Summary

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. The rheumatoid factor is characteristically absent in the serum of PsA patients. Etiology of the disease is still unclear but a number of genetic associations have been identified. Inheritance of the disease is multilevel and the role of environmental factors is emphasized. Immunology of PsA is also quite complex. Inflammation is caused by immunological reactions leading to a release of kinins. Destructive changes in bones usually appear after a few months from the onset of clinical symptoms.

Material/Methods:

PsA typically involves joints of the axial skeleton with an asymmetrical patern. The spectrum of symptoms includes inflammatory changes in attachments of articular capsules, tendons, and ligaments to bone surface. The disease can have a diverse clinical course but usually manifests as oligoarthritis.

Results:

Imaging plays an important role in the diagnosis of PsA. Classical radiography has been used for this purpose for over a hundred years. It allows to identify late stages of the disease, when bone tissue is affected. In the last 20 years however many new imaging modalities, such as ultrasonography (US), computed tomography (CT) and magnetic resonance (MR), have been developed and became important diagnostic tools for evaluating rheumatoid diseases. They enable the assessment and monitoring of early inflammatory changes.

Conclusions:

As a result, patients have earlier access to modern treatment and thus formation of destructive changes in joints can be markedly delayed or even avoided.

Summary

Background:

Since introduction of multislice CT scanners into clinical practice, virtual brochoscopy has gained a lot of quality and diagnostic potential. Nevertheless it does not have established place in diagnostics of tracheal and bronchi disorders and its potential has not been examined enough. Nowadays a majority of bronchial tree variants and lesions are revealed by bronchofiberoscopy, which is an objective and a relatively safe method, but has side effects, especially in higher-risk subjects. Therefore noninvasive techniques enabling evaluation of airways should be consistently developed and updated.

Material/Methods:

Material consisted of 100 adults (45 female, 55 male) aged between 18 and 65 years (mean 40 years, median 40.5 years, SD 14.02), who underwent chest CT examination by means of a 16-slice scanner. Every patient had normal appearance of chest organs, with the exception of minor abnormalities that did not alter airways route.

Divisions of bronchial tree to segmental level were evaluated and assigned to particular types by means of virtual bronchoscopy projection. In case of difficulties MPR or MinIP projection was used.

Results:

The frequency of lobar bronchi divisions other than the typical ones was in: right upper lobar bronchi 45%, left 55%; middle lobar bronchi 21%, lingula 26%; right lower lobar bronchi 28%, left 29%. Subsuperior bronchus or bronchi were found on the right side in 44% and on the left side in 37%. No dependency between types of bronchial divisions on different levels was found.

Summary

Background:

Myelodysplastic syndrome is a rare, chronic hematological disease characterized by heterogeneous clinical presentations. Subtypes of myelodysplastic syndrome are characterized by different survival times and ability to transform into acute myeloid leukemia.

Objectives:

The objective of the study included the assessment of the relationship between the images obtained by magnetic resonance scans of lumbar spine and the clinical symptoms of the disease in patients diagnosed with myelodysplastic syndrome, as well as the assessment of the correlation of the images with the phase of transformation into acute myeloid leukemia.

Material/Methods:

The study-related tests were carried out in Specialist Hospital No. 1 in Bytom between 2006 and 2011 and involved 53 patients aged 55÷77, divided into groups according to the diagnosed subtype of myelodysplastic syndrome. The study also included the prognosis of overall survival and time to transformation into AML on the basis of valid classifications.

The spinal magnetic resonance scans were obtained from medical documentation. The analysis included images obtained using T1- and T2-weighted sequences in sagittal, transverse and frontal planes in all patients, images obtained using the STIR sequence from 21 patients as well as 40 images obtained after contrast administration.

The statistical analysis of the results was carried out using STATISTICA software.

