BACKGROUND: Lumbar paraspinal muscles (LPM) are a part of the deep spinal stabilisation system and play an important role in stabilising the lumbar spine and trunk. Inadequate function of these muscles is thought to be an essential aetiological factor in low back pain, and several neuromuscular diseases are characterised by dysfunction of LPM. The main aims of our study were to develop a methodology for LPM assessment using advanced magnetic resonance imaging (MRI) methods, including a manual segmentation process, to confirm the measurement reliability, to evaluate the LPM morphological parameters [fat fraction (FF), total muscle volume (TMV) and functional muscle volume (FMV)] in a healthy population, to study the influence of physiological factors on muscle morphology, and to build equations to predict LPM morphological parameters in a healthy population. METHODS: This prospective cross-sectional observational comparative single-centre study was conducted at the University Hospital in Brno, enrolling healthy volunteers from April 2021 to March 2023. MRI of the lumbar spine and LPM (erector spinae muscle and multifidus muscle) were performed using a 6-point Dixon gradient echo sequence. The segmentation of the LPM and the control muscle (psoas muscle) was done manually to obtain FF and TMV in a range from Th12/L1 to L5/S1. Intra-rater and inter-rater reliability were evaluated. Linear regression models were constructed to assess the effect of physiological factors on muscle FF, TMV and FMV. RESULTS: We enrolled 90 healthy volunteers (median age 38 years, 45 men). The creation of segmentation masks and the assessment of FF and TMV proved reliable (Dice coefficient 84% to 99%, intraclass correlation coefficient ≥0.97). The univariable models showed that FF of LPM was influenced the most by age (39.6% to 44.8% of variability, P<0.001); TMV and FMV by subject weight (34.9% to 67.6% of variability, P<0.001) and sex (24.7% to 64.1% of variability, P<0.001). Multivariable linear regression models for FF of LPM included age, body mass index and sex, with R-squared values ranging from 45.4% to 51.1%. Models for volumes of LPM included weight, age and sex, with R-squared values ranged from 37.4% to 76.8%. Equations were developed to calculate predicted FF, TMV and FMV for each muscle. CONCLUSIONS: A reliable methodology has been developed to assess the morphological parameters (biomarkers) of the LPM. The morphological parameters of the LPM are significantly influenced by physiological factors. Equations were constructed to calculate the predicted FF, TMV and FMV of individual muscles in relation to anthropometric parameters, age, and sex. This study, which presented LPM assessment methodology and predicted values of LPM morphological parameters in a healthy population, could improve our understanding of diseases involving LPM (low back pain and some neuromuscular diseases).

• Publikační typ
• časopisecké články MeSH

Pneumoperitoneum je stav, kterým označujeme přítomnost volného vzduchu, resp. plynu v dutině břišní. Diferenciální diagnostika příčiny vzniku pneumoperitonea je poměrně široká a představuje různý stupeň závažnosti. Pokud pacient není recentně po laparotomii či laparoskopii, je nález přítomnosti pneumoperitonea obvykle známkou perforace gastrointestinálního traktu vyžadující okamžitou chirurgickou intervenci pro riziko vzniku peritonitidy s následnou život ohrožující sepsí. Ne však všechny příčiny vzniku pneumoperitonea vyžadují operační zákrok. V naší kazuistice prezentujeme vzácný případ klinicky asymptomatického pneumoperitonea, které se rozvinulo u 66leté pacientky po CT kolografii. Vzhledem k tomu, že při CT kolografii je aplikován do střeva oxid uhličitý (CO2), můžeme vzniklé pneumoperitoneum označit de facto jako kapnoperitoneum. U pacientky se volný vzduch (plyn) v dutině břišní projevil tzv. benigním pneumoperitoneem, které je definováno jako asymptomatický volný vzduch v dutině břišní, resp. pneumoperitoneum bez peritonitidy. I přesto, že je CT kolografie považována za metodu s velmi nízkým výskytem komplikací, je nutno při její indikaci brát zřetel na přítomnost rizikových faktorů a kontraindikací kvůli zamezení počtu povýkonových komplikací. Zásadním sdělením naší kazuistiky je, že i poměrně rozsáhlé pneumoperitoneum po provedené CT kolografii může probíhat asymptomaticky a při příznivém klinickém a laboratorním obrazu lze postupovat konzervativně.

Pneumoperitoneum is a condition that refers to the presence of free air (gas) in the abdominal cavity. Differential diagnosis of the causes of pneumoperitoneum varies widely and represents varying degrees of severity. In the patients who have not recently underwent laparotomy or laparoscopy, the finding of pneumoperitoneum is usually a sign of gastrointestinal perforation that requires immediate surgical approach due to the risk of peritonitis with subsequent life-threatening sepsis. However, not all causes of pneumoperitoneum require surgery. In our case report, we present a rare case of clinically asymptomatic pneumoperitoneum that developed in a 66-year-old patient after CT colonography. In this diagnostic method, we inflate colon with carbon dioxide (CO2); therefore this kind of pneumoperitoneum can de facto be called capnoperitoneum. In this patient, free air (gas) in the abdominal cavity manifested itself in the so-called benign pneumoperitoneum, which is defined as asymptomatic free air in the abdominal cavity and pneumoperitoneum without peritonitis. Despite the fact that CT colonography is considered a method with a very low incidence of complications, it is necessary to take into account the presence of risk factors in its indication and to contraindicate to avoid the number of postoperative complications. The fundamental message of our case report is that extensive pneumoperitoneum after proven CT colonography can be asymptomatic and can be treated conservatively (if clinical and laboratory results are favorable).

• MeSH
• divertikulóza tlustého střeva diagnóza   MeSH
• kolonografie počítačovou tomografií metody   škodlivé účinky   MeSH
• kolonoskopie škodlivé účinky   MeSH
• lidé MeSH
• pneumoperitoneum * etiologie   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH