464]. N Engl J Med. 343(2):94-9, 2000 Jul 13. Observational-Dx 34,069 patients; 818 patients had CSI Multicenter study. Prospective observational study to determine validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study. (NEXUS). Decision instrument had sensitivity of 99% [95% CI, 98.0%-99.6%]), NPV of 99.8% (95% CI, 99.6%-100%), specificity 12.9%, and PPV 2.7%. Decision instrument based on clinical criteria can help physicians identify patients who need radiography of the cervical spine after blunt trauma. Application of this instrument could reduce the use of imaging in such patients. 3
29. Liu WH, Hsieh CT, Chiang YH, Chen GJ. Spontaneous spinal epidural hematoma of thoracic spine: a rare case report and review of literature. Am J Emerg Med. 2008;26(3):384 e381-382. Review/Other-Dx 1 patient To present a case of a 50-year-old man who sustained sudden onset of severe back pain, followed by progressive weakness and numbness over bilateral lower limbs. Magnetic resonance imaging of thoracic spine demonstrated an epidural mass extending from T6 through T8, causing spinal cord compression. Emergent decompressive surgery was performed, and epidural hematoma was diagnosed postoperatively; the patient had significant improvement of neurologic deficits. 4
30. Spontaneous complete recovery of paraplegia caused by epidural hematoma complicating epidural anesthesia: a case report and review of literature Review/Other-Dx 1 case To report a patient who developed epidural hematoma following epidural anesthesia causing acute paraplegia. Patient showed early signs of recovery with complete resolution of neurological deficits in 12 weeks. 4
31. Thiele RH, Hage ZA, Surdell DL, Ondra SL, Batjer HH, Bendok BR. Spontaneous spinal epidural hematoma of unknown etiology: case report and literature review. Neurocrit Care. 2008;9(2):242-246. Review/Other-Dx 1 case To emphasize the importance of recognizing and rapidly treating spontaneous spinal epidural hematoma (SSEH). No results stated in abstract. 4
32. Bailitz J, Starr F, Beecroft M, et al. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 66(6):1605-9, 2009 Jun. Observational-Dx 1,505 consecutive patients Prospective blinded study to compare the sensitivity of cervical CT to cervical spine radiographs in the initial diagnosis of blunt CSI for patients meeting one or more of the NEXUS criteria. Of 1,505 patients, 78 (4.9%) had evidence of a radiographic injury by cervical spine radiographs or cervical CT. Of these 78 patients with radiographic injury, 50 (3.3%) patients had clinically significant injuries. Cervical CT detected all patients with clinically significant injuries (100% sensitive), whereas cervical spine radiographs detected 18 (36% sensitive). Of the 50 patients, 15 were at high risk, 19 at moderate risk, and 16 at low risk for CSI according to previously published risk stratification. Cervical spine radiographs detected clinically significant injury in 7 high risk (46% sensitive), 7 moderate risk (37% sensitive), and 4 low risk patients (25% sensitive). Results demonstrate the superiority of cervical CT compared with cervical spine radiographs for the detection of clinically significant CSI. The improved ability to exclude injury rapidly provides further evidence that cervical CT should replace cervical spine radiographs for the initial evaluation of blunt CSI in patients at any risk for injury. 2
33. Hauser CJ, Visvikis G, Hinrichs C, et al. Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma. 55(2):228-34; discussion 234-5, 2003 Aug. Observational-Dx 222 patients 215 patients fully evaluated Prospective clinical study to validate CT screening of the thoracolumbar spine in trauma. All patients had CT/CAP and lateral radiographs of the thoracolumbar spine. Sensitivity, specificity, PPV and NPV were better for CT/CAP than for lateral radiographs of the thoracolumbar spine. CT/CAP diagnoses thoracolumbar spine fractures more accurately than lateral radiographs of the thoracolumbar spine. Neither misses unstable fractures, but CT scanning finds small fractures that benefit by treatment and identifies chronic disease better. CT screening is far faster and shortens time to removal of spine precautions. CT scan-based diagnosis does not result in greater radiation exposure and improves resource use. Screening the thoracolumbar spine on truncal helical CT scanning performed for the evaluation of visceral injuries is more accurate than thoracolumbar spine imaging by standard radiography. CT/CAP should replace radiographs in high-risk trauma patients who require screening. 3
34. Inaba K, Munera F, McKenney M, et al. Visceral torso computed tomography for clearance of the thoracolumbar spine in trauma: a review of the literature. [Review] [19 refs]. J Trauma. 60(4):915-20, 2006 Apr. Review/Other-Dx N/A To identify and review all published studies comparing reformatted CT to traditional radiography for thoracolumbar spine clearance. Reformatted CT showed better sensitivity and interobserver variability than radiographic screening. CT was also more accurate in localizing, classifying, and delineating the age, bony intrusion, and soft-tissue damage associated with the fracture. For studies with time-motion components, a protocol utilizing CT clearance was not only more accurate but faster and more economical. Screening with reformatted visceral CT data required no additional scan time or radiation exposure. 4
35. Karul M, Bannas P, Schoennagel BP, et al. Fractures of the thoracic spine in patients with minor trauma: comparison of diagnostic accuracy and dose of biplane radiography and MDCT. Eur J Radiol. 82(8):1273-7, 2013 Aug. Observational-Dx 107 patients To investigate the accuracy of biplane radiography in the detection of fractures of the thoracic spine in patients with minor trauma using multidetector computed tomography (MDCT) as the reference and to compare the dose of both techniques. MDCT revealed 77 fractures in 65/107 patients (60.7%). Biplane radiography was true positive in 32/107 patients (29.9%), false positive in 19/107 patients (17.8%), true negative in 23/107 (21.5%) and false negative in 33/107 patients (30.8%), showing a sensitivity of 49.2%, a specificity of 54.7%, a positive predictive value (PPV) of 62.7%, a negative predictive value (NPV) of 41.1%, and an accuracy of 51.4%. The presence of a fracture on biplane radiography was highly statistical significant, if this was simultaneously proven by MDCT (?(2)=7.6; p=0.01). None of the fractures missed on biplane radiography was unstable. The mean DLP on biplane radiography was 14.5mGycm (range 1.9-97.8) and on MDCT 374.6mGycm (range 80.2-871). 2
36. Rajasekaran S, Vaccaro AR, Kanna RM, et al. The value of CT and MRI in the classification and surgical decision-making among spine surgeons in thoracolumbar spinal injuries. Eur Spine J. 26(5):1463-1469, 2017 May. Observational-Dx 30 thoracolumbar fractures To determine the value of CT and MRI in the classification and surgical decision-making among spine surgeons in thoracolumbar spinal injuries. Surgeons correctly classified 43.4 % of fractures with plain radiographs alone; after, additionally, evaluating CT and MRI images, this percentage increased by further 18.2 and 2.2 %, respectively. AO type A fractures were identified in 51.7 % of fractures with radiographs, while the number of type B fractures increased after CT and MRI. The number of type C fractures diagnosed was constant across the three steps. Agreement between radiographs and CT was fair for A-type (k = 0.31), poor for B-type (k = 0.19), but it was excellent between CT and MRI (k > 0.87). CT and MRI had similar sensitivity in identifying fracture subtypes except that MRI had a higher sensitivity (56.5 %) for B2 fractures (p < 0.001). The need for surgical fixation was deemed present in 72 % based on radiographs alone and increased to 81.7 % with CT images (p < 0.0001). The assessment for need of surgery did not change after an MRI (p = 0.77). 3
37. Rhea JT, Sheridan RL, Mullins ME, Novelline RA. Can chest and abdominal trauma CT eliminate the need for plain films of the spine? – Experience with 329 multiple trauma patients. Emerg Radiol. 2001;8(2):99-104. Observational-Dx 329 patients To compare the accuracy of spine plain films with chest and abdominal trauma CT in detection of spine fractures Of the fractures visible at either chest trauma CT or thoracic spine plain film examination, all were diagnosed on CT and 62 % on plain films. Of fractures visible at either abdominal trauma CT or lumbar spine plain films, 94 % were diagnosed on CT and 67 % on plain films. The one false negative CT involved an articular process fracture, which was visible but not mentioned, in a patient with a sacral fracture. 4
38. Sheridan R, Peralta R, Rhea J, Ptak T, Novelline R. Reformatted visceral protocol helical computed tomographic scanning allows conventional radiographs of the thoracic and lumbar spine to be eliminated in the evaluation of blunt trauma patients. J Trauma. 55(4):665-9, 2003 Oct. Observational-Dx 1,915 patients Prospective study to determine if reformatted CT images of the thoracic and lumbar spine were effective in diagnosing thoracic and lumbar fractures and they could replace radiography. Of 1,915 patients, 78 (4.1%), with an average Injury Severity Score of 21.3 +/- 1.2, sustained one or more thoracic (n=35 patients) or lumbar (n=43 patients) spine fractures. Reformatted CT images identified 97% of thoracic and 95% of lumbar fractures as opposed to 62% and 86% respectively for radiographs. Study concludes that reformatted images provide accurate screening, eliminating the time, expense, and radiation exposure associated with conventional radiography. 2
39. Forster BB, Koopmans RA. Magnetic resonance imaging of acute trauma of the cervical spine: spectrum of findings. Can Assoc Radiol J. 46(3):168-73, 1995 Jun. Review/Other-Dx N/A To discuss the appearance of the traumatized cord, including intramedullary hemorrhage, and the causes of spinal cord compression, such as disk herniation, epidural hematoma, fracture, dislocation and underlying spinal stenosis. No results stated in abstract. 4
40. Guarnieri G, Izzo R, Muto M. The role of emergency radiology in spinal trauma. [Review]. Br J Radiol. 89(1061):20150833, 2016. Review/Other-Dx N/A To describe incidence and type of vertebral fracture; imaging indication and guidelines for cervical trauma; imaging indication and guidelines for thoracolumbar trauma; multidetector CT indication for trauma spine; MRI indication and protocol for trauma spine. No results stated in abstract. 4
