Range Of Motion Assessment Pdf Merge

Range of motion assessment pdf merge

The two-dimensional multi-echo recombined gradient echo MERGE technique automatically acquires and sums multiple gradient echoes at various echo times in cervical spine magnetic resonance MR imaging. This technique increases the grey—white matter contrast within the spinal cord and should also improve the depiction of cervical cord lesions.

Nineteen consecutive patients 10 males and 9 females; age range 22—62 years, mean age Qualitative evaluation for MS lesion conspicuity was performed.

Range of motion assessment pdf merge

Detection of hyperintense lesions on T2-weighted magnetic resonance MR images is important in the assessment of damage to the spinal cord in patients with multiple sclerosis MS. Several studies have shown that spinal cord lesions are very uncommon in people with other neurological diseases 2 — 8 and the existence of T2-hyperintensities can increase the confidence in the diagnosis of MS.

This is true especially when MR imaging abnormalities of the brain white matter are interpreted as non-specific or equivocal. In addition, hyperintense lesions on T2-weighted images are often associated with sensory or motor symptoms and can be a marker of disease activity.

This technique automatically acquires and sums multiple gradient echoes at various echo times.

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MERGE increases the gray—white matter contrast within the spinal cord and should theoretically increase lesion conspicuity. A similar technique has been proven to be useful for detecting abnormalities of the cervical spinal cord, such as hemorrhage and edema, but no patients with MS were analyzed. We reviewed the medical records and imaging database from our institution. We excluded patients who had cervical degenerative changes that could cause spinal cord changes similar to MS lesions.

Nineteen patients 10 men and 9 women; age range 22—62 years, median 44 years met the criteria and were included in this study. Fifteen subjects were classified as having relapsing—remitting MS, two as primary progressive type, and one as a clinically isolated syndrome.

MR studies were performed in all patients on a 3. A dedicated phased array spine coil was used. Each sequence had 3. Equal numbers of images at the same levels were obtained with each sequence. To minimize cerebrospinal fluid CSF pulsation, flow compensation was used for both imaging modalities.

The qualitative analysis was performed by a neuroradiologist and a radiologist experienced at reading cervical spine MR imaging.

The radiologists reached a consensus regarding the presence and number of lesions. To minimize the visual misjudgment in detecting lesions, we varied window widths and levels for each sequence to obtain the best depiction of the lesions.

Range of motion assessment pdf merge

The window width is the range of pixel values displayed across an image and the level is the central window width value. We added 10 normal controls to the qualitative analysis to evaluate whether the MERGE technique may cause false-positive lesions in the spinal cord. All images from both patients and controls were randomly blended for reviewing. The number and location of lesions depicted with each image modality were documented.

Then both image modalities were re-evaluated side-by-side to compare lesion detection on a lesion-by-lesion basis. The lesion conspicuity was compared between the two image modalities.

Range of motion assessment pdf merge

Statistical significance was determined with the sign test. A significant difference was accepted if the P value was less than 0.

Range of motion assessment pdf merge

The statistical significance of the quantitative data was determined with the paired t -test. No abnormal spinal cord signal, which could be confused with an MS lesion, was found in the 10 normal controls. Motion artifact obscured evaluation at one level for one of the normal controls.

Two lesions at the C2—C3 level are depicted in A arrows. Only one lesion at the C2—C3 level is visible in B arrow. The lesion on the left side is depicted at the C2—C3 level in C arrows. In the remaining eight lesions, both slight hyperintensity and CSF flow artifact were the reasons for false-negative results when T2WFSE images were evaluated alone. Two lesions are depicted in A arrows. CSF flow artifact is seen in B and the lesions are not visible. The lesion is depicted in both images, but more conspicuously in A.

Four lesions occupied nearly the whole spinal cord on the axial section and the spinal cord surrounding the lesions was too small to have the signal intensity measured. The horizontal lines indicate the mean CNR in each group. The spinal cord is frequently involved in MS and imaging the spinal cord is often an essential element in the diagnosis of MS. Rocca et al.

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The spinal cord is a small and mobile structure. The MERGE technique is a gradient-echo method with multiple bipolar gradient-echo formations that combines the signal from the individual echoes. The early echoes provide increased signal-to-noise ratio, while later echoes boost contrast.

CSF flow artifact on the FSE sequence causes subtle changes around and in the spinal cord that causes lesions to be missed. Like the FSE sequence, the MERGE sequence has a short acquisition time and the whole length of the cervical spinal cord can be scanned within a reasonable time usually 5—6 minutes.

A limitation of this study is that for the MERGE sequence the TRs were automatically selected by the MR sequence based on the number of slices needed for imaging the cervical spinal cord.

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The TR of the T2WFSE sequence was varied by the technologist as per standard practice to optimize coverage without markedly changing the imaging time. Another limitation is the sample size of this study. The number of patients and controls were not large. In this retrospective study, we were not able to compare MERGE with the fast short-inversion-time inversion recovery STIR sequence that was not included in our standard imaging routine.

National Center for Biotechnology Information , U. J Spinal Cord Med. Matthew L. White , 1 Yan Zhang , 1 and Kathleen Healey 2. Author information Copyright and License information Disclaimer.

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Correspondence to: Matthew L. Email: ude. This article has been cited by other articles in PMC. Abstract Objective The two-dimensional multi-echo recombined gradient echo MERGE technique automatically acquires and sums multiple gradient echoes at various echo times in cervical spine magnetic resonance MR imaging. Methods Nineteen consecutive patients 10 males and 9 females; age range 22—62 years, mean age Keywords: Neuroimaging, Multi-echo recombined gradient echo, Multiple sclerosis, Cervical spinal cord.

Introduction Detection of hyperintense lesions on T2-weighted magnetic resonance MR images is important in the assessment of damage to the spinal cord in patients with multiple sclerosis MS. Methods We reviewed the medical records and imaging database from our institution.

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Open in a separate window. Figure 1. Figure 2. Figure 3.

Introduction

Figure 4. Discussion The spinal cord is frequently involved in MS and imaging the spinal cord is often an essential element in the diagnosis of MS.

References 1. Simon JH. The contribution of spinal cord MRI to the diagnosis and differential diagnosis of multiple sclerosis.

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