Conclusions:

The obtained results demonstrated that the magnetic resonance scans revealed statistically significant changes in the images of bone marrow in vertebral body scans; with a decrease in the intensity of MRI signals correlated with the RAEB subtype, particularly with transformation into acute myeloid leukemia as well as with the high IPSS risk score with regard to the time of survival and transformation into acute myeloid leukemia. The research-related test results indicate the importance of magnetic resonance imaging in diagnostics and the assessment of the disease dynamics.

Summary

Background:

Susceptibility weighted imaging (SWI) is a novel MRI sequence which demonstrates the susceptibility differences between adjacent tissues and it is promising to be a sequence useful in the assessment of brain tumors vascularity. The aim of our study was to demonstrate usefulness of SWI in evaluation of intratumoral vessels in comparison to CET1 sequence in a standardized, objective manner.

Material/Methods:

10 patients with supratentorial brain tumors were included in the study. All of them underwent conventional MRI examination with a 1,5 T scanner. SWI sequence was additionally performed using the following parameters: TR 49 ms,TE 40 ms. We used authors’ personal computer software – Vessels View, to assess the vessels number.

Results:

Comparison of SWI and CET1 sequences was performed using our program. Analysis of all 26 ROIs demonstrated predominance of SWI in the amount of white pixels (vessel cross-sectional) and a similar number of elongated structures (blood vessels).

Conclusions:

To conclude, the results of this study are encouraging; they confirm the added value of SWI as an appropriate and useful sequence in the process of evaluation of intratumoral vascularity. Using our program significantly improved visualization of blood vessels in cerebral tumors. The Vessel View application assists radiologists in demonstrating the vessels and facilitates distinguishing them from adjacent tissues in the image.

Summary

Assessing the pathology of the synovium, its thickening and increased vascularity through ultrasound and magnetic resonance examinations (more often an ultrasound study alone) is still considered a sensitive parameter in the diagnosis of rheumatoid arthritis and in monitoring of treatment efficacy. Magnetic resonance studies showed that, aside from the joint pannus, the subchondral bone tissue constitutes an essential element in the development of rheumatoid arthritis. Bone marrow edema correlates with inflammation severity, joint destruction, clinical signs and symptoms of rheumatoid arthritis, and thus is considered a predictor of rapid radiological progression of the disease. The newest studies reveal that bone marrow edema may be a more sensitive indicator of the response to therapy than appearance of the synovium. Bone marrow edema presents with increased signal in T2-weighted images, being most visible in fat saturation or IR sequences (STIR, TIRM). On the other hand, it is hypointense and less evident in T1-weighted images. It becomes enhanced (hyperintense) after contrast administration. Histopathological studies confirmed that it is a result of bone inflammation (osteitis/osteomyelitis), i.e. replacememt of bone marrow fat by inflammatory infiltrates containing macrophages, T lymphocytes, B lymphocytes, plasma cells and osteoclasts. Bone marrow edema appears after a few weeks from occurrence of symptoms and therefore is considered an early marker of inflammation. It correlates with clinical assessment of disease activity and elevated markers of acute inflammatory phase, i.e. ESR and CRP. It is a reversible phenomenon and may become attenuated due to biological treatment. It is considered a “herald” of erosions, as the risk of their formation is 6-fold higher in sites where BME was previously noted

Summary

Background:

Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, CT examination is susceptible to coil artifacts, which sometimes makes it difficult to assess recanalization. We report 2 cases where recanalization was successfully visualized using time-resolved magnetic resonance angiography after coil embolization of visceral artery aneurysms (one case of right internal iliac artery aneurysm and one case of splenic artery aneurysm). Repeat coil embolization was successfully performed.