41. Wintermark M, Mouhsine E, Theumann N, et al. Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology. 2003; 227(3):681-689. Observational-Dx 100 patients; radiographs, 5 observers; CT, 3 observers To determine if MDCT can replace radiography and be performed alone in trauma patients to diagnose thoracolumbar spine fractures. 67 fractures were identified in 26 patients. Mean sensitivity and interobserver agreement, respectively, for detection of unstable fractures were 97.2% and 0.951 for MDCT and 33.3% and 0.368 for conventional radiography. Study concludes that MDCT is more effective than radiography for finding fractures and should replace radiography in patients with severe trauma. 1
42. Zhang Z, Wang H, Zhou Y, Wang J. Computed tomographic angiography of anterior spinal artery in acute cervical spinal cord injury. Spinal Cord. 51(6):442-7, 2013 Jun. Review/Other-Dx 20 patients To identify spinal cord ischemia secondary to anterior spinal artery (ASA) rupture in acute cervical SCI. The ASA was visualized in all 20 patients. No ASA rupture was found in CCS and BSS patients, even for sever blunt cervical fracture and dislocation tetraplegia patients, except one stab-wound patient. 4
43. Dundamadappa SK, Cauley KA. MR imaging of acute cervical spinal ligamentous and soft tissue trauma. [Review]. EMERG. RADIOL.. 19(4):277-86, 2012 Aug. Review/Other-Dx N/A To familiarize the reader with some of the more common soft tissue, vascular, and ligamentous injuries seen on MRI of the cervical spine in the emergent setting. No results stated in abstract. 4
44. Erwood AM, Abel TJ, Grossbach AJ, Ahmed R, Dahdaleh NS, Dlouhy BJ. Acutely unstable cervical spine injury with normal CT scan findings: MRI detects ligamentous injury. J Clin Neurosci. 24:165-7, 2016 Feb. Review/Other-Dx N/A The authors present a trauma patient with normal CT imaging despite dislocation on standing radiograph. No results stated in abstract. 4
45. Kerkovsky M, Bednarik J, Dusek L, et al. Magnetic resonance diffusion tensor imaging in patients with cervical spondylotic spinal cord compression: correlations between clinical and electrophysiological findings. Spine. 37(1):48-56, 2012 Jan 01. Observational-Dx 52 patients To analyze the potential of DTI of the cervical spinal cord in the detection of changes associated with spondylotic myelopathy, with particular reference to clinical and electrophysiological findings. Significant differences in both the DTI parameters measured at the maximal compression level, between patients with compression and control group, were found, while no difference was observed at the noncompression level. Moreover, FA values were lower and ADC values were higher at the maximal compression level in the symptomatic patients than in the asymptomatic patients. The DTI showed higher potential to discriminate between clinical subgroups in comparison with standard MRI parameters and electrophysiological findings. 2
46. Song T, Chen WJ, Yang B, et al. Diffusion tensor imaging in the cervical spinal cord. European Spine Journal. 20(3):422-8, 2011 Mar. Observational-Dx 53 patients and 20 healthy volunteers To elucidate the usage of DTI in analyzing the early findings of the compressive cervical spinal cord and in depicting the diffusion characteristics of cervical cord in healthy volunteers of Chinese. Intramedullary ADC and FA values were measured in 4 segments (C2/3, C3/4, C4/5, C5/6) for volunteers, in lesions (or the compressed cord) and normal cord for patients. DTI original images were processed to produce color DTI maps. In the volunteers' group, cervical cord exhibited blue on the color DTI map. FA values between 4 segments had a significant difference (P<0.01), with the highest FA value (0.85 +/- 0.03) at C2/3 level. However, ADC value between them had no significant difference (P>0.05). For patients, only 24 cases showed hyperintense on T2-weighted image, while 39 cases shown patchy green signal on color DTI maps. ADC and FA values between lesions or the compressed cord and normal spinal cord of patients had a significant difference (both P<0.01). FA value at C2/3 cord is the highest of other segments and it gradually decreases towards the caudal direction. Using single-shot spin echo echo-planar imaging sequence and 6 noncollinear diffusion directions with b value of 400 s mm(-2), DTI can clearly show the intramedullary microstructure and more lesions than conventional MRI. 2
47. Emery SE, Pathria MN, Wilber RG, Masaryk T, Bohlman HH. Magnetic resonance imaging of posttraumatic spinal ligament injury. J Spinal Disord. 1989; 2(4):229-233. Observational-Dx 37 patients; 2 observers 2 blinded readers examined T-1 and T-2 weighted multiplanar images, 35 radiographs, 16 tomographs, and 30 CT images to evaluate role of MRI in detecting ligament injury in acute post-trauma spinal patients. 19 patients were considered to have torn posterior ligaments. MRI detected ligament damage in 17. All patients considered to have intact posterior ligament clinically and radiographically had no evidence of ligament damage on MRI. T-2 weighted images were essential for valid detection of ligament damage. MRI is recommended in the assessment of the integrity of spinal ligaments after acute trauma. 3
48. Zhang JS, Huan Y. Multishot diffusion-weighted MR imaging features in acute trauma of spinal cord. Eur Radiol 2014;24:685-92. Observational-Dx 20 patients To analyse diffusion-weighted MRI of acute spinal cord trauma and evaluate its diagnostic value. Twenty cases were classified into four categories according to the characteristics of DWI: (1) Oedema type: ten cases presented with variable hyperintense areas within the spinal cord. There were significant differences in the apparent diffusion coefficients (ADCs) between lesions and unaffected regions (t?=?-7.621, P?<?0.01). ADC values of lesions were markedly lower than those of normal areas. (2) Mixed type: six cases showed heterogeneously hyperintense areas due to a mixture of haemorrhage and oedema. (3) Haemorrhage type: two cases showed lesions as marked hypointensity due to intramedullary haemorrhage. (4) Compressed type (by epidural haemorrhage): one of the two cases showed an area of mild hyperintensity in the markedly compressed cord due to epidural haematoma. 2
49. Jadhav AP, Jovin TG. Vascular imaging of the head and neck. [Review]. Semin Neurol. 32(4):401-10, 2012 Sep. Review/Other-Dx N/A To discuss the application of magnetic resonance angiography (MRA), computed tomographic angiography (CTA), and digital subtraction angiography (DSA) in the evaluation of cerebrovascular diseases with an emphasis on ischemic and hemorrhagic stroke. No results stated in abstract. 4
50. Bruylant K, Crols R, Humbel RL, Appel B, De Deyn PP. Probably anti-Tr associated paraneoplastic cerebellar degeneration as initial presentation of a squamous cell carcinoma of the lung. Clin Neurol Neurosurg. 2006; 108(4):415-417. Review/Other-Dx 1 patient Case report on paraneoplastic cerebellar degeneration associated with anti-Tr (anti-Purkinge cell) antibodies. 14 months after onset of symptoms, whole body PET-scan showed a pathological focus at the right hilus of the lungs. Anatomopathological analysis revealed a non-well differentiated squamous cell carcinoma. This is first report about the association between an anti-Tr associated paraneoplastic cerebellar degeneration and squamous cell carcinoma. 4
51. Desai J, Mitchell WG. Acute cerebellar ataxia, acute cerebellitis, and opsoclonus-myoclonus syndrome. J Child Neurol. 2012;27(11):1482-1488. Review/Other-Dx N/A To describe distinguishable characteristics of Acute cerebellar ataxia, acute cerebellitis, and opsoclonus-myoclonus syndrome. There is considerable overlap between these entities. The mildest cases of acute cerebellar ataxia represent a benign condition that is characterized by acute truncal and gait ataxia, variably with appendicular ataxia, nystagmus, dysarthria, and hypotonia. It occurs mostly in young children, presents abruptly, and recovers over weeks. Neuroimaging is normal. Severe cases of cerebellitis represent the other end of the spectrum, presenting with acute cerebellar signs often overshadowed by alteration of consciousness, focal neurological deficits, raised intracranial pressure, hydrocephalus, and even herniation. Neuroimaging is abnormal and the prognosis is less favorable than in acute cerebellar ataxia. Acute disseminated encephalomyelitis may be confused with acute cerebellitis when the clinical findings are predominantly cerebellar, but lesions on neuroimaging are usually widespread. Paraneoplastic opsoclonus-myoclonus syndrome is often initially misdiagnosed as acute cerebellar ataxia, but has very specific features, course, and etiopathogensis. 4
52. Adachi M, Kawanami T, Ohshima H, Hosoya T. Cerebellar atrophy attributed to cerebellitis in two patients. Magn Reson Med Sci. 2005; 4(2):103-107. Review/Other-Dx 2 patients Describe the late findings of cerebellitis in two rare patients considered to be in late-stage cerebellitis. Findings included isolated cerebellar atrophy and slightly increased cortical signal intensity on FLAIR images. 4
53. Kanoto M, Hosoya T, Toyoguchi Y, Oda A. Brain stem and cerebellar atrophy in chronic progressive neuro-Behcet's disease. Eur J Radiol. 82(1):146-50, 2013 Jan. Observational-Dx 23 patients To identify the characteristic magnetic resonance imaging (MRI) findings of chronic progressive neuro-Behcet's disease (CPNBD) and to clarify the differences between the MRI findings of CPNBD and those of multiple sclerosis (MS). Brain stem atrophy, cerebellar atrophy, and leukoencephalopathy were seen in all CPNBD cases. Prepontine distance was significantly different between the CPNBD group and the MS group (p<0.05), and between the CPNBD group and the normal control group (p<0.001). Pontine and mesencephalic distance were significantly different between the CPNBD group and the MS group (p<0.001, p<0.01 respectively), and between the CPNBD group and the normal control group (p<0.001). 3
