CORRELATION OF SPURLING TEST WITH MAGNETIC RESONANCE IMAGING FINDINGS IN PATIENTS WITH CERVICAL DISK HERNIATION

Diagnostic accuracy of ultrasound in diagnosis of rotator cuff injuries keeping MRI as gold standard.

Its strong concordance with MRI supports its use as a first-line diagnostic tool, particularly for full-thickness tears, and remains essential in equivocal cases or when detailed pre-operative assessment is required.

Paired Magnetic Resonance Imaging and Clinical Outcomes Following Intervertebral Differential Dynamics Therapy for Cervical and Lumbar Disc Bulges and Herniations: A Secondary Analysis of a Retrospective Cohort

Background: Intervertebral Differential Dynamics (IDD) Therapy is used as a targeted, non-surgical decompression intervention for selected patients with disc-related spinal pain. A previously published cohort reported significant short-term improvements in pain and disability, while paired magnetic resonance imaging (MRI) outcomes were reserved for subsequent analysis. Objective: To evaluate paired MRI findings and clinical outcomes following IDD Therapy in adults with MRI-confirmed cervical or lumbar disc bulges and herniations. Methods: This retrospective secondary analysis included 21 adults with 47 treated disc levels who completed a 30-session protocol. Previously published Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcomes were linked to paired MRI measurements. Posterior disc contour extension, canal anteroposterior diameter, and disc height were analyzed separately for 14 lumbar and 7 cervical index lesions. Radiographic response and exploratory clinical-imaging correlations were also evaluated. Results: Mean VAS improved from 5.8 to 1.5 and ODI from 18.5 to 6.5 in the parent cohort. Lumbar mean changes were -1.75 mm for disc contour extension, +1.31 mm for canal diameter, and +0.64 mm for disc height; cervical mean changes were -1.20 mm, +0.89 mm, and +0.53 mm, respectively. All region-specific changes were statistically significant. Global radiographic improvement was observed in 16 of 21 patients and 34 of 47 treated levels. Disc contour reduction was strongly associated with VAS improvement (r=0.95; 95% CI, 0.88-0.98; P<0.001). Conclusions: Completion of IDD Therapy was associated with substantial clinical improvement and favorable paired-MRI changes in most patients in this selected cohort. Because the study was retrospective, lacked a comparator, used non-standardized clinical imaging, and included only treatment completers, the findings are hypothesis-generating rather than causal.

Assessment of the Reliability and Diagnostic Accuracy of Indirect MRI Signs for ACL Tears: Comparison with Arthroscopic Findings as the Gold Standard

Background: The objective of this study was to evaluate the sensitivity and specificity of indirect MRI signs (PCL Angle, PCL Inclination Angle, PCL-PCA, and Anterior Drawer Sign) in diagnosing ACL tears, as confirmed by arthroscopy. Methodology: This retrospective case-control study, conducted at Shifa International Hospital in Islamabad from January to December 2023, included 100 patients divided into two groups based on arthroscopy findings: 50 with a healthy ACL (Control) and 50 with ACL deficiency (Test). MRI signs were analyzed retrospectively to calculate cut-off values, sensitivity, specificity, and AUC. Results: The study involved 100 patients (77 males, 23 females), with a mean age of 35.12 years (range 16–75). Among MRI parameters, PCL-PCA was the most sensitive (81.3%, AUC 0.821), followed by PCL angle (78.1%, AUC 0.870) and PCL inclination angle (68.8%, AUC 0.697). The Anterior Drawer Sign showed high specificity (89.19%) but lower sensitivity (57.14%) and was statistically significant (p = 0.001). Conclusion: The crux of this study is that PCL-PCA is highly sensitive in diagnosing ACL tear as an indirect and secondary parameter, followed by PCL angle, then by PCL inclination angle, and lastly by anterior drawer sign. These provided an excellent distinction between patients with and without an ACL tear.

Can CT-guided cervical nerve root injections delay or prevent the need for surgical intervention in cervical radiculopathy?

Diagnostic approaches for lumbar epidural varix causing radiculopathy: a systematic review

Lumbosacral radiculopathy, commonly caused by disc protrusion or joint hypertrophy, can also stem from lumbar epidural varix (LEV), a rare condition involving vertebral venous plexus dilation. This systematic review evaluates the diagnostic approaches used to identify LEVs in patients presenting with radiculopathy, with particular emphasis on imaging modalities and clinical diagnostic strategies. Using the PICO framework, studies from January 2014 to June 2024 were systematically reviewed. MEDLINE, CINAHL, PubMed, and Embase were searched for peer-reviewed articles in English. Included studies examined diagnostic methods used to identify LEVs, including imaging modalities such as magnetic resonance imaging (MRI), CT myelography, and venospondylography, as well as clinical findings reported in affected patients. Data synthesis focused on diagnostic accuracy parameters and treatment outcomes following surgical interventions. Seven studies met the inclusion criteria, involving 109 patients with LEV-related radiculopathy. MRI demonstrated high sensitivity (87%–100%) and specificity (80%–95%) in identifying varices and associated neural compression. Surgical interventions, including laminectomy and microsurgical techniques, consistently led to symptom resolution and minimal recurrence rates. This review underscores MRI’s efficacy in diagnosing LEV and guiding effective surgical management, despite diagnostic challenges. Early and accurate diagnosis through comprehensive clinical and imaging evaluations is crucial for optimizing therapeutic strategies and improving patient outcomes in LEV-related radiculopathy.

Comparative Evaluation of MRI and Ultrasonography for Temporomandibular Joint Pathologies with Emphasis on Bone Marrow Edema.

OBJECTIVES This retrospective diagnostic accuracy study compared magnetic resonance imaging and ultrasonography in 98 temporomandibular joints from 49 patients for evaluating disc position, disc configuration, joint effusion, condylar degenerative changes, and bone marrow edema. METHODS A total of 98 temporomandibular joints from 49 patients who underwent both modalities were retrospectively evaluated by two independent, blinded observers using established classification systems. All imaging was performed prior to the initiation of any specific TMJ treatment. Intra- and inter-observer agreement, the diagnostic accuracy of ultrasonography relative to the magnetic resonance imaging reference standard, diagnostic likelihood ratios, and associations between parameters were analysed statistically. RESULTS Intra- and inter-observer agreement was good to excellent for both modalities (Kappa 0.71-0.91, p < 0.05). Ultrasonography showed high sensitivity and specificity for disc displacement (94.4-97.4% and 61.5-70.0%) and effusion (87.5-92.3% and 84.0-87.0%), but more limited performance for bone marrow edema, particularly in specificity (60.0-61.1%). On the left side, magnetic resonance imaging identified bone marrow edema in 63.3% of cases compared with 36.7% on ultrasonography (p = 0.015). Folded and convex disc configurations and marked or severe effusion were both associated with displacement without reduction (p ≤ 0.046). CONCLUSIONS Ultrasonography appears suitable as a first-line screening modality for selected TMJ abnormalities, whereas magnetic resonance imaging remains indispensable whenever bone marrow pathology or complex internal derangement is suspected. ADVANCES IN KNOWLEDGE This study provides direct, same-patient diagnostic accuracy data comparing ultrasonography with magnetic resonance imaging across multiple temporomandibular joint pathologies, including an indirect ultrasonographic assessment of bone marrow edema via cortical irregularity, clarifying which findings ultrasonography can reliably screen for and which still require magnetic resonance imaging confirmation.