Case Report:

Case 1. An 80-year-old male patient with right internal iliac artery (IIA) aneurysm underwent coil embolization. Aneurysm was located at the bifurcation of the right IIA and therefore, after making a femorofemoral bypass, the distal part of the right IIA, aneurysm and the common iliac artery were embolized with a coil. One year later, the size of the aneurysm seemed to have increased on CT. However, the details were not determined because of metal artifacts. Thus, time-resolved MRA was performed and showed minute vascular flow inside the aneurysm. Angiography was subsequently performed and blood flow inside the aneurysm was visualized similar to the findings in time-resolved MRA. Coil embolization was performed once more and vascular flow inside the aneurysm disappeared. Case 2. A 36-year-old male patient with a splenic artery aneurysm underwent coil packing with preservation of splenic artery patency. Four years later, coil compaction was suspected in a CT scan, but CT could not evaluate recanalization because of severe metal artifacts. Angiography was subsequently performed, showing recanalization of the aneurysm as did the time-resolved MRA. Therefore, coil embolization of the aneurysm and splenic artery was performed again.

Conclusions:

Follow-up imaging after coil embolization of visceral artery aneurysms is important for detecting recanalization. However, it is sometimes difficult to assess recanalization with CT because of artifacts caused by metal. In our cases, recanalization of aneurysms was clearly shown by time-resolved MRA and re-embolization was successfully performed.

In conclusion, time-resolved MRA appears to be useful in assessment of recanalization of visceral artery aneurysms after coil embolization.

Summary

Although radiotherapy is a part of treatment in cancers, it can also induce malignancy as a late complication. The presence of radiation-induced sarcomas in bone, although not very common, is acknowledged. The onset of radiation-induced sarcoma in the spine however, is not well recognized. We present here a case of radiation-induced fibrosarcoma in the T1 lamina and spinous process in a patient with a history of breast cancer treated with radiotherapy 30 years prior.

Summary

Psoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. It is characteristic that the rheumatoid factor in serum is absent. Etiology of the disease is still unclear but a number of genetic associations have been identified. Inheritance of the disease is multilevel and the role of environmental factors is emphasized. Immunology of PsA is also complex. Inflammation is caused by immunological reactions leading to release of kinins. Destructive changes in bones usually appear after a few months from the onset of clinical symptoms.

Typically PsA involves joints of the axial skeleton with an asymmetrical pattern. The spectrum of symptoms include inflammatory changes in attachments of articular capsules, tendons, and ligaments to bone surface. The disease can have divers clinical course but usually manifests as oligoarthritis.

Imaging plays an important role in the diagnosis of PsA. Classical radiography has been used for this purpose for over a hundred years. It allows to identify late stages of the disease, when bone tissue is affected. In the last 20 years many new imaging modalities, such as ultrasonography (US), computed tomography (CT) and magnetic resonance (MR), have been developed and became important diagnostic tools for evaluation of rheumatoid diseases. They enable the assessment and monitoring of early inflammatory changes. As a result, patients have earlier access to modern treatment and thus formation of destructive changes in joints can be markedly delayed or even avoided.

Summary

Background:

Interrupted aortic arch (IAA) is a rare congenital malformation of the aortic arch, which might be accompanied with other coexisting cardiovascular anomalies.

Case Report:

Many cases with IAA are diagnosed at their neonatal and newborn period but in rare cases the diagnosis is not established until adulthood. The patients may have no clinical symptoms but the signs of heart failure will gradually appear and may cause death.

Results:

The development of imaging methods such as computed tomography (CT) and magnetic resonance (MR) imaging has dramatically changed the diagnostics. Here we report a 20-year-old young man with IAA associated with sinus venosus atrial septal defect (SVD) and partial anomalous pulmonary venous connection (PAPVC) referred to our hospital.

Summary

Background:

Successful treatment of chronic occlusion of inferior vena cava (IVC) and iliocaval confluence with angioplasty and stent implantation is very rare.

Case Report:

We present a case of a 59-year-old patient with iatrogenic occlusion of IVC following L3/L4 discectomy. The wall of the ventral IVC was ruptured during the operation.