54. Sundar U, Shrivastava MS. Acute disseminated encephalomyelitis--a prospective study of clinical profile and in-hospital outcome predictors. Journal of the Association of Physicians of India. 60:21-6, 2012 Mar. Observational-Dx 29 patients To study the clinical profile, laboratory and imaging parameters, in-hospital morbidity/ mortality and clinical and imaging predictors of in-hospital outcome in acute disseminated encephalomyelitis (ADEM). A total of 29 patients were studied, gender ratio being not significantly different. Prior infection was present in 55.1% patients. Motor deficits (68.9%), bowel bladder abnormalities (65.5%) and sensory deficits (24.1%) were the commonest presenting features. Encephalopathy was seen in 24.1% patients. 10.3% patients had seizures and meningism. A polysymptomatic presentation was seen in 79.3% patients. Pure spinal cord affection (41.3%) was the commonest magnetic resonance imaging (MRI) pattern followed by subcortical (31%) and periventricular white matter involvement (24.1%). A normal MRI was seen in 17.2% of patients. 63% patients showed raised Cerebrospinal fluid (CSF) protein. The commonest in-hospital morbidity was urinary tract infection (18.5%). At admission; 81.4% patients had modified Rankin's score (MRS) between 4 and 6. At 6 weeks post admission, 90.4% patients had MRS score between 0-3, i.e, a favourable MRS. 2
55. Zuccoli G, Siddiqui N, Cravo I, Bailey A, Gallucci M, Harper CG. Neuroimaging findings in alcohol-related encephalopathies. AJR. 2010; 195(6):1378-1384. Review/Other-Dx N/A Review the emergent neuroimaging findings of alcohol-related central nervous system nontraumatic disorders. Alcohol-related encephalopathies can be life-threatening conditions but can be prevented or treated, if recognized. 4
56. Spampinato MV, Castillo M, Rojas R, Palacios E, Frascheri L, Descartes F. Magnetic resonance imaging findings in substance abuse: alcohol and alcoholism and syndromes associated with alcohol abuse. Top Magn Reson Imaging. 2005; 16(3):223-230. Review/Other-Dx N/A Review imaging alterations associated with chronic ethanol abuse. Mechanisms of brain toxicity and imaging findings associated with Wernicke encepha-lopathy, fetal alcohol syndrome, Marchiafava-Bignami disease, chronic hepatic encepha-lopathy, osmotic demyelization syndrome, and methanol toxicity are reviewed and illustrated. No results stated in abstract. 4
57. Offiah C, Hall E. Heroin-induced leukoencephalopathy: characterization using MRI, diffusion-weighted imaging, and MR spectroscopy. Clin Radiol. 2008; 63(2):146-152. Review/Other-Dx 6 patients To describe the MRI characteristics of heroin-induced leukoencephalopathy and, in particular, the DWI and MRS features. Cerebellar white matter was involved in all 6 cases demonstrating similar symmetrical distribution with sparing of the dentate nuclei. Brain stem signal change was evident in 5/6 patients imaged. Supratentorial brain parenchymal involvement, as well as brain stem involvement, correlated anatomically with corticospinal tract distribution. None of the areas of signal abnormality were restricted on DWI. Of those patients subjected to MRS, the areas of parenchymal damage demonstrated reduced N-acetylaspartate, reduced choline, and elevated lactate. Heroin-induced leukoencephalopathy results in characteristic and highly specific signal abnormalities on MRI, which can greatly aid diagnosis. DWI and MRS findings can be explained by known reported neuropathological descriptions in this condition and can be used to support a proposed mechanism for the benefit of current recommended drug treatment regimes. 4
58. Borne J, Riascos R, Cuellar H, Vargas D, Rojas R. Neuroimaging in drug and substance abuse part II: opioids and solvents. Top Magn Reson Imaging. 2005; 16(3):239-245. Review/Other-Dx N/A To review the imaging finding associated with opiate and solvent abuse. Imaging alterations are mediated by vascular, infectious, cytotoxic and demyelinating mechanisms. Cerebellar atrophy and infarction are frequent. 4
59. Abbaslou P, Zaman T. A Child with elemental mercury poisoning and unusual brain MRI findings. Clin Toxicol (Phila). 2006; 44(1):85-88. Review/Other-Dx 1 patient Describe unusual brain MRI findings in a child with mercury vapor poisoning. Multiple regions of high T2 signal intensity were demonstrated in cerebral white matter, left globus pallidus and putamen. 4
60. Korogi Y, Takahashi M, Okajima T, Eto K. MR findings of Minamata disease--organic mercury poisoning. J Magn Reson Imaging. 1998; 8(2):308-316. Review/Other-Dx N/A Describe the MRI findings of Minimata disease. There is prominent atrophy of the visual cortex, cerebellar vermis and cerebral cortex, though most prominently in pre and post central cortex. There is increased T2 signal intensity in occipital cortex. 4
61. Heaney CJ, Campeau NG, Lindell EP. MR imaging and diffusion-weighted imaging changes in metronidazole (Flagyl)-induced cerebellar toxicity. AJNR Am J Neuroradiol. 2003; 24(8):1615-1617. Review/Other-Dx 1 patient Describe MRI changes associated with metranidazole toxicity. MRI included increased T2 signal intensity in the dentate nuclei with associated restricted diffusion. Follow-up imaging 8 weeks after cessation of metronidazole therapy showed resolution of imaging findings, including diffusion changes. 4
62. Kim E, Na DG, Kim EY, Kim JH, Son KR, Chang KH. MR imaging of metronidazole-induced encephalopathy: lesion distribution and diffusion-weighted imaging findings. AJNR Am J Neuroradiol. 2007; 28(9):1652-1658. Review/Other-Dx 7 total patients initial MRI (n=7), DWI (n=5), follow-up MRI (n=4) Retrospective review of images to determine the topographic distributions and DWI findings of metronidazole-induced encephalopathy. Brain lesions were typically located at the cerebellar dentate nucleus, midbrain, dorsal pons, medulla, and splenium of the corpus callosum. According to DWI, most of the lesions in metronidazole-induced encephalopathy probably corresponded to areas of vasogenic edema, whereas only some of them, located in the corpus callosum, corresponded to cytotoxic edema. 4
63. Battisti C, Toffola ED, Verri AP, et al. Clinical and stabilometric monitoring in a case of cerebellar atrophy with vitamin E deficiency. Brain Dev. 1998; 20(4):253-257. Review/Other-Dx 1 patient Describe MRI alterations associated with vitamin E deficiency, ataxia and cerebellar atrophy. MRI demonstrated diffuse cerebellar atrophy. 4
64. Patel S, Barkovich AJ. Analysis and classification of cerebellar malformations. AJNR Am J Neuroradiol. 2002; 23(7):1074-1087. Review/Other-Dx 70 patients Retrospective review of MRI to provide a description and classification of cerebellar malformations. Classification system helps in the segregation and understanding of the relationship among cerebellar malformations. 4
65. Vedolin L, Gonzalez G, Souza CF, Lourenco C, Barkovich AJ. Inherited cerebellar ataxia in childhood: a pattern-recognition approach using brain MRI. AJNR Am J Neuroradiol. 2013;34(5):925-934, S921-922. Review/Other-Dx N/A To discuss a pattern-recognition approach to inherited cerebellar ataxia in childhood. Ataxias caused by dysfunction of the cerebellum occur in acute, intermittent, and progressive disorders. Most of the chronic progressive processes are secondary to degenerative and metabolic diseases. In addition, congenital malformation of the midbrain and hindbrain can also be present, with posterior fossa symptoms related to ataxia. Brain MR imaging is the most accurate imaging technique to investigate these patients, and imaging abnormalities include size, shape, and/or signal of the brain stem and/or cerebellum. Supratentorial and cord lesions are also common. 4
66. Akar E, Kara S, Akdemir H, Kiris A. Fractal dimension analysis of cerebellum in Chiari Malformation type I. Computers in Biology & Medicine. 64:179-86, 2015 Sep. Observational-Dx 33 patients To examine the morphological complexity features of this disorder, fractal dimension (FD) of cerebellar regions were estimated from magnetic resonance images (MRI) of 17 patients with Chiari Malformation type I (CM-I) and 16 healthy control subjects in this study. The results indicated that CM-I patients had significantly higher (p<0.05) FD values of gray matter (GM),  white matter (WM) and cerebrospinal fluid (CSF) tissues compared to control group. According to the results of correlation analysis between FD values and the corresponding area values, FD and area values of GM tissues in the patients group were found to be correlated. The results of the present study suggest that FD values of cerebellar regions may be a discriminative feature and a useful marker for investigation of abnormalities in the cerebellum of CM-I patients. 3
67. Alorainy IA, Sabir S, Seidahmed MZ, Farooqu HA, Salih MA. Brain stem and cerebellar findings in Joubert syndrome. J Comput Assist Tomogr. 2006; 30(1):116-121. Review/Other-Dx N/A Illustrate the brainstem and cerebellar findings in Joubert syndrome. Awareness of clinical and neuroimaging findings in Joubert syndrome and maintenance of a high index of suspicion are important in diagnosis. 4
68. Boltshauser E. Cerebellum-small brain but large confusion: a review of selected cerebellar malformations and disruptions. Am J Med Genet A. 2004; 126(4):376-385. Review/Other-Dx N/A Review congenital disorders of the cerebellum. No results stated in abstract. 4
69. Poretti A, Huisman TA, Scheer I, Boltshauser E. Joubert syndrome and related disorders: spectrum of neuroimaging findings in 75 patients. AJNR Am J Neuroradiol. 2011;32(8):1459-1463. Review/Other-Dx 75 patients To extend and better characterize the spectrum of neuroimaging findings in the largest series of patients with JSRD reported so far, to our knowledge. All patients had VH and enlargement of the fourth ventricle. The degree of VH and the form of the MTS were variable. In most patients, the cerebellar hemispheres were normal and the PF was enlarged. Brain stem morphology was abnormal in 30% of the patients. Supratentorial findings included hippocampal malrotation, callosal dysgenesis, migration disorders, cephaloceles, and ventriculomegaly. All patients with OFD VI had a similar pattern, including HH in 2 patients. No neuroimaging-genotype correlation could be found. 4
