The presence of disc extrusion and/or ipsilateral, severe nerve compression at one or multiple sites is strongly associated with distal leg pain. Mild to moderate nerve compression, disc degeneration or bulging, and central spinal stenosis are not significantly associated with specific pain patterns. Although segmental distributions of pain can be determined reliably from pain drawings, this finding alone is of little use in predicting lumbar impairment. The self-report of lower extremity weakness or dysesthesia is not significantly related to any specific lumbar impairments. [Key words: back pain, diagnosis, magnetic resonance imaging, nerve compression, pain drawing, pathology]
Subjects and MethodsFourteen symptomatic patients underwent sonography of the patellar tendon, using a high frequency linear transducer ( 10 MHz) on an HDI 3000 scanner (Advanced Technology Laborato ties, Bothell, WA).The study cohort included five females and nine males who were 11â€"43 years old (mean, 24 years old). Six patients had bilateral symptoms. and eight had unilateral symptoms.The examination consisted of gray-scale and color Doppler sonography of the right and left patellar tendons of patients with unilateral and bilateral symptoms. The patellar tendon was scanned with the transducer oriented parallel to the long axis of the tendon for longitudinal images and perpendic ular to the long axis of the tendon for transaxial images. On gray-scale sonography,the anteropos tenor dimension of the proximal patellar tendon was measured. If a hypoechoic region was seen within the proximal tendon. it was measured. Also. distortion of the normal parallelism of the tendon fibers was assessed. Color flow Doppler sonogra phy was then used to evaluate the tendon. Care was taken to ensure that the sonographic settings were the same for the right and left patellar ten dons. The examination was considered to show pa tellar tendinosis when increased flow was detected in the tendon at the site of gray-scale abnormality (Fig. I ). The values for sensitivity. specificity, and the kappa statistic of flow revealed by Doppler sonography versus gray-scale sonography were determined using version 5.3 of True Epistat soft ware (Epistat, Richardson,TX). Gray-scale and Doppler sonography showed excellent agreement for findings of patellar tendinosis (K = .92).
Results
Color flow
DiscussionOur preliminary data show that color flow
Although systematic plus targeted biopsy was the most accurate biopsy method to detect cribriform morphology, biopsy sensitivity and specificity remained poor.
Reduced visibility of cribriform pattern on multiparametric magnetic resonance imaging has significant ramifications for prostate cancer detection, surveillance and focal therapy.
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