No abstract

Recent advances in MR diffusion weighted imaging (DWI) enable the identification of anisotropic white matter tracts with diffusion tensor imaging (DTI). We aimed to use a novel DTI technique to safely study patients with recent stroke in a high field (3 T) MR machine with its intrinsically higher spatial resolution and signal-to-noise ratio. Of ten patients studied, six had disruption of white matter tracts as determined by DTI. A further patient had distortion of white matter tracts around an infarct rather than actual disruption of the tracts themselves. The lack of tract destruction may imply a beneficial prognosis, information that is not available with conventional DWI.

A case of chrondrosarcoma of the petrous temporal bone is presented. Chondrosarcomas rarely occur intracranially and typically present as a petrous apex mass. The dilemmas faced in the diagnosis and treatment of petrous apex chondrosarcomas are discussed. This case also gives interesting insight into the natural history of this tumour.

The authors present a prospective study of quality of life and MRI findings in patients with low back pain (LBP). Disc herniation and nerve root compression contribute to LBP and poor quality of life. However, significant proportions of asymptomatic subjects have disc herniation and neural compromise. Little is known about the influence of disc abnormalities and neural compression on quality of life in symptomatic patients. The purpose of this study was to assess the relationship between the extent of disc abnormality, neural impingement and quality of life. A total of 317 consecutive patients with LBP referred for MRI completed an SF-36 health status questionnaire immediately before imaging and again 6 months later. Patients were grouped according to the most extensive disc abnormality and any neural compromise reported at MRI. The relationship between symptoms, radiological signs and SF-36 scores was assessed. Eighty percent (255/317) and 65% (205/317) of patients completed the initial and 6-month SF-36, respectively. Thirty-six percent of patients (115/317) had one or more herniated discs and 44% (140/317) had neural impingement. There was little relationship between the extent of disc abnormality and quality of life. Patients with radiological evidence of neural impingement reported better general health (P < 0.01). SF-36 scores improved at 6 months in four dimensions, but general health deteriorated (P < 0.01). Patients with neural impingement had improved pain scores at 6 months (P < 0.05). The study results showed that the pain and dysfunction caused by disc herniation and neural compromise are not sufficiently distinct from other causes of back pain to be distinguished by the SF-36. Whilst neural compromise may be the best radiological feature distinguishing patients who may benefit from intervention, it cannot predict quality of life deficits in the diffuse group of patients with LBP.