70. Abel TW, Baker SJ, Fraser MM, et al. Lhermitte-Duclos disease: a report of 31 cases with immunohistochemical analysis of the PTEN/AKT/mTOR pathway. J Neuropathol Exp Neurol. 2005; 64(4):341-349. Review/Other-Dx 31 patients To review histopathologic and molecular characteristics of LDD, and its association with CD. Basic imaging findings and histopathology are illustrated. The pathogenesis of LDD is thought to relate to loss of inhibitory regulation on cell growth and migration. Search for manifestations of CD is needed. 4
71. Al-Maawali A, Blaser S, Yoon G. Diagnostic approach to childhood-onset cerebellar atrophy: a 10-year retrospective study of 300 patients. J Child Neurol. 2012;27(9):1121-1132. Review/Other-Dx 300 patients We review the common causes of cerebellar atrophy in childhood and propose a diagnostic approach based on correlating specific neuroimaging patterns with clinical and genetic diagnoses. A diagnosis was established in 47% of patients: Mitochondrial disorders were most common, followed by neuronal ceroid lipofuscinosis, ataxia telangiectasia, and late-onset GM2 gangliosidosis. 4
72. Lin DD, Barker PB, Lederman HM, Crawford TO. Cerebral abnormalities in adults with ataxia-telangiectasia. AJNR Am J Neuroradiol. 2014;35(1):119-123. Review/Other-Dx 10 patients To analyze the MR imaging features of the supratentorial brain in a small series of young adults with A-T, all otherwise healthy and neurologically stable for years, though they were manifesting substantial persistent neurologic deficits. Intracerebral telangiectasia with multiple punctate hemosiderin deposits were identified in 60% of subjects. These lesions were apparently asymptomatic. They are similar in appearance to radiation-induced telangiectasia and to cryptogenic vascular malformations. Also noted, in the 2 oldest subjects, was extensive white matter T2 hyperintensity, and in 1 of these a space-occupying fluid collection consistent with transudative capillary leak and edema as evidenced by reduced levels of metabolites on MR spectroscopic imaging. 4
73. Tavani F, Zimmerman RA, Berry GT, Sullivan K, Gatti R, Bingham P. Ataxia-telangiectasia: the pattern of cerebellar atrophy on MRI. Neuroradiology. 2003; 45(5):315-319. Review/Other-Dx 19 patients Describe MRI finding and correlate findings with neurologic deficit in patients with patients with ataxia-telangiectasia. Lateral cerebellar and vermis atrophy occurred by age 3-7 years. It progressed to severe volume loss by late teen age years. 4
74. Akhlaghi H, Corben L, Georgiou-Karistianis N, et al. Superior cerebellar peduncle atrophy in Friedreich's ataxia correlates with disease symptoms. Cerebellum. 10(1):81-7, 2011 Mar. Observational-Dx 12 patients; 13 healthy controls To demonstrate whether structural magnetic resonance imaging (MRI) could be adopted as a biomarker in rating the severity of Friedreich’s ataxia (FRDA). The corrected cross-sectional areas of the right (left) superior cerebellar peduncle (SCP) in the individuals with FRDA (R, 20 +/- 7.9 mm(2); L, 25 +/- 5.6 mm(2)) were significantly smaller than for controls (R, 68 +/- 16 mm(2); L, 78 +/- 17 mm(2)) (p < 0.001). The SCP volumes of individuals with FRDA were negatively correlated with Friedreich's ataxia rating scale score (r = -0.553) and disease duration (r = -0.541), and positively correlated with the age of onset (r = 0.548) (p < 0.05). 2
75. Bhidayasiri R, Perlman SL, Pulst SM, Geschwind DH. Late-onset Friedreich ataxia: phenotypic analysis, magnetic resonance imaging findings, and review of the literature. Arch Neurol. 2005; 62(12):1865-1869. Observational-Dx 13 patients Describe the clinical and imaging findings of late onset Friedreich ataxia. In contrast to imaging findings associated with the usual presentation of Friedreich ataxia, cerebellar and vermis atrophy is common in late onset Friedreich ataxia. 3
76. Clemm von Hohenberg C, Schocke MF, Wigand MC, et al. Radial diffusivity in the cerebellar peduncles correlates with clinical severity in Friedreich ataxia. Neurological Sciences. 34(8):1459-62, 2013 Aug. Observational-Dx 9 patients To investigate the relationship of clinical and genetic data with diffusion-tensor imaging (DTI) indices reflecting white matter integrity of the cerebellar peduncles. For Bonferroni correction, significance threshold was set to p < 0.0056. We found that radial diffusivity (D( perpendicular)) within the inferior cerebellar peduncles (ICP) significantly correlated with scores on the Friedreich Ataxia Rating Scale (FARS, Spearman's rho = 0.883, p = 0.0016, all two-sided) and, at trend level, with number of trinucleotide repeats (rho = 0.812, p = 0.008). D( perpendicular) in the superior cerebellar peduncles (SCP) correlated with scores on the Scale for the Assessment and Rating of Ataxia (SARA, rho = 0.867, p = 0.0025). 3
77. Corben LA, Kashuk SR, Akhlaghi H, et al. Myelin paucity of the superior cerebellar peduncle in individuals with Friedreich ataxia: an MRI magnetization transfer imaging study. Journal of the Neurological Sciences. 343(1-2):138-43, 2014 Aug 15. Observational-Dx 10 patients; 10 controls To examine and contrast the integrity of white matter (WM) in the superior cerebellar peduncle (SCP) and the corpus callosum (CC) (control region) in ten individuals with Friedreich ataxia (FRDA) and ten controls with the help of magnetization transfer imaging (MTI). Individuals with FRDA demonstrated a significant reduction in the magnetization transfer ratio (MTR) in the SCP compared to control participants. However, there was no significant difference between groups in MTR in the CC. When comparing regions within groups, there was a significant reduction in MTR in the SCP compared to CC in participants with FRDA only. 3
78. Della Nave R, Ginestroni A, Diciotti S, Salvatore E, Soricelli A, Mascalchi M. Axial diffusivity is increased in the degenerating superior cerebellar peduncles of Friedreich's ataxia. Neuroradiology. 53(5):367-72, 2011 May. Observational-Dx 14 patients; 14 healthy controls To better define the type of axial diffusivity change occurring in a typical human neurodegenerative disease, we investigated axial and radial diffusivity in Friedreich's ataxia (FRDA) which is characterized by selective neuronal loss of the dentate nuclei and atrophy and decreased fractional anisotropy (FA) of the superior cerebellar peduncles (SCPs). Tract-based spatial statistics (TBSS) analysis showed a single area in the central midbrain corresponding to the decussation of the superior cerebellar peduncles (SCPs) which exhibited lower fractional anisotropy (FA) in patients than in controls. In this area, a significant increase of both axial and radial diffusivity was observed. No clusters of significantly decreased axial diffusivity were observed, while additional clusters of increase of radial diffusivity were present throughout the brain. 3
79. Zalesky A, Akhlaghi H, Corben LA, et al. Cerebello-cerebral connectivity deficits in Friedreich ataxia. Brain Structure & Function. 219(3):969-81, 2014 May. Observational-Dx 13 patients; 14 control participants To use novel tractography techniques to comprehensively map cerebello-cerebral connectivity in Friedreich ataxia (FRDA). No qualitative between-group differences in mean fractional anisotropy (FA) were evident. Statistical testing revealed a single cluster spanning portions of the brain stem, dentate nucleus and cerebellar peduncles with significantly reduced FA in the FRDA group compared to controls (p\0.001, corrected). 3
80. Renaud M, Perriard J, Coudray S, et al. Relevance of corpus callosum splenium versus middle cerebellar peduncle hyperintensity for FXTAS diagnosis in clinical practice. Journal of Neurology. 262(2):435-42, 2015 Feb. Observational-Dx 27 patients To report a practical justification of the relevance of corpus callosum splenium (CCS) hyperintensity in parallel with middle cerebellar peduncle (MCP) hyperintensity for the diagnosis of FXTAS. Among the 22 patients with Fragile X-associated tremor ataxia syndrome (FXTAS) premutation [17 men, 5 women; mean age, 63 +/- 7.5 (46-84)], 14 were diagnosed with definite FXTAS with the initial criteria. Considering CCS hyperintensity as a new major radiological criterion permitted the diagnosis of definite FXTAS in 3 additional patients. Overall CCS proved as frequent as MCP hyperintensity (64 versus 64 %), while 23 % of patients had CCS but not MCP hyperintensity, 14 % of patients had CCS hyperintensity but neither MCP, nor brainstem hyperintensity. In contrast with CCS hyperintensity, MCP hyperintensity proved less frequent in women than in men. CCS and MCP hyperintensity were more frequent in FXTAS than in the other neurodegenerative disorders. The combination of CCS and MCP hyperintensity was specific of FXTAS. 3
81. Hashimoto R, Srivastava S, Tassone F, Hagerman RJ, Rivera SM. Diffusion tensor imaging in male premutation carriers of the fragile X mental retardation gene. Movement Disorders. 26(7):1329-36, 2011 Jun. Observational-Dx 71 male patients To study male premutation carriers with and without fragile X-associated tremor/ataxia syndrome and healthy sex-matched controls using diffusion tensor imaging. Compared with healthy controls, patients with fragile X-associated tremor/ataxia syndrome showed significant reductions of fractional anisotropy in multiple white matter tracts, including the middle cerebellar peduncle, superior cerebellar peduncle, cerebral peduncle, and the fornix and stria terminalis. Significant reduction of fractional anisotropy in these tracts was confirmed by voxel-wise analysis using tract-based spatial statistics. Analysis of axial and radial diffusivities showed significant elevation of these measures in middle cerebellar peduncle, even among premutation carriers without fragile X-associated tremor/ataxia syndrome. Furthermore, regression analyses demonstrated a clear inverted U-shaped relationship between CGG-repeat size and axial and radial diffusivities in middle cerebellar peduncle. 3
82. Mascalchi M. Spinocerebellar ataxias. Neurol Sci. 2008; 29 Suppl 3:311-313. Review/Other-Dx N/A Review imaging of SCAs. Conventional MRI in patients with progressive ataxia demonstrates the three main patterns of macroscopic damage, namely spinal atrophy, OPCA and cortical cerebellar atrophy. Non-conventional MRI techniques detect nervous tissue abnormalities before development of atrophy which are correlated with the severity of the clinical deficit. 4