Results:

The torn wall was treated by patch angioplasty, resulting in a permanent IVC occlusion, as confirmed by angiography. Iatrogenic permanent occlusion of IVC was successfully treated with recanalization and implantation of a non-covered aortic stent.

Summary

Background:

Intervertebral disc calcification is a rare condition in children; in most cases, it is asymptomatic and therefore not diagnosed.

Case Reports:

In our study, we present a case of idiopathic intervertebral disc calcification within the cervical segment, at the level of C2/C3 and C4/C5 vertebrae in a 5-year-old girl with torticollis. Basic neurological examination supplemented by X-ray examination was performed, showing calcification within the cervical segment at the level of C2/C3 and C4/C5 vertebrae.

Conclusions:

In order to complement the diagnostics, a CT scan of the cervical spine was performed; the scan confirmed the diagnosis and revealed additional calcification of the anterior longitudinal ligament at the level of C4/C5 vertebrae.

Summary

Background:

Secondary hyperparathyroidism is a frequent complication of chronic renal failure. Patients resistant to pharmacotherapy are candidates for parathyroidectomy. Invasiveness of surgical treatment can be minimized by precise preoperative localization of parathyroid glands. Imaging modalities routinely used for this purpose are ultrasonography and MIBI-Tc99m scintigraphy.

Case Report:

Our case report shows advantages of co-registered computer tomography and conventional SPECT imaging (SPECT/CT) in a patient with advanced secondary hyperparathyroidism successfully treated with surgery.

Results:

Hybrid SPECT/CT parathyroid imaging enables better surgical planning and is superior to conventional scintigraphy.

Summary

Background:

Arterioportal fistula (APF) is an abnormal, direct connection between hepatic artery or its branch and the portal vein. Fistula can be acquired or, rarely, congenital. One of the acquired causes of fistula is a liver biopsy. Patients with liver cirrhosis are particularly vulnerable to its development due to the large number of performed biopsies. APF increases mortality and morbidity of liver transplantation procedure and may be a contraindication to it. The authors present a patient with liver cirrhosis, in whom percutaneous APF closure facilitated liver transplantation.

Case Report:

We describe a case of a 50-year-old patient with liver cirrhosis and APF, probably formed as a result of liver biopsy. Due to the presence of a high-flow fistula, which elevated portal hypertension, patient did not qualify for the liver transplantation. Patient was transferred to the interventional radiology department, where the fistula’s vascular supply was endovascularly closed using the Amplatzer occluder. This subsequently enabled the execution of transplantation.

Conclusions:

Percutaneous closure of APF should be considered a relatively simple and fast-acting tool to facilitate or even enable liver transplant surgery. Currently, there are more and more products available such as e.g. Amplatzer occluder to simplify the procedure and shorten the duration of exposure to ionizing radiation.

Summary

Background:

Rib fracture is the most common thoracic injury. It is thought to be present in 10% of all traumatic injuries and in almost 40% of patients who sustained severe non-penetrating trauma. There are 12 pairs of ribs. This study reviews various methods of acquisition and reconstruction of radiographic images of traumatic rib fractures in order to determine the optimal views and to simplify rib fracture diagnostics.

Material/Methods:

Eight different plain radiography pictures of ribs were performed with the patient in an erect position. The following projections were obtained in sequence: oblique at 45° or 30° angle on inspiration, oblique at 45° or 30° angle on expiration as well as 45° and 39° projections during slow and fast breathing. All radiographic examinations were performed using a Philips three-phase scanner installed at the Al- Razi Hospital in Jenin, Palestine.

Results:

The results demonstrate that the 45° antero-posterior oblique projection performed on expiration is recommended for diagnostics and interpretation of traumatic rib fractures.

Conclusions:

Conclusion emerging from this study are such that for a 45° oblique view on expiration is recommended for radiographic imaging of patients with clinical signs of fracture, e.g. evaluation of lower rib fractures, while 45° oblique view during fast breathing is recommended for suspected upper rib fractures.

Summary

Background:

A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970.

Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages.

Material/Methods:

Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined.

Results:

Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis.

Conclusions:

We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers.

Summary

The goal of this work was to assess the effectiveness of endovascular treatment of common and external iliac artery stenosis/occlusion classified according to TASC using a self-expanding stent Jaguar SM. The study group included 95 patients (61 men and 34 women) who underwent treatment for stenosis or occlusion of lower limb arteries at the Department of Radiology of the University Hospital in Bialystok and the Diagnostic Radiology Department of the Central Clinical Hospital of the Ministry of Interior (MSWiA) in Warsaw between 2005 and 2007. All arterial lesions were of atherosclerotic etiology. The shortest stenotic fragment was 10 mm long and the longest occluded arterial fragment did not exceed 90 mm. Morphological classification of iliac artery lesions in treated patients was performed according to TASC II classification and included 10 patients with type A, 39 cases of type B, 36 with type C and 10 patients with type D lesions. Endovascular procedure failed to restore flow in five patients with TASC type D lesions, who were later referred for surgery. One patient suffered a complication – vessel perforation during predilatation, and had a stentgraft implanted. In 95% of patients stents were expanded using a balloon after implantation. Good results were achieved in practically all patients who underwent stent implantation. Patients were subjected to follow-up clinical and imaging evaluation during next 1–24 months. Success rate of the performed procedures as well as in a 30-day observation period was 100% in case of stenosis and 80% in case of vessel occlusion. A follow-up after 12 and 24 months showed patency of treated vessels in 84% and 76% of patients, respectively.

Summary

Aortic valve calcification (AVC) is a common disease of the elderly. It is a progressive disease ranging from mild valve thickening to severe calcification with aortic valve stenosis. Risk factors for AVC are similar to those for atherosclerosis: age, gender, hypercholesterolemia, diabetes, hypertension, smoking and renal failure. AVC shares many similarities to atherosclerosis, including inflammatory cells and calcium deposits, and correlates with coronary plaque burden. Presence of AVC is associated with increased risk of adverse cardiovascular events. The objective for this review is to discuss the clinical features, natural history and prognostic significance of aortic valve calcifications, including mechanical and hemodynamic factors of flow distribution.

Summary

Breast cancer is the most common neoplasm of the female population and its incidence is constantly rising. Social campaigns educating the public about the importance of the problem have been conducted for the past several years. Women are encouraged to self-examine on a monthly basis. Women aged 50–69 years can have an x-ray mammography performed once every 2 years as part of a prophylactic screening program. Ultrasound studies or MR mammography are adjuvant or, in some cases, alternative to x-ray mammography. Nuclear medicine techniques with application of oncophilic markers and receptor studies (this publication will not cover nuclear medicine methods) are not routinely used. Other techniques, such as computed tomography and conventional radiography are of no significance in the diagnostics of mammary cancer. However, together with isotopic methods, they are helpful in staging of the disease.

X-ray mammography is, up to date, the only method with proven value in decreasing mortality. It is also the best available method for visualization of microcalicifications. Ultrasound examination is complementary to x-ray mammography as it is a cheap, easily available method of imaging mammary glands with higher glandular tissue content. It is also the most commonly used modality aiding in targeted biopsy of mammary gland. To date, MR mammography, characterized by the highest sensitivity in cancer diagnostics, remained a method reserved for “special tasks”. MR is used for prophylaxis mainly in a population of women with particularly high risk of the disease and in cases where x-ray and ultrasound examinations are insufficient.

Picture of mammary carcinoma in imaging studies is heterogeneous. However, it most often presents as an irregularly demarcated mass. Moreover, each modality can aid in visualization of additional features of a lesion such as typical shape of microcalcifications in x-ray mammography, characteristic pattern of contrast enhancement in MR examination or less strain in elastography.

