Background: The aim of this study was to investigate the diagnostic efficiency of magnetic resonance (MR) spectroscopy with diffusion-weighted imaging in the evaluation of the recurrent contrast-enhancing regions at the location of treated gliomas. Patients and Methods: In 49 patients who had new contrast-enhancing lesions at the vicinity of previously resected and irradiated high-grade gliomas, single-voxel MR spectroscopy and diffusion-weighted imaging were performed. Spectral data for N-acetylaspartate (NAA), creatine (Cr), choline (Cho), lipid (Lip), and lactate (Lac) were analyzed in combination with the apparent diffusion coefficient (ADC) in all patients. Diagnosis of these lesions was allocated by means of follow-up or histopathology. Results: The Cho/NAA and Cho/Cr ratios were significantly higher in recurrent tumor group than in radiation injury group (p < 0.001). The ADC values and ADC ratios (quotient of ADC of contrastenhancing lesion and matching structure in the contralateral hemisphere) were significantly higher in radiation injury regions than in recurrent tumor (p< 0.001). With MR spectroscopy, two variables (Cho/NAA and Cho/Cr ratios) were proved to differentiate recurrent glioma from radiation injury, and 81.5% of total patients were classified into correct groups. Using discriminant analysis for MR spectroscopy with diffusion-weighted imaging, three independent variables (Cho/NAA, Cho/Cr, and ADC ratio) could classify 91% of total patients into their correct groups. There was a significant difference between the diagnostic accuracy of the two discriminant analyses (Chi-square=4.15, p=0.042). Conclusion: MR spectroscopy combined with ADC ratio can enhance the ability to differentiate recurrent glioma from radiation injury.

Background: Osteoporosis is a worldwide health problem and a common cause of bone fractures; the most common type of osteoporosis is post-menopausal type. MRI has a role in the diagnosis of osteoporosis and can be used as a screening tool, so the purpose of our study was to define a quantitative MRI-based score (M-score) for the detection of lumbar spine osteoporosis and to evaluate the correlation between lumbar spine signal intensity measured by MRI and BMD (bone mineral density) in post-menopausal women. Our case-control study involved 100 cases (50 old post-menopausal females as a case group and 50 healthy females as a control group of matched age). Both groups were subjected to history taking, dual-energy X-ray absorptiometry (DEXA), and conventional lumbar MRI. DEXA was performed for the lumbar spine and all scores (T-score, Z-score, BMD) were calculated. Lumbar MRI was performed (sagittal T1WI and T2WI) from L1-L4 levels. SNR L1-L4 and M-score were calculated from T1W images. Results: All DEXA scores were significantly lower in post-menopausal females compared to the control group (P < 0.0001). Meanwhile, SNR L1-L4 and M-score were significantly higher among cases than controls (P < 0.0001). The diagnostic threshold of SNR L1-L4 and M-score for distinguishing osteoporotic from non-osteoporotic females was 104.5 for SNR L1-L4 with a sensitivity of 94%, specificity 60%, positive predictive values (PPV) 31%, and negative predictive values (NPV) 98%, and 3.5 for M-score with a sensitivity of 93.

Background Data: A terminal myelocystocele occurs at the distal (terminal) end of the spine from the lumbar to coccygeal regions. It is characterized by a skin-covered mass with spinal dysraphism of the associated spinal cord. Within this herniated sac is the distal spinal cord with a large cystic dilatation of its central canal that occupies the posterior aspect and CSF and arachnoid membrane forming a meningocele lying anterior to the terminal cyst of the central canal. Purpose: To report our clinical results with repair and untethering of five cases with terminal myelocystoceles. Study Design: A descriptive cross section retrospective study. Patients and Methods: This is a retrospective analysis of five cases of terminal myelocystoceles treated between February 2008 and March 2015. All patients underwent neurological examination and magnetic resonance imaging (MRI) of the spine. One patient (older one) had presented with weakness of feet dorsiflexion and plantar flexion bilaterally while 4 (80 %) patients had no deficits at all. Bladder bowel involvement was evident in all cases. Results: A total of five patients were included. The mean age of intervention was 5 months. Three of five patients were females. All the patients had lower lumbar and upper sacral mass. The mean operative time of the study group was 150 minutes and the mean operative blood loss was 70CC. The mean hospital stay was 8.4 days. The status of all patients with no preoperative deficits remained unchanged. The patient with motor weakness had improvement during follow up.