83. Mascalchi M, Diciotti S, Giannelli M, et al. Progression of brain atrophy in spinocerebellar ataxia type 2: a longitudinal tensor-based morphometry study. PLoS One. 2014;9(2):e89410. Observational-Dx 10 patients including 16 healthy controls To investigate the capability of magnetic resonance imaging (MRI) to track in vivo progression of brain atrophy in SCA2 by examining twice 10 SCA2 patients (mean interval 3.6 years) and 16 age- and gender-matched healthy controls (mean interval 3.3 years) on the same 1.5 T MRI scanner. With respect to controls, SCA2 patients showed significant higher atrophy rates in the midbrain, including substantia nigra, basis pontis, middle cerebellar peduncles and posterior medulla corresponding to the gracilis and cuneatus tracts and nuclei, cerebellar white matter (WM) and cortical gray matter (GM) in the inferior portions of the cerebellar hemisphers. No differences in WM or GM volume loss were observed in the supratentorial compartment. TBM findings did not correlate with modifications of the neurological deficit. 3
84. Perlman SL. Spinocerebellar degenerations. Handb Clin Neurol. 2011;100:113-140. Review/Other-Dx N/A To describe various spinocerebellar ataxias and how each affects the cerebellum and its afferent and efferent pathways. The typical dominant ataxias with associated hyperkinetic movements are SCA1-3, 6-8, 12, 14, 15, 17, 19-21, and 27. The common recessive ataxias with associated hyperkinetic movements are ataxia telangiectasia and Friedreich's ataxia. Fragile X tremor-ataxia syndrome (FXTAS) and multiple-system atrophy (a sporadic ataxia which is felt to have a genetic substrate) also have hyperkinetic features. A careful work-up should be done in all apparently sporadic cases, to rule out acquired causes of ataxia, some of which can cause hyperkinetic movements in addition to ataxia. Some testing should be done even in individuals with a confirmed genetic cause, as the presence of a secondary factor (nutritional deficiency, thyroid dysfunction) can contribute to the phenotype. 4
85. Reetz K, Costa AS, Mirzazade S, et al. Genotype-specific patterns of atrophy progression are more sensitive than clinical decline in SCA1, SCA3 and SCA6. Brain. 2013;136(Pt 3):905-917. Observational-Dx 82 patients To use structural imaging methods to capture the dynamics of neurodegeneration in relation to the clinical course in SCA1, SCA3 and SCA6. Volumetry revealed loss of brainstem, cerebellar and basal ganglia volume in all genotypes. Most sensitive to change was the pontine volume in spinocerebellar ataxia-1, striatal volume in spinocerebellar ataxia-3 and caudate volume in spinocerebellar ataxia-6. Sensitivity to change, as measured by standard response mean, of the respective MRI measures was greater than that of the most sensitive clinical measure, the Scale for the Assessment and Rating of Ataxia. Longitudinal voxel-based morphometry revealed greatest grey matter loss in the cerebellum and brainstem in spinocerebellar ataxia-1, in the putamen and pallidum in spinocerebellar ataxia-3 and in the cerebellum, thalamus, putamen and pallidum in spinocerebellar ataxia-6. There was a mild correlation between CAG repeat length and volume loss of the bilateral cerebellum and the pons in spinocerebellar ataxia-1. Quantitative volumetry and voxel-based morphometry imaging demonstrated genotype-specific patterns of atrophy progression in spinocerebellar ataxias-1, 3 and 6, and they showed a high sensitivity to detect change that was superior to clinical scales. 3
86. Solodkin A, Peri E, Chen EE, Ben-Jacob E, Gomez CM. Loss of intrinsic organization of cerebellar networks in spinocerebellar ataxia type 1: correlates with disease severity and duration. Cerebellum. 10(2):218-32, 2011 Jun. Observational-Dx 6 subjects; 8 controls To apply intrinsic functional connectivity analysis combined with diffusion tensor imaging to define the state of cerebellar connectivity in spinocerebellar ataxias (SCA1). Our results on the intrinsic functional connectivity in lateral cerebellum and thalamus showed progressive organizational changes in SCA1 noted as a progressive increase in the absolute value of the correlation coefficients. In the lateral cerebellum, the anatomical organization of functional clusters seen as parasagittal bands in controls is lost, changing to a patchy appearance in SCA1. Lastly, only fractional anisotropy in the superior peduncle and changes in functional organization in thalamus showed a linear dependence to duration and severity of disease. 2
87. Kumar N. Neuroimaging in superficial siderosis: an in-depth look. AJNR Am J Neuroradiol. 2010; 31(1):5-14. Review/Other-Dx N/A Review role of neuroimaging in the diagnosis and management of superficial siderosis with a focus on recent developments in the understanding of this disorder. MRI shows the characteristic marginal T2 hypointensity around the brain stem, cerebellum, and spinal cord and may also provide a clue to the possible etiology. Due to widespread use of MRI, superficial siderosis is being increasingly recognized. With longitudinally extensive collections, a CT myelogram may help localize the defect and direct the site of laminectomy. With large defects and high-flow leaks, a dynamic CT myelogram or digital substraction myelography may be needed to identify the dural defect. Dynamic CT myelography and digital substraction myelography are invasive techniques that are time-intensive and need a higher radiation dose. They should be used in carefully selected patients, and further research is needed to define their role in clinical practice. 4
88. Kumar N, Cohen-Gadol AA, Wright RA, Miller GM, Piepgras DG, Ahlskog JE. Superficial siderosis. Neurology. 2006; 66(8):1144-1152. Review/Other-Dx 30 consecutive patients Review the clinical and imaging features of superficial siderosis. Hearing loss and slowly progressive ataxia were the most common presenting symptoms. Cerebellar atrophy and low T2 superficial signal intensity were typical. 4
89. Jaggi RS, Husain M, Chawla S, Gupta A, Gupta RK. Diagnosis of bacterial cerebellitis: diffusion imaging and proton magnetic resonance spectroscopy. Pediatr Neurol. 2005; 32(1):72-74. Review/Other-Dx 1 patient Describe diffusion imaging and proton spectroscopy in brain abscess and briefly review the literature. Diffusion is restricted in abscess, and spectroscopy in the presence of obligate anaerobes demonstrates elevated lactate, acetate and succinate. 4
90. Kato Z, Kozawa R, Teramoto T, Hashimoto K, Shinoda S, Kondo N. Acute cerebellitis in primary human herpesvirus-6 infection. Eur J Pediatr. 2003; 162(11):801-803. Review/Other-Dx 1 patient Describe cerebellitis due to herpesvirus-6. Herpes virus can cause an isolated cerebellitis. Imaging findings consisted of increased T2 signal intensity and restricted diffusion in the cerebellum. 4
91. Mendonca RA, Martins G, Lugokenski R, Rossi MD. Subacute spongiform encephalopathies. Top Magn Reson Imaging. 2005; 16(2):213-219. Review/Other-Dx N/A Describe the clinical course, pathology and imaging of the subacute spongiform encephalopathies. Diffusion imaging is the most sensitive initial sequence, while MRI has an overall sensitivity of 91%, specificity of 95% and accuracy of 94%. 4
92. Gaballo A, Palma M, Dicuonzo F, Carella A. Lhermitte-Duclos disease: MR diffusion and spectroscopy. Radiol Med. 2005;110(4):378-384. Review/Other-Dx 2 patients Describe MRI diffusion and spectroscopic imaging findings in LDD. Diffusion coefficients were normal relative to surrounding cerebellar parenchyma. Proton spectroscopy demonstrated a lactate peak and reduction in the choline peak. 4
93. American College of Radiology. ACR Appropriateness Criteria®: Dementia and Movement Disorders. Available at: Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
94. Zecca C, Cereda C, Wetzel S, et al. Diffusion-weighted imaging in acute demyelinating myelopathy. Neuroradiology. 54(6):573-8, 2012 Jun. Review/Other-Dx 6 patients To describe DWI characteristics of acute, spinal demyelinating lesions. All spinal lesions showed a restricted diffusion pattern (DWI+/ADC-) with a 24% median ADC signal decrease. A good correlation between clinical presentation and lesion site was observed. 4
95. Dula AN, Pawate S, Dortch RD, et al. Magnetic resonance imaging of the cervical spinal cord in multiple sclerosis at 7T. Multiple Sclerosis. 22(3):320-8, 2016 Mar. Observational-Dx 13 healthy controls; 15 patients To study the spinal cord of healthy controls and patients with multiple sclerosis (MS) using magnetic resonance imaging at 7 tesla (7T). High-resolution images at 7T exceeded resolutions reported at lower field strengths. Gray and white matter were sharply demarcated and MS lesions were more readily visualized at 7T compared to clinical acquisitions, with lesions apparent at both fields. Nerve roots were clearly visualized. White matter lesion counts averaged 4.7 vs 3.1 (52% increase) per patient at 7T vs 3T, respectively (p=0.05). 3
96. Kearney H, Schneider T, Yiannakas MC, et al. Spinal cord grey matter abnormalities are associated with secondary progression and physical disability in multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry. 86(6):608-14, 2015 Jun. Observational-Dx 113 people To study a cohort of patients with clinically isolated syndrome (CIS) along with healthy controls (HC) to investigate whether microstructural abnormalities are already present at what is often the first presentation of relapse-onset multiple sclerosis (MS). 113 people were included in this study: 30 controls, 21 CIS, 33 relapsing remitting (RR)and 29 secondary progressive (SP) MS. Spinal cord radial diffusivity (RD), fractional anisotropy and mean diffusivity in the grey matter (GM) and posterior columns were significantly more abnormal in SPMS than in RRMS. Spinal cord GM RD (beta=0.33, p<0.01) and cord area (beta=-0.45, p<0.01) were independently associated with expanded disability status scale (EDSS) (R(2)=0.77); spinal cord GM RD was also independently associated with a 9-hole peg test (beta=-0.33, p<0.01) and timed walk (beta=-0.20, p=0.04). 3