Summary

Reconversion of bone marrow is a reverse process of natural replacement of red marrow by yellow marrow. The occurrence of reconversion can be misleading and challenging in interpretation of musculoskeletal system imaging. Changes of signal intensity in bone marrow are frequently observed in radiological routine and its diversity can cause a suspicion of pathologic findings. Therefore, the knowledge about distribution of red and yellow bone marrow depending on age, concomitant diseases and presentation of the patient are essential for MR image interpretation.

Summary

Background:

Despite the fact that joint tuberculosis is one of the most common forms of extrapulmonary tuberculosis, it is a disease entity that is very rare in Poland (less than 100 cases a year in the last 10 years). The symptoms are non-specific, and thus the disease is rarely taken into account in preliminary differential diagnosis.

Case Report:

A 68-year-old female patient was admitted to the Internal Diseases Clinic due to oedema and pain of the right shoulder joint. The pain has been increasing for about 8 months. Physical examination revealed increased circumference and elevated temperature of the right shoulder joint. Limb function was retained. The full range of radiological and laboratory diagnostic examinations was performed, including the biopsy of the affected tissue which revealed the presence of Mycobacterium tuberculosis in the bacterial culture. Clinical improvement was obtained after introduction of TB drugs.

Conclusions:

Radiological diagnostic methods (X-ray, CT scans, MRI scans) provide high precision monitoring of articular lesions. However, the decisive diagnosis requires additional laboratory tests as well as histopathological and bacteriological assays.

Summary

Background:

Exogenous lipoid pneumonia is an uncommon condition caused by inhalation or aspiration of a fatty substance. It usually presents as chronic respiratory illness mimicking interstitial lung diseases. Acute exogenous lipoid pneumonia is uncommon and typically is caused by an episode of aspiration of a large quantity of a petroleum-based product. Radiological findings vary and may imitate many other diseases.

Case Report:

We present a rare case of acute exogenous lipoid pneumonia in a fire-eater who aspirated liquid paraffin during his flame-blowing show (fire-eater’s lung). He was admitted to the hospital with productive cough, fever, hemoptysis, chest pain and dyspnea. Diagnosis was made on the basis of history of exposure to fatty substance, characteristic findings in CT examination and presence of lipid-laden macrophages in bronchoalveolar lavage fluid.

Conclusions:

Acute exogenous lipoid pneumonia is a very rare disease that typically occurs in fire-eaters and is called a fire-eater’s lung. The diagnosis is made on the basis of typical history and radiological, as well as histopathological findings.

Summary

Background:

Persistent left superior vena cava is a rare but important congenital vascular anomaly. However, PLSVC with absent RSVC (isolated PLSVC) is a very rare venous malformation We report on a rare case of persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC).

Case Report:

This venous malformation was identified incidentally in a 69-year-old woman during chest multi-detector computed tomography (MDCT). On chest MDCT, the SVC was noted on the left side. A bridging vein drained the right jugular and right subclavian veins and joined the left brachiocephalic vein in order to form the PLSVC, which descended on the left side of the mediastinum and drained into the left atrium (LA). The patient had no additional cardiac anomaly.

Conclusions:

Isolated PLSVC is usually asymptomatic but it can pose difficulties for establishing central venous access, pacemaker implantation and cardiothoracic surgery. This condition is also associated with an increased incidence of congenital heart disease, arrhythmias and conduction disturbances. A wide spectrum of clinicians should be aware of this anomaly, its variations and possible complications.

Summary

Background:

Takayasu arteritis is an inflammatory disease of large-diameter arteries. Aorta and its branches are most frequently affected. Takayasu arteritis occurs mainly in young women and, if left untreated, leads to fatal complications. Digital subtraction angiography (DSA) is considered the gold standard in imaging of Takayasu arteritis.

Case Report:

A thirty-five-year-old woman was admitted to the hospital with transient loss of consciousness, effort-associated vertigo, upper limb weakness and temporary vision problems. On admission, there was no pulse on the left radial artery while there were bruits over subclavian arteries. Imaging of the aortic arch (computed tomography angiography, DSA) revealed stenoses of its main branches, indicating Takayasu arteritis.

