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Magnetic resonance imaging as a determinant for surgical release of congenital muscular torticollis: correlation with the histopathologic findings.

Hwang JH, Lee HB, Kim JH, Park MC, Kwack KS, Han JD, Yim SY - Ann Rehabil Med (2012)

Bottom Line: The neck MRI findings of 33 subjects who underwent surgical release for CMT were compared with those of 18 subjects who were successfully managed only with conservative management.The histopathologic findings and MRI findings showed good correlation in terms of the amount of fibrosis and aberrant dense connective tissue within the SCM.If multiple or large low signal intensities within the SCM are noted, we think that surgical release should be considered.

View Article: PubMed Central - PubMed

Affiliation: The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon 443-721, Korea.

ABSTRACT

Objective: (1) To present the magnetic resonance imaging (MRI) findings of congenital muscular torticollis (CMT) of subjects who underwent surgical release and subjects who showed a good prognosis with stretching exercises and (2) to correlate the MRI findings with the histopathologic findings of CMT for subjects who underwent surgical release in order to examine the hypothesis that the MRI findings of CMT can be used as a determinant to perform surgical release of CMT.

Method: The neck MRI findings of 33 subjects who underwent surgical release for CMT were compared with those of 18 subjects who were successfully managed only with conservative management. The MRI findings were correlated with the histopathologic sections of the CMT mass.

Results: All 33 subjects (100%) who underwent surgical release showed one or more low signal intensities within the involved sternocleidomastoid muscle (SCM) on the T1- and T2-weighted images of neck MRI. The eighteen non-surgical candidates showed only enlargement of the SCM without low signal intensity within the SCM. The histopathologic findings showed interstitial fibrosis and/or the presence of aberrant tendon-like excessive dense connective tissue that was either well-arranged or disorganized.

Conclusion: The histopathologic findings and MRI findings showed good correlation in terms of the amount of fibrosis and aberrant dense connective tissue within the SCM. If multiple or large low signal intensities within the SCM are noted, we think that surgical release should be considered.

No MeSH data available.


Related in: MedlinePlus

The neck MRI findings of a one month old girl with right congenital muscular torticollis show high signal intensity on the (A) T2-weighted image compared to the (B) T1-weighted image (arrows).
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Figure 2: The neck MRI findings of a one month old girl with right congenital muscular torticollis show high signal intensity on the (A) T2-weighted image compared to the (B) T1-weighted image (arrows).

Mentions: Most of the neck MRIs were performed in order to determine whether or not surgical release was required. The majority of the subjects who showed full range of motion (ROM) of the neck with/without a mass at the age of 4 months old did not undergo neck MRI. Our previous clinical experience as well as the reports of previous studies7,8 showed that the neck MRIs of subjects younger than 4 months old demonstrate high signal intensity on T2 and proton density-weighted images (Fig. 2). This high signal intensity disappears as the infants get older, and at the age of 4 months, those high signal intensities can no longer be observed. This was the rationale for taking neck MRI at the age of 4 months or older in this study. We checked the neck MRI at the age of 4 months or older if there were limitations of neck flexion and rotation despite intensive stretching exercises for 3-6 months. The exception to this was longstanding neglected CMT subjects in whom neck MRIs were performed without a follow up period of physical therapy. We thought that an early diagnosis of CMT and a decision about surgical release of SCM was important to prevent the progress of secondary musculoskeletal complications in these neglected subjects. The neck MRIs were obtained using one of two 1.5-T MRI units (Signa, GE Healthcare). The following imaging parameters were used: TR/TE, 400-600/11-14 for T1-weighted imaging and 3,000-4,000/75-100 for T2-weighted imaging; section thickness, 3.0-6.0 mm; slice gap, 1-2.5 mm; and FOV, 180-240 mm depending on body size and section planes. The neck MRIs of the subjects were reviewed by both a doctor with over 10 years of experience with CMT patients and a radiologist specializing in the musculoskeletal system. The major review points were as follows:


Magnetic resonance imaging as a determinant for surgical release of congenital muscular torticollis: correlation with the histopathologic findings.