97. Kim G, Khalid F, Oommen VV, et al. T1- vs. T2-based MRI measures of spinal cord volume in healthy subjects and patients with multiple sclerosis. BMC Neurology. 15:124, 2015 Jul 31. Observational-Dx 31 patients; 18 controls To compare two commonly-available sequences to measure cord volume: 1) T2-weighted fast spin-echo (FSE) sequences; 2) T1-weighted gradient recalled echo (GRE) sequences. T1-derived cord areas were higher than T2 areas in the whole cohort (estimated mean difference = 7.03 mm(2) (8.89%); 95% Confidence Interval (CI): 5.91, 8.14; p < 0.0001) and in both groups separately. There were trends for lower spinal cord areas in MS vs. NC with both sequences. For the T1 cord area, the mean difference was 3.7 mm(2) (4.55%) (95% CI: -1.36, 8.78; p = 0.15). For the T2 cord area, the difference was larger [mean difference 4.9 mm(2) (6.52%) (95% CI: -0.83, 10.67); p = 0.091]. The T1 and T2 cord areas showed similar weak to moderate correlations with measures of clinical status and T2 spinal cord lesion volume in the MS group. Superficial spinal cord T2 lesions had no apparent confounding effect on the outlining tool. The mean intra-rater and inter-rater coefficients of variation ranged from 0.27 to 0.91% for T1- and 0.66 to 0.99% for T2-derived cord areas. 2
98. Klein JP, Arora A, Neema M, et al. A 3T MR imaging investigation of the topography of whole spinal cord atrophy in multiple sclerosis. Ajnr: American Journal of Neuroradiology. 32(6):1138-42, 2011 Jun-Jul. Observational-Dx 62 subjects To identify the levels most susceptible to atrophy in patients with Multiple Sclerosis (MS) versus controls and also tested for differences among MS clinical phenotypes. There was a trend toward decreased spinal cord volume at the upper cervical levels in primary-progressive multiple sclerosis/ secondary-progressive multiple sclerosis (PPMS/SPMS) versus controls. A trend toward increased spinal cord volume throughout the cervical and thoracic cord in relapsing-remitting multiple sclerosis/ clinically isolated syndrome (RRMS/CIS) versus controls reached statistical significance at the T10 vertebral level. A statistically significant decrease was found in spinal cord volume at the upper cervical levels in PPMS/SPMS versus RRMS/CIS. 2
99. Martin N, Malfair D, Zhao Y, et al. Comparison of MERGE and axial T2-weighted fast spin-echo sequences for detection of multiple sclerosis lesions in the cervical spinal cord. AJR. American Journal of Roentgenology. 199(1):157-62, 2012 Jul. Observational-Dx 29 control; 83 standard lesions To compare axial multiple-echo recombined gradient echo (MERGE) with axial T2-weighted fast spin-echo (FSE) imaging for the detection of multiple sclerosis (MS) lesions in the cervical spinal cord on magnetic resonance imaging (MRI). Eighty-three lesions were assessed. The mean true-positive lesion detection rate was 87% (95% CI, 79-93%) with MERGE and 67% (60-75%) with T2-weighted FSE, with interreader positive agreement scores of 74% and 75%, respectively. A greater number of false-positive findings were seen with MERGE for both the MS and control cases. Average confidence and artifact scores were similar for both sequences. Subjectively, lesions were more conspicuous in 21 cases with MERGE and four cases with T2-weighted FSE and were equally conspicuous in four cases. 2
100. Ozturk A, Aygun N, Smith SA, Caffo B, Calabresi PA, Reich DS. Axial 3D gradient-echo imaging for improved multiple sclerosis lesion detection in the cervical spinal cord at 3T. Neuroradiology. 55(4):431-9, 2013 Mar. Observational-Dx 62 patients; 19 healthy controls To compare to T2-weighted fast-spin-echo (T2-FSE) images for the detection of multiple sclerosis (MS) lesions in the cervical cord at 3 tesla (3T). The number and volume of lesions detected with high confidence was more than three times as high on both gradient-recalled echo (GRE) sequences compared to T2-weighted fast-spin-echo (T2-FSE) (p < 0.0001). Approximately 5 % of GRE scans were affected by artifacts that interfered with image interpretation, not significantly different from T2W-FSE. 3
101. Rocca MA, Horsfield MA, Sala S, et al. A multicenter assessment of cervical cord atrophy among MS clinical phenotypes. Neurology. 76(24):2096-102, 2011 Jun 14. Observational-Dx 333 patients; 143 controls To investigate the correlation between cord atrophy and clinical disability in a large sample of patients with multiple sclerosis (MS). Cord cross-sectional area (CSAn) was significantly lower in primary progressive MS (PPMS) vs healthy controls, benign MS (BMS) vs relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) vs BMS, and RRMS. From C2 to C5, a net separation and definition of the plots of patients with BMS, PPMS, and SPMS was seen with respect to those of the other study groups. CSAn was correlated with Expanded Disability Status Scale (r = -0.49, p < 0.0001), with a differential effect among disease clinical phenotypes: no association in either clinically isolated syndromes (CIS) or in BMS; association in RRMS (r = -0.30, p = 0.001), SPMS (r = -0.34, p = 0.001), and PPMS (r = -0.27, p = 0.01). 3
102. Schlaeger R, Papinutto N, Panara V, et al. Spinal cord gray matter atrophy correlates with multiple sclerosis disability. Annals of Neurology. 76(4):568-80, 2014 Oct. Observational-Dx 127 patients To determine the association of the spinal cord (SC) gray matter (GM) and SC white matter (WM) areas with multiple sclerosis (MS) disability and disease type. Relapsing MS (RMS) patients showed smaller SC GM areas than age- and sex-matched controls (p = 0.008) without significant differences in SC WM areas. Progressive MS patients showed smaller SC GM and SC WM areas compared to RMS patients (all p </= 0.004). SC GM, SC WM, and whole cord areas inversely correlated with Expanded Disability Status Score (EDSS) (rho: -0.60, -0.32, -0.42, respectively; all p </= 0.001). The SC GM area was the strongest correlate of disability in multivariate models including brain GM and WM volumes, fluid-attenuated inversion recovery lesion load, T1 lesion load, SC WM area, number of SC T2 lesions, age, sex, and disease duration. Brain and spinal GM independently contributed to EDSS. 2
103. Weier K, Mazraeh J, Naegelin Y, et al. Biplanar MRI for the assessment of the spinal cord in multiple sclerosis. Multiple Sclerosis. 18(11):1560-9, 2012 Nov. Observational-Dx 202 patients To investigate the entire spinal cord (SC) of multiple sclerosis (MS) patients with biplanar magnetic resonance imaging (MRI) and to relate these MRI findings to clinical functional scores. The combined analysis of sagittal and axial planes demonstrated slightly differing results in 97/202 (48%) patients. There were 9% additional lesions identified, leading to a higher lesion count in 28% of these patients, but also rejection of equivocal abnormality leading to a lower lesion count in 11% of patients. Considering both sagittal and axial images, SC abnormalities were found in 167/202 (83%) patients. When compared with Expanded Disability Status Scale (EDSS) scores, the combination of focal lesions, signs of atrophy and diffuse abnormalities showed a moderate correlation (rho=0.52), that precludes its use for individual patient assessment. 3
104. White ML, Zhang Y, Healey K. Cervical spinal cord multiple sclerosis: evaluation with 2D multi-echo recombined gradient echo MR imaging. Journal of Spinal Cord Medicine. 34(1):93-8, 2011. Observational-Dx 19 patients To evaluate the potential of Multi-echo recombined gradient echo (MERGE) imaging for depicting multiple sclerosis (MS) lesions in the cervical spinal cord at 3 tesla (3 T), and to compare it qualitatively and quantitatively with a conventional technique, T2-weighted fast spin-echo (T2WFSE) imaging. Multi-echo recombined gradient echo (MERGE) imaging showed 79 lesions and missed 1 that was depicted on T2-weighted fast spin-echo (T2WFSE) imaging. T2WFSE imaging showed 46 lesions and missed 34 that were depicted on MERGE imaging. MERGE imaging was markedly superior to T2WFSE imaging in rendering greater lesion conspicuity. In the quantitative evaluation, the lesion-to-background contrast-to-noise ratio (CNR) upon MERGE imaging was significantly higher than that upon T2WFSE imaging (P < 0.001, paired t-test). 3
105. Hayashida S, Masaki K, Yonekawa T, et al. Early and extensive spinal white matter involvement in neuromyelitis optica. Brain Pathology. 27(3):249-265, 2017 May. Observational-Dx 30 patients To clarify spinal white matter pathology of longitudinally extensive spinal cord lesions (LESCLs) in neuromyelitis optica (NMO). Pathological analysis revealed seven cases of aquaporin-4 (AQP4) loss and four predominantly demyelinating cases. Forty-four lesions from AQP4 loss cases involved significantly more frequently posterior columns (PC) and lateral columns (LC) than anterior columns (AC) (59.1%, 63.6%, and 34.1%, respectively). The posterior horn (PH), central portion (CP), and anterior horn (AH) were similarly affected (38.6%, 36.4% and 31.8%, respectively). Isolated perivascular inflammatory lesions with selective loss of astrocyte endfoot proteins, AQP4 and connexin 43, were present only in white matter and were more frequent in PC and LC than in AC (22.7%, 29.5% and 2.3%, Pcorr = 0.020, and Pcorr = 0.004, respectively). Magnetic resonance imaging (MRI) indicated LESCLs more frequently affected PC and LC than AC in anti-AQP4 antibody-seropositive NMO/NMO spectrum disorder (NMOSD) (86.7%, 60.0% and 20.0%, Pcorr = 0.005, and Pcorr = 0.043, respectively) and AQP4 antibody-seronegative MS patients (86.7%, 73.3% and 33.3%, Pcorr = 0.063, and Pcorr = 0.043, respectively). PH, CP and AH were involved in 93.3%, 86.7% and 73.3% of seropositive patients, respectively, and in 53.3%, 60.0% and 40.0% of seronegative patients, respectively. 3
106. Jeantroux J, Kremer S, Lin XZ, et al. Diffusion tensor imaging of normal-appearing white matter in neuromyelitis optica. Journal of Neuroradiology. Journal de Neuroradiologie. 39(5):295-300, 2012 Dec. Observational-Dx 25 patients; 20 control group To evaluate Diffusion tensor imaging (DTI) abnormalities in brain normal-appearing white matter (NAWM), optic radiations and spinal cord of neuromyelitis optica (NMO) patients in order to increase our  knowledge of the pathophysiological mechanisms in this rare pathology. Apparent diffusivity coefficient (ADC) was increased and fractional anisotropy (FA) decreased in NMO patients in the posterior limb of the internal capsule [IC] in the optic radiations and in spinal cord NAWM. FA was lower in spinal cord lesions. In contrast, there was no difference between the two groups in the anterior limb of the IC nor in the corpus callosum [CC]. 2
