This document discusses several issues related to spine imaging. It covers the importance of radiation exposure from various imaging modalities like CT and highlights strategies to reduce radiation dose. Guidelines for imaging low back pain recommend no imaging for non-specific back pain but imaging if neurological deficits are present or specific causes are suspected. The document reviews imaging modalities like X-ray, bone scan, CT and MRI and what each shows. It provides details on MRI sequences and appearances of common spine findings.
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Doppler ultrasound of different diseases of visceral arteries including arterial stenosis and occlusion, arterial aneurysm, artrial pseudoaneurysm, arterio-venous fistula, artrial dissection, and abdominal vascular compression syndromes
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and spinal st
• The young athlete with back pain
• Indications for vertebroplasty
• A few cases
3. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and
spinal stenosis
• The young athlete with back pain
• Indications for vertebroplasty
• A few cases
4. CT radiation dose
• Background average 2-3 mSv/year
– Natural background 85%
– Medical 14%
– CT 40-67% of medical
• CT use increased by 600-820% over 20 years
from mid-80s
– Plateaued/ decrease more recently
5. CT dose reduction strategies
• Only use CT where appropriate (US, MRI)
• Scan parameters: pitch, kvp, mAs
– Paediatrics
– Built-in protocols
– Automatic tube current modulation
– Iterative image reconstruction
• Minimize phases
– No pre-contrast for trauma, oncology follow-up
• Minimize coverage
– L3 to S1 in most cases
6. Radiation doses
Imaging test Effective
dose (mSv)
CXRs Background
exposure
Flying hours
CXR 0.02 1 3 days 4
Lumbar X-ray 1.5 75 6/12 300
Lumbar CT 2-10 100-500 8/12 - 3 years 400 - 1800
Bone scan 6 300 2 years 1200
7. CT risk controversies
• Validity of linear, no threshold model
• Variable literature
– Increased cancer risk in some
– Beneficial effect of low level radiation in others
• Children more radiosensitive and at greater risk
for decades
• Triple risk secondary tumours
– Leukaemia 50mGy
– Brain tumour 60mGy
• Lancet 2012;380:499-505
8.
9. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and
spinal stenosis
• The young athlete with back pain
• Indications for vertebroplasty
• A few cases
12. Radiographs
What you see
• Bony anatomy and
alignment
• Disc height
Disadvantages
• Radiation
• Nonspecific
– OA changes in most
adults
• Insensitive
– No direct visualisation
of neural and other
nonbony structures
14. Bone scan
What you see
• Bone pathology
– Osteoblastic activity
Disadvantages
• Radiation
• Very nonspecific
• Relatively poor
anatomical resolution
– (Improved with
SPECT; SPECT/CT)
– No direct visualisation
of neural and other
nonbony structures
21. CT
What you see
• Bony anatomy and
alignment
• Cross sectional view
of spinal canal and
foramina
• Disc, thecal sac,
nerve roots
22. CT
What you see
• Bony anatomy and
alignment
• Cross sectional view
of spinal canal and
foramina
• Disc, thecal sac,
nerve roots
Disadvantages
• Nonspecific
– Most adults have
‘findings’
• Poor visualisation of
individual neural
structures and disc
anatomy
• Radiation
23. MRI
What you see
• Bony anatomy and
alignment
• Bone pathology
• Multiplanar view of
spinal canal and
foramina
• Disc: hydration and
structure
• Neural structures:
cord, nerve roots
24. MRI
What you see
• Bony anatomy and
alignment
• Bone pathology
• Multiplanar view of
spinal canal and
foramina
• Disc: hydration and
structure
• Neural structures:
cord, nerve roots
Disadvantages
• Nonspecific
– Most adults have
‘findings’
• Availability
• Expense
– Rebate
28. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and
spinal stenosis
• The young athlete with back pain
• Indications for vertebroplasty
• A few cases
44. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and
spinal stenosis
• The young athlete with back pain
• Indications for vertebroplasty
• A few cases
45. Ineffectiveness of imaging for
nonspecific LBP
• Favourable natural Hx
– Most improve by 4 weeks; unaffected by imaging
• Nonspecificity: loose association between findings
and symptoms
– ‘Abnormalities’ or normal aging?