Hwang JH, Lee HB, Kim JH, Park MC, Kwack KS, Han JD, Yim SY - Ann Rehabil Med (2012)

The neck MRI findings of a one month old girl with right congenital muscular torticollis show high signal intensity on the (A) T2-weighted image compared to the (B) T1-weighted image (arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3400870&req=5

Figure 2: The neck MRI findings of a one month old girl with right congenital muscular torticollis show high signal intensity on the (A) T2-weighted image compared to the (B) T1-weighted image (arrows).
Mentions: Most of the neck MRIs were performed in order to determine whether or not surgical release was required. The majority of the subjects who showed full range of motion (ROM) of the neck with/without a mass at the age of 4 months old did not undergo neck MRI. Our previous clinical experience as well as the reports of previous studies7,8 showed that the neck MRIs of subjects younger than 4 months old demonstrate high signal intensity on T2 and proton density-weighted images (Fig. 2). This high signal intensity disappears as the infants get older, and at the age of 4 months, those high signal intensities can no longer be observed. This was the rationale for taking neck MRI at the age of 4 months or older in this study. We checked the neck MRI at the age of 4 months or older if there were limitations of neck flexion and rotation despite intensive stretching exercises for 3-6 months. The exception to this was longstanding neglected CMT subjects in whom neck MRIs were performed without a follow up period of physical therapy. We thought that an early diagnosis of CMT and a decision about surgical release of SCM was important to prevent the progress of secondary musculoskeletal complications in these neglected subjects. The neck MRIs were obtained using one of two 1.5-T MRI units (Signa, GE Healthcare). The following imaging parameters were used: TR/TE, 400-600/11-14 for T1-weighted imaging and 3,000-4,000/75-100 for T2-weighted imaging; section thickness, 3.0-6.0 mm; slice gap, 1-2.5 mm; and FOV, 180-240 mm depending on body size and section planes. The neck MRIs of the subjects were reviewed by both a doctor with over 10 years of experience with CMT patients and a radiologist specializing in the musculoskeletal system. The major review points were as follows:

Bottom Line: The neck MRI findings of 33 subjects who underwent surgical release for CMT were compared with those of 18 subjects who were successfully managed only with conservative management.The histopathologic findings and MRI findings showed good correlation in terms of the amount of fibrosis and aberrant dense connective tissue within the SCM.If multiple or large low signal intensities within the SCM are noted, we think that surgical release should be considered.

View Article: PubMed Central - PubMed

Affiliation: The Center for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon 443-721, Korea.

ABSTRACT

Objective: (1) To present the magnetic resonance imaging (MRI) findings of congenital muscular torticollis (CMT) of subjects who underwent surgical release and subjects who showed a good prognosis with stretching exercises and (2) to correlate the MRI findings with the histopathologic findings of CMT for subjects who underwent surgical release in order to examine the hypothesis that the MRI findings of CMT can be used as a determinant to perform surgical release of CMT.

Method: The neck MRI findings of 33 subjects who underwent surgical release for CMT were compared with those of 18 subjects who were successfully managed only with conservative management. The MRI findings were correlated with the histopathologic sections of the CMT mass.

Results: All 33 subjects (100%) who underwent surgical release showed one or more low signal intensities within the involved sternocleidomastoid muscle (SCM) on the T1- and T2-weighted images of neck MRI. The eighteen non-surgical candidates showed only enlargement of the SCM without low signal intensity within the SCM. The histopathologic findings showed interstitial fibrosis and/or the presence of aberrant tendon-like excessive dense connective tissue that was either well-arranged or disorganized.

Conclusion: The histopathologic findings and MRI findings showed good correlation in terms of the amount of fibrosis and aberrant dense connective tissue within the SCM. If multiple or large low signal intensities within the SCM are noted, we think that surgical release should be considered.

No MeSH data available.


Related in: MedlinePlus