107. Klawiter EC, Xu J, Naismith RT, et al. Increased radial diffusivity in spinal cord lesions in neuromyelitis optica compared with multiple sclerosis. Multiple Sclerosis. 18(9):1259-68, 2012 Sep. Observational-Dx 30 subjects To determine the utility of diffusion tensor imaging (DTI) to differentiate the spinal cord lesions of neuromyelitis optica (NMO) from Multiple sclerosis (MS) within and outside T2 lesions. Within T2 affected white matter regions, radial diffusivity was increased in both NMO and MS compared with healthy controls (p<0.001, respectively), and to a greater extent in NMO than MS (p<0.001). Axial diffusivity was decreased in T2 lesions in both NMO and MS compared with controls (p<0.001, p=0.001), but did not differ between the two diseases. Radial diffusivity and fractional anisotropy within white matter regions upstream and downstream of T2 lesions were different from controls in each disease. 2
108. Liu Y, Wang J, Daams M, et al. Differential patterns of spinal cord and brain atrophy in NMO and MS. Neurology. 84(14):1465-72, 2015 Apr 07. Observational-Dx 105 patients To investigate spinal cord and brain atrophy in neuromyelitis optica (NMO), and its relationship with other magnetic resonance imaging (MRI) measurements and clinical disability, compared with patients with multiple sclerosis (MS) and healthy controls (HC). Patients with NMO showed smaller Mean upper cervical cord area (MUCCA) than HC (p = 0.004), and patients with MS had a trend of smaller MUCCA compared to HC (p = 0.07), with no significant difference between the patient groups. Patients with NMO showed lower brain parenchymal fraction (BPF) than HC, and patients with MS had lower BPF and gray matter fraction (GMF) than patients with NMO. In NMO, MUCCA was correlated with Expanded Disability Status Scale score (EDSS), number of relapses, and total spinal cord lesion length, while in MS, MUCCA was correlated with WMF and EDSS. MUCCA was the only independent variable for predicting clinical disability measured by EDSS in NMO (R(2) = 0.55, p < 0.001) and MS (R(2) = 0.17, p = 0.013). 2
109. Pessoa FM, Lopes FC, Costa JV, Leon SV, Domingues RC, Gasparetto EL. The cervical spinal cord in neuromyelitis optica patients: a comparative study with multiple sclerosis using diffusion tensor imaging. European Journal of Radiology. 81(10):2697-701, 2012 Oct. Observational-Dx 40 patients; 17 healthy controls To evaluate "in vivo" the integrity of the normal-appearing spinal cord in patients with neuromyelitis optica (NMO), using diffusion tensor magnetic resonance (MR) imaging, comparing to controls and patients with multiple sclerosis (MS). At C2, the FA value was decreased in NMO patients compared to MS and controls in the anterior column. Also in this column, radial diffusivity (RD) value showed increase in NMO compared to MS and to controls. The Fractional anisotropy (FA) value of the posterior column was decreased in NMO in comparison to controls. At C7, axial diffusivity (AD) value was higher in NMO than in MS in the right column. At the same column, MD values were increased in NMO compared to MS and to controls. 3
110. Qian W, Chan Q, Mak H, et al. Quantitative assessment of the cervical spinal cord damage in neuromyelitis optica using diffusion tensor imaging at 3 Tesla.[Erratum appears in J Magn Reson Imaging. 2011 Sep;34(3):727]. Journal of Magnetic Resonance Imaging. 33(6):1312-20, 2011 Jun. Observational-Dx 10 patients; 12 controls To investigate whether quantitative Magnetic Resonance Imaging (MRI) measures of cervical spinal cord white matter (WM) using diffusion tensor imaging (DTI) in neuromyelitis optica (NMO) differed from controls and correlated with clinical disability. Statistical test results indicated high reliability of all DTI measurements between two raters. NMO patients showed reduced fractional anisotropy (FA), increased mean diffusivity (MD) and lambda[perpendicular] compared with controls while lambda[parallel] did not show any significant difference. The former three DTI metrics also showed significant correlations with disability scores, and especially FA was found to be sensitive to mild NMO (Expanded Disability Status Scale (EDSS)</= 3) 2
111. Wang Y, Wu A, Chen X, et al. Comparison of clinical characteristics between neuromyelitis optica spectrum disorders with and without spinal cord atrophy. BMC Neurology. 14:246, 2014 Dec 20. Observational-Dx 185 patients To investigate and compare the clinical, laboratory, and magnetic resonance imaging (MRI) characteristics between Neuromyelitis optica spectrum disorders (NMOSD) with and without Spinal cord atrophy (SCA). 12.4% of patients had SCA in NMOSD. Patients with SCA had a longer disease duration and higher Expanded Disability Status Scale (EDSS) at clinical onset and last visit. More importantly, SCA patients were more prone to reach disability milestones (EDSS >/= 6.0). Bowel or bladder dysfunction, movement disorders, and sensory disturbances symptoms were more common in patients with SCA. ESR and C-reactive protein(CRP) were significantly higher in patients with SCA than those without SCA. Patients with SCA were more frequently complicated with cervical cord lesions. However, the Annualized relapse rate (ARR), progression index, seropositive rate of NMO-IgG and oligoclonal bands (OCBs) were similar in the two groups. Futhermore, Longitudinally extensive transverse myelitis (LETM) did not differ significantly between patients with SCA and without SCA in NMOSD patients. 3
112. Yokote H, Nose Y, Ishibashi S, et al. Spinal cord ring enhancement in patients with neuromyelitis optica. Acta Neurologica Scandinavica. 132(1):37-41, 2015 Jul. Observational-Dx 12 patients To examine the prevalence of spinal cord ring enhancement (RE) in neuromyelitis optica (NMO) and to determine the association between clinical characteristics and spinal cord RE. Of the 30 patients with NMO, we enrolled 12 patients with 16 Gd-enhanced spinal cord magnetic resonance imaging (MRI) scans in this study. Five scans revealed RE (31.2%). Male ratio, as well as myelin basic protein (MBP) levels, in the cerebrospinal fluid (CSF) of patients with RE was significantly higher than those of patients without RE (P = 0.018, P = 0.026, respectively). 3
113. Wang L, Li Y. Longitudinal ultra-extensive transverse myelitis as a manifestation of neurosarcoidosis. Journal of the Neurological Sciences. 355(1-2):64-7, 2015 Aug 15. Observational-Dx 7 patients To analyze the clinical characteristics and outcome of patients with neurosarcoidosis manifesting as longitudinal transverse myelitis spanning 6 or more spinal segments. Four males and 5 African-American were included. The mean onset age for neurological symptoms was 49.1 years old. Only 1 patient had a prior diagnosis of sarcoidosis. In all patients, spinal MRI showed contiguous cervical and/or thoracic cord lesions predominantly in a central or centrodorsal location, associated with parenchymal or leptomeningeal gadolinium enhancement. Cerebral spinal fluid (CSF) pleocytosis was present in all and hypoglycorrhachia in 3 patients. Angiotensin-converting enzyme (ACE) level was elevated in the serum of 1 patient while being normal in the CSF of all 4 cases tested. Chest imaging facilitated the diagnosis of sarcoidosis in all cases. The use of corticosteroid and immunosuppressive agents including infliximab and methotrexate led to improved outcome 3
114. Flanagan EP, O'Neill BP, Porter AB, Lanzino G, Haberman TM, Keegan BM. Primary intramedullary spinal cord lymphoma. Neurology. 77(8):784-91, 2011 Aug 23. Observational-Dx 14 patients To describe primary intramedullary spinal cord lymphoma (PISCL) presentation, imaging characteristics, and outcomes. The 14 patients' median age at presentation was 62.5 years (range 41-82 years) and 10 were men (71%). Two had lymphoma risk factors (HIV infection 1; chronic immunosuppression postorgan transplant 1). Most had initial presumptive diagnoses of central nervous system (CNS) demyelinating disease and definitive diagnosis of lymphoma was delayed a median of 8 months (range 1-22 months). CNS lymphoma was pathologically confirmed by biopsy (brain 6; spinal cord 4), cerebral spinal fluid (CSF) cytology (3), and autopsy (1). Most patients had multifocal, persistently enhancing lesions on spinal MRI and 8 had involvement of conus medullaris, cauda equina, or both. IV methotrexate was the initial treatment in 9 of 12 (75%) but lymphoma recurred in the majority. Half of the patients were wheelchair-dependent at 10 months and 2-year survival was 36%. 2
115. Flanagan EP, McKeon A, Lennon VA, et al. Paraneoplastic isolated myelopathy: clinical course and neuroimaging clues. [Review]. Neurology. 76(24):2089-95, 2011 Jun 14. Review/Other-Dx 31 patients To report the clinical phenotype and outcome of isolated paraneoplastic myelopathy. Of 31 patients who presented with a progressive myelopathy, symptom onset was subacute in 16 (52%). The median age was 62 years. cerebro spinal fluid (CSF) abnormalities included elevated protein (>45 mg/dL), 22; pleocytosis, 15; excess oligoclonal bands (normal <4), 7. Magnetic resonance imaging (MRI) cord abnormalities identified in 20 patients were longitudinally extensive (>3 vertebral segments), 14; symmetric tract or gray matter-specific signal abnormality, 15 (enhancing in 13). Myelopathy preceded cancer diagnosis in 18 patients (median interval 12 months; range 2-44). After myelopathy onset, 26 patients underwent oncologic treatment, immunosuppressive treatment (median delay to commencing immunotherapy 9.5 months [range 1-54]), or both; only 8 improved (31%). At last neurologic evaluation (median interval after onset 17 months; range 1-165 months), 16 patients (52%) were wheelchair-dependent (median time from onset to wheelchair 9 months [range 1-21]). Ten patients died after a median of 38 months from symptom onset (range 7-152). 4
116. Bassi SS, Bulundwe KK, Greeff GP, Labuscagne JH, Gledhill RF. MRI of the spinal cord in myelopathy complicating vitamin B12 deficiency: two additional cases and a review of the literature. Neuroradiology. 1999; 41(4):271-274. Review/Other-Dx 2 patients Report two cases of MRI of the spinal cord in myelopathy complicating vitamin B12 deficiency and review the literature. MRI of early B12 related myelopathy can show cord swelling and increased T2 signal intensity with or without enhancement following contrast administration. There may be late atrophy or findings may resolve with treatment. The cord may also appear normal, even though symptomatic. 4