• Potential harms:
– Radiation
– ‘Labelling’
– Incidental findings
Ann Intern Med 2011;154:181-190
46. Degenerative changes on imaging
• Ubiquitous and nonspecific
Brinjikji AJNR 2015;36:811
Imaging Finding
Age (yr)
20 30 40 50 60 70 80
Disk degeneration 37% 52% 68% 80% 88% 93% 96%
Disk signal loss 17% 33% 54% 73% 86% 94% 97%
Disk height loss 24% 34% 45% 56% 67% 76% 84%
Disk bulge 30% 40% 50% 60% 69% 77% 84%
Disk protrusion 29% 31% 33% 36% 38% 40% 43%
Annular fissure 19% 20% 22% 23% 25% 27% 29%
Facet degeneration 4% 9% 18% 32% 50% 69% 83%
Spondylolisthesis 3% 5% 8% 14% 23% 35% 50%
47. Appropriate imaging for back
pain
• Clinical presentations: classification into 3 broad
categories
1. Nonspecific low back pain
2. Back pain associated with radiculopathy
3. Back pain associated with a specific cause requiring
prompt evaluation
49. Back pain categories
2. Back pain associated with radiculopathy
a) Unilateral acute nerve root compression (sciatica)
– Leg pain >> back pain
– Disc herniation
a) Unilateral chronic nerve root compression
– Disc herniation or spinal stenosis
a) Bilateral chronic nerve root compression
– Spinal stenosis
– DD vascular claudication
a) Bilateral acute nerve root compression = ‘cauda equina
syndrome’
50. Cauda equina syndrome
• Bilateral acute nerve root compression
– Massive disc protrusion/ sequestration
• Sudden onset bilateral leg pain
• Saddle anaesthesia
• Rapidly progressive or severe neurological
deficits
– Motor deficits at >1 level
– Faecal incontinence
– Urinary retention
51. Back pain categories
3. Back pain associated with a specific cause requiring
prompt evaluation
− Cauda equina syndrome
− Cancer
− Vertebral infection
− Vertebral compression fracture
− Ankylosing spondylitis (inflammatory
spondyloarthropathy)
52. LOW BACK PAIN GUIDELINES
Diagnostic triage
1. Non-specific LBP
2. Radiculopathy
3. Specific LBP
• ‘Red flags’
‘Red Flags’
• Cauda equina syndrome
• Known 10
tumour
• Weight loss
• Severe symptoms, not
settling
• Fever
• Recent infection or Sx
• Osteoporosis
• Steroid use
• Non-mechanical pain
• Child*
53. LOW BACK PAIN GUIDELINES
1.Focused Hx and examination to place patients
into 1 of 3 categories
2.No imaging for nonspecific LBP
3.Imaging for LBP + severe or progressive
neurological deficits OR risk factors for specific
cause
4.Imaging for LBP and radiculopathy if candidates
for surgery or epidural injection
54. LOW BACK PAIN GUIDELINES
• American College of Physicians & American
Pain Society Recommendations
– Ann Intern Med 2007;147:478-491
• Choosing Wisely Australia
– www.choosingwisely.org.au
• National Institute for Clinical Excellence (NICE)
UK
• ACR Appropriateness Criteria
56. Diagnostic work-up
Possible cause Imaging Additional studies
Nonspecific LBP None None
Radiculopathy MRI (CT)
Cauda equina MRI
Cancer MRI for known 10
X-ray for other eg wt loss
Staging: bone scan; PSMA
ESR
Vertebral infection MRI ESR, CRP
Vertebral compression # X-ray
MRI pre vertebroplasty
Ankylosing spondylitis X-ray, incl pelvis (MRI) HLA-B27; ESR, CRP
Ann Intern Med 2007;147:478-491
57.
58. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and
spinal stenosis
• The young athlete with back pain
• Indications for vertebroplasty
• A few cases
59. NOMENCLATURE
• Consistent
• Reflect common usage where appropriate
• Surgically relevant
• ‘Able to visualize over the phone’
• 2 morphological characteristics:
– Nature of disc pathology
– Location
• Able to add further descriptors
– Neural structures
– Clinical context
• www.asnr.org/spine_nomenclature/reporting
• Spine Journal 2014;14:2525-2545
60. Annular tear/ fissure
• Annular fissure = degeneration
• Annular tear: outdated
– When ‘tear’ obvious result of trauma use the term
‘rupture’
• Annular high intensity zone (HIZ)
– Not synonymous with ‘fissure’
– Does not imply trauma
– Does not imply pain generator
61.
62. Disc bulge
• Extension of disc tissue beyond intervertebral
disc space = displacement of annulus
• >25% circumference (>900
)
• Relatively short distance, <3mm
• Normal at L5/S1
63.
64. Herniated disc
• Localised displacement of disc material beyond
intervertebral disc space (ie disrupted annulus) OR break in
vertebral end plate (Schmorl’s node)
• ‘Localised’ = <25% circumference (<900
)
– No longer divide into ‘broad based’ and ‘focal’
• ‘Herniation’ or ‘protrusion’
• Disc between but not beyond osteophyte OR adaptive to
subluxation/ listhesis is NOT herniation
• ‘HNP’ not accurate
– Herniation may include NP, cartilage, annulus, bone
• ‘Rupture’ tends to refer to trauma/ acute event
• ‘Prolapse’ and ‘bulging disc’ outdated
65.
66. Protrusion vs extrusion
• Based on appearance
• Extrusion = greatest distance in any
plane between edges > base
OR
• Protrusion: contained
• Extrusion: uncontained = ruptured PLL
• Presence or absence of containment
more clinically relevant:
– Surgical approach
– Prediction of resorption
67. Sequestered disc
• Extruded disc material that has no continuity
with the disc of origin
• = free fragment
• Migrated disc:
– Disc material displaced away from site of extrusion
69. Location of herniation
• Anatomic system that correlates with surgery
• Landmarks, transverse plane:
– Sagittal and coronal planes at centre of disc
– Medial edge of articular facet
– Medial, lateral borders of pedicles
75. Volume: degree of canal
compromise
• X-sectional area at site of maximal narrowing
• ‘Mild’: <1/3
• ‘Moderate’: 1/3 – 2/3
• ‘Severe’: > 2/3
• Correlation with fluid around cauda and
‘crowding’ of neural structures
• Other descriptors such as compression of
specific neural structures
81. Nomenclature: summary
• No consensus for cervical and thoracic
• Cannot date disc pathology without serial
imaging
• Definitions based on morphology and pathology
• No implication of aetiology
• No distinction between symptomatic and
asymptomatic findings
82.
83. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and
spinal stenosis
• The young athlete with back pain
• Indications for vertebroplasty
• A few cases
84. Pars protocol
LBP in 40% children and adolescents
Structural causes 12-26%
Pars defect = spondylolysis
Common cause
Pars interarticularis (interarticular
part) = weakest part of neural arch
Often accelerated by athletic
activity
2 key concepts:
Spectrum of pars pathology
DD: other causes of pain
12F
85. Pars pathology
Developmental deficiency
Asymmetry of posterior elements: laminae and facet
joints
Traumatic fracture: uncommon
Stress injury
Chronic repetitive low grade trauma
Oedema early
Sclerosis or fracture/ defect later
86. Pars stress injury
Lumbar, esp L5
Often bilateral
Spondylolisthesis
Disc pathology
Unilateral defect →
contralateral stress
Symptoms:
Often asymptomatic
LBP
Hamstring tightness
Increased by activity
87. Imaging of LBP in children
Radiography
CT
SPECT/ SPECT-CT
RadioGraphics 2015;35:819-834
MRI
Radiation dose in
children
Triple risk secondary
tumours
Leukaemia 50mGy
Brain tumour 60mGy
Lancet 2012;380:499-505
99. 17F Left LBP, acute on chronic
T1 GEFS T2
Multiple findings:
Left pars defect + oedema
Degenerate discs L4/5, L5/S1
Muscle tear or denervation left multifidus
100.
101. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and
spinal stenosis
• The young athlete with back pain
• Vertebroplasty
• A few cases
115. Post procedure care
• Lie prone for 20 minutes
• Bed rest for 2-3 hours
• Discharge if well
– Post-sedation instructions
– Rest 24 hours
– Mobilize according to pain
• Advise re muscle pain
• Follow-up phone call(s)
117. My results
• Audit of first 250 patients, 2001 to 2006
• Complete or near complete response
– No or minimal pain
– Good return of activity level
– 83.0 %
• Moderate response
– Still suffer pain, though noticeably reduced
– Some return of activity, though still restricted
– 12.0 %
• No response
– 5.0 %
118. Percutaneous vertebroplasty
Keys to success
• Patient selection
– Early referral
– MRI
• High quality fluoroscopy
– Accurate needle placement
– Cement injection
• Nursing care
– Cement preparation
– Patient care: pre and post
120. So, what happened?
• Buchbinder NEJM 2009;361:557-68
– Multicentre, randomized, double blind
– Vertebroplasty vs placebo ‘sham’ procedure
– N = 78: 38 vertebroplasty, 40 sham
– No difference in pain scales or quality of life
• MJA (Editorial) 2009;191:476-7
– ‘Percutaneous vertebroplasty is not an effective
treatment for acute osteoporotic vertebral fractures’
121. • Patient selection
– Up to 12 months pain
• Recruitment
– Majority of eligible
patients not recruited
• Technique
– Up to 3ml cement
– Stopped injection if
leaking
123. Where are we now?
• Uncommon in most places
• Ongoing studies
– Clark Lancet 2016;388:1408-1416
– ‘Vertebroplasty is superior to placebo for pain
reduction in acute osteoporotic spinal fractures of less
than 6 weeks' in duration. These findings will allow
patients with acute painful fractures to have an
additional means of pain management that is known
to be effective’.
• Included in appropriateness guidelines in UK
and USA
• No Medicare rebate
• Our cost: 1200 + day bed about 700
124.
125. Some issues in spine imaging
• Radiation exposure: is it important?
• Role of X-ray, bone scan and other modalities
• CT vs MRI for back pain
• Guidelines for imaging of low back pain
• Imaging appearances of disc herniation and
spinal stenosis
• The young athlete with back pain
• Vertebroplasty
• A few cases
126. • 68M
• Sudden onset bilateral leg pain and weakness
• Urinary retention
127.
128.
129. • Dx: Cauda equina syndrome
• Cause: massive sequestration
• Other causes:
– Tumour
• Primary of lower cord: ependymoma
• Primary of nerve: BPNST
• Primary of dura: meningioma
• Primary of vertebral body: chordoma, giant cell
tumour
• Secondary
– Trauma
135. • 62 year old male
• Severe low back pain of rapid onset
• Febrile and unwell
• 4 weeks ago underwent abdominal surgery for
perforated diverticulitis
145. What is the most likely diagnosis?
1. Massive disc sequestration
2. Discitis complicated by abscess
3. Synovial cyst
4. Benign peripheral nerve sheath tumour
147. • Dx: benign peripheral nerve sheath tumour
(BPNST) of left L3 nerve root
– Many clinicians use the term ‘neuroma’
• Pathologically imprecise term
– Most are benign
• Schwannoma or neurofibroma
• Difficult (impossible) to differentiate on imaging
– BPNST is probably the best terminology
– Associated with NF1 and ‘NF2’ (MISME)
148. • 66 year old female
• Severe lower back pain on and off for years
• More recent (2 months) development of right
sciatica
149.
150. What is the most likely diagnosis?
1. Massive disc sequestration
2. Discitis complicated by abscess
3. Synovial cyst
4. Benign peripheral nerve sheath tumour
152. • Severe OA of facet (zygoapophyseal) joints
• Round heterogeneous lesion projecting into right
spinal canal
• Note: close relationship to facet joint
• Dx: synovial cyst
153. Synovial cyst lumbar facet joint
• Fairly common
• Key is relationship to degenerate facet joint
• Density may vary from pure cyst to varying levels of
calcification and heterogeneity
• Usually present clinically with intractable sciatica
• May respond to aspiration and steroid injection, but
usually treated surgically