Conclusions:

Computed tomography angiography (CTA) performed with a 64-slice unit revealed high effectiveness in localization of vascular wall and lumen pathologies resulting from Takayasu arteritis. Thanks to this fast diagnostic method, it is now possible to perform successful monitoring of patients with Takayasu arteritis and to plan possible interventional treatment.

Summary

Background:

Lack of standardised orbital MR protocols leads to a situation, when each institution/centre may arbitrarily choose sequence parameters. Therefore, the results obtained and published by the authors may not be compared freely, and what is most important may not be considered fully reliable. Signal intensity (IS) and T2 time (T2) are important parameters in estimation of inflammatory processes of extraocular muscles in the clinical practice.

The aim of this study was to determine the reference values (i.e. cut-off values) for absolute signal intensity and T2 relaxation time in healthy subjects, their relativised values to white matter (WM) and temporal muscles (TM) and to evaluate the correlation between those parameters.

Material/Methods:

The orbital examination was performed in healthy volunteers according to the protocol prepared in the Radiology-Imaging Diagnostic Department of the Medical University of Lodz for patients with suspected/diagnosed thyroid orbitopathy. Using two of the standard sequences IS and T2 time were calculated for the muscles and two relativisation tissues in realtion to WM and TM. Subsequently cut-off values for healthy volunteers were calculated.

Results:

The differences between muscles for IS, IS MAX, IS/TM, IS/WM, IS MAX/TM, IS MAX/WM and T2 MAX/WM were not statistically significant. Therefore one cut-off value of these parameters for all the rectus muscles was calculated. T2-relaxation time and T2 relativised to white matter had to be calculated separately for each muscle.

Conclusions:

No statistical correlation was found between IS and T2-time for extraocular muscles in healthy volunteers. We calculated the reference ranges (cut-off values) for absolute IS and T2-time values and relativised parameters. In the clinical practice the objectification of IS and T2-time values should be done to WM, than to IS or T2 of the temporal muscle. The T2 MAX/WM seems to have the highest clinical utility for the assessment of the pathophysiological status of extraocular muscles.

Summary

Background:

The most common cause of low back pain is degenerative disease of the intervertebral disc and other structures of the lumbar spine. However, in some cases other less frequent causes of such pain can be seen, for example septic facet joint arthritis. Until now, only 40 cases of such inflammatory changes within the spine have been reported in the literature. The disease is probably underestimated due to improper diagnostic pathway.

Case Report:

The authors describe a case of a 53-year-old woman who was repeatedly hospitalized during a five-month period because of an acute, severe low back pain, with sphincter dysfunction, partially resembling sciatic symptoms. Physical examinations revealed also focal tenderness in the area of the lumbar spine. Inflammatory markers (ESR – erythrocyte sedimentation rate, CRP – C-reactive protein) were elevated. Conservative analgetic treatment brought only partial and temporary relief of the pain and symptoms. The final accurate diagnosis of isolated septic facet joint arthritis at the level of L5/S1 was established after several months from the onset of the first symptoms, after performing various imaging examinations, including bone scintigraphy as well as CT and MRI of the lumbosacral spine. The patient fully recovered after antibiotic therapy and surgery, which was proven in several follow-up examinations showing no relevant pathology of the lumbar spine. The authors broadly describe the etiology and clinical symptoms of the septic facet joint arthritis as well as the significant role of imaging methods, especially MRI, in diagnostic process. The authors also discuss currently available treatment options, both conservative and surgical.

Conclusions:

The diagnostic procedure of septic facet joint arthritis requires several steps to be taken. Establishing a correct diagnosis may be difficult, that is why it is important to remember about rare causes of low back pain and to perform detailed physical examination, laboratory tests and choose appropriate imaging techniques.