117. Kara B, Celik A, Karadereler S, et al. The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI. Neuroradiology. 53(8):609-16, 2011 Aug. Observational-Dx 16 patients To determine whether DTI may provide further information about early detection of CSM. The authors evaluated the FA and ADC values of spinal cord in patients with clinical manifestations of CSM, whose conventional MRI examinations showed no abnormal signal in T2-weighted sequences. All patients showed changes in DTI parametrics at stenotic segments. While FA values of the spinal cord at the stenotic level showed a statistically significant reduction, there was a statistically significant increase in the measured ADC values (P<0.001). There was no statistical correlation between the duration of symptoms and DTI parametrics. 3
118. Lindberg PG, Sanchez K, Ozcan F, et al. Correlation of force control with regional spinal DTI in patients with cervical spondylosis without signs of spinal cord injury on conventional MRI. European Radiology. 26(3):733-42, 2016 Mar. Observational-Dx 16 patients; 20 healthy controls To investigate spinal cord structure in patients with cervical spondylosis where conventional magnetic resonance imaging (MRI) fails to reveal spinal cord damage. Diffusion tensor imaging (DTI) revealed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) in the lateral spinal cord at the level of greatest compression (lowest Pavlov ratio) in patients (p < 0.05). Patients with spondylosis had greater error and longer release duration in both grip and foot force-tracking. Similar spinal cord deficits were present in patients without neurological signs. Increased error in grip and foot tracking (low accuracy) correlated with increased RD in the lateral spinal cord at the level of greatest compression (p </= 0.01). 3
119. Qizhi S, Lili Y, Ce W, Yu C, Wen Y. Factors associated with intramedullary MRI abnormalities in patients with ossification of the posterior longitudinal ligament. Journal of Spinal Disorders & Techniques. 28(5):E304-9, 2015 Jun. Observational-Dx 82 men; 31 women patients To evaluate the risk factors affecting the intramedullary spinal cord changes in signal intensity on magnetic resonance imaging (MRI) for the patients with ossification of the posterior longitudinal ligament (OPLL). Changes in the intramedullary signal intensity on MRI were observed in 33 of the 113 patients. Statistical results show that duration of symptoms, occupying ratio of OPLL, preoperative Japanese Orthopedic Association (JOA) score, kyphosis, and instability of the cervical spine are the relevant risk factors for intramedullary spinal cord changes in signal intensity on MRI, with regression coefficients of 2.437, 0.953, -1.952, 2.093, and 1.516, respectively. For patients with OPLL, the longer the duration of the symptoms, or the higher occupying ratio of OPLL, or the lower preoperative JOA score, the greater the likelihood of intramedullary spinal cord changes in signal intensity on MRI. 3
120. Donghai W, Ning Y, Peng Z, et al. The diagnosis of spinal dural arteriovenous fistulas. Spine. 38(9):E546-53, 2013 Apr 20. Review/Other-Dx 282 males; 44 female patients To review and analyze clinical presentations and radiological imaging of 326 consecutive patients with spinal dural arteriovenous fistula (SDAVF) from 2 institutions. Two hundred eighty-two males and 44 females (male/female ratio 6.4:1; mean age, 53.9 yr; SD, 12.1) were included in the study. Fistulas were located at the T7 spinal segment (41, 12.6%), but were more typically found at T5 to L5 (273, 82.5%). The most common initial symptoms were lower extremity weakness (234, 71.8%), sensory disturbance (229, 70.2%), and sphincter disturbance (87, 26.7%). These percentages increased to, 85.6%, 80.8%, and 52.5%, respectively, until patients were properly diagnosed. The mean diagnostic time to SDAVF was 19.9 months (SD, 25.2). Two major changes noted on magnetic resonance images were intramedullary T2-weighted signal hyperintensity (284, 87.1%) and perimedullary dilated vessels (251, 77%). Fistulas were often located outside of the vertebral segments of T2-weighted signal change (P = 0.005). Magnetic resonance angiography and computed tomography angiography of 33 (71.7%) patients revealed perimedullary dilated vessels and precisely located fistulas in 19 (41.3%) patients. Magnetic resonance angiography and computed tomography angiography studies of the perimedullary vessels also led to identification of a second fistula through angiography. Degenerative disc disease and myelitis were the most common misdiagnoses, and the patients were often treated incorrectly. 4
121. Kirsch M, Berg-Dammer E, Musahl C, Bazner H, Kuhne D, Henkes H. Endovascular management of spinal dural arteriovenous fistulas in 78 patients. Neuroradiology. 55(3):337-43, 2013 Feb. Observational-Dx 78 patients To evaluate the safety and efficiency of the endovascular treatment of spinal dural arteriovenous fistulas (SDAVFs). Endovascular treatment resulted in a complete occlusion of the fistula in 47 cases (77 %). After failed embolization with residual shunt, 14 DAVFs were surgically cured (23 % failure rate). We had one permanent and two minor complications after endovascular therapy. Within a postoperative period of 2 weeks, 73.6 % of patients improved in gait disability, 51.1 % in micturition function, and 70.5 % in paresthesia of the lower extremities. Long-term follow-up data showed further improvement of clinical symptoms confirmed by normalization or resolution of spinal changes on magnetic resonance imaging (MRI). 2
122. Multidetector CT angiography in diagnosing type I and type IVA spinal vascular malformations Review/Other-Dx 2 cases To present 2 cases in which Multidetector Computed Tomography (MDCT) angiography led to diagnosis of a type I (spinal dural arteriovenous fistula) in one and type IVA (perimedullary spinal cord simple arteriovenous fistula fed by a single arterial feeder) spinal vascular malformation, both confirmed by conventional angiography. No results stated in abstract. 4
123. Backes WH, Nijenhuis RJ. Advances in spinal cord MR angiography. AJNR Am J Neuroradiol 2008;29:619-31. Review/Other-Dx N/A To review the  advances in spinal cord MR angiography. No results stated in abstract. 4
124. Binkert CA, Kollias SS, Valavanis A. Spinal cord vascular disease: characterization with fast three-dimensional contrast-enhanced MR angiography. AJNR Am J Neuroradiol 1999;20:1785-93. Review/Other-Dx 12 consecutive patients To assess the potential of a dynamic 3D contrast-enhanced MR angiographic sequence to characterize spinal vascular lesions and to identify their arterial feeders and venous drainage. The MR angiographic findings proved that the lesions were correctly characterized as spinal arteriovenous malformations (AVMs) (n = 6), spinal dural arteriovenous fistulas (AVFs) (n = 3), a hemangioblastoma (n = 1), a teratoma (n = 1), and a vertebral hemangioma (n = 1). The arterial feeder was visible in all six AVMs and in the hemangioblastoma, corresponding to conventional angiographic findings. In two of three spinal dural AVFs, an enlarged draining medullary vein was seen within the neural foramen, providing correct localization. The third fistula could not be seen owing to reduced image quality from motion artifacts. 4
125. Mull M, Nijenhuis RJ, Backes WH, Krings T, Wilmink JT, Thron A. Value and limitations of contrast-enhanced MR angiography in spinal arteriovenous malformations and dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2007;28(7):1249-1258. Review/Other-Dx 34 patients To study the validity of MRA for identification of spinal arteriovenous abnormalities. DSA revealed spinal dural arteriovenous fistulas in 20 abnormalities of which 19 were spinal and 1 was tentorial with spinal drainage, as well as spinal arteriovenous malformations in 11 patients. In 3 patients, MRA and DSA were both normal. For detection of spinal arteriovenous abnormalities, neither false-positive nor false-negative MRA results were obtained. The MRA-derived level of the feeding artery in spinal dural arteriovenous fistulas agreed with DSA in 14/19 cases. In 5 cases, a mismatch of 1 vertebral level (not side) was noted for the feeding artery. For the tentorial arteriovenous fistulas, only the spinal drainage was depicted; the feeding artery was outside the MRA field of view. In intradural spinal arteriovenous malformations, the main feeding artery was identified by MRA in 10/11 patients. MRA could differentiate between glomerular and fistulous spinal arteriovenous malformations in 4/6 cases and between sacral spinal dural arteriovenous fistulas and filum terminale spinal arteriovenous malformations in 2/5 cases. 4
126. Pattany PM, Saraf-Lavi E, Bowen BC. MR angiography of the spine and spinal cord. Top Magn Reson Imaging 2003;14:444-60. Review/Other-Dx N/A To describe spinal vascular anatomy, focusing on thoracolumbar intradural vessels detectable by both magnetic resonance angiography (MRA) and digital subtraction x-ray angiography (DSA), 2) to compare the MRA techniques that have been used to detect the major intradural vessels, and 3) to illustrate the clinical application of these MRA techniques, especially their efficacy in characterizing spinal dural arteriovenous fistulae (AVF). Normal intradural vessels detected on standard CE MRA are primarily veins (medullary and median), whereas both arteries and veins are detected on fast CE MRA. Identification of arteries (artery of Adamkiewicz, anterior spinal artery) is limited, and their differentiation from veins can be incomplete. Intradural vessels in patients with dural fistulae have abnormal features on MRI (length of flow voids and postcontrast serpentine enhancement) and standard 3D CE MRA (length, tortuosity, and qualitative size of dominant perimedullary vessel), which differ significantly from those of normal vessels. Standard MRA added to a conventional MRI study significantly (P=0.016) increased the rate of detection of the spinal level of a dural fistula. The correct level +/- one vertebral segment was identified in 73% of true-positive patients. 4
127. Lloyd KM, DelGaudio JM, Hudgins PA. Imaging of skull base cerebrospinal fluid leaks in adults. [Review] [48 refs]. Radiology. 248(3):725-36, 2008 Sep. Review/Other-Dx N/A N/A No results stated in abstract. 4
128. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4