J Korean Soc Radiol.  2012 Jun;66(6):551-558. 10.3348/jksr.2012.66.6.551.

Three-Dimension Magnetic Resonance Lumbosacral Radiculography by Principles of the Selective Excitation Technique Imaging in the Diagnosis of Symptomatic Foraminal Stenosis

• Lim JK
• Byun WM

• KMID: 1439474
• DOI: http://doi.org/10.3348/jksr.2012.66.6.551

Abstract

PURPOSE
To investigate significance of three-dimension (3D) magnetic resonance (MR) lumbosacral radiculography by principles of the selective excitation technique (Proset) in the diagnosis of symptomatic foraminal stenosis.
MATERIALS AND METHODS
A total of 288 foramina in 48 patients were analyzed (from L3-4 to L5-S1). Conventional spin echo sequence and 3D coronal fast-field echo sequences with selective water excitation by Proset were acquired. Through conventional MR imaging, the presence of lumbar foraminal stenosis was evaluated. Three morphologic changes (swelling, indentation, and tilting angle abnormality) of corresponding nerve roots were assessed on 3D MR lumbosacral radiculography. Relationships between the three morphologic findings and corresponding symptoms were evaluated.
RESULTS
In 288 foramina, symptomatic and asymptomatic foraminal stenoses were found in 49 and 14 foramina, respectively. In symptomatic foraminal stenosis, swelling, indentation and tilting angle abnormality of the nerve root were found in 36, 18, and 10 foramina, respectively. One or more of the three findings was found in 46 foramina. In 12 foramina with asymptomatic foraminal stenosis, no morphologic changes were found. A statistically significant difference among three morphologic changes of nerve root in symptomatic foraminal stenosis was found (chi2 test, p < 0.001).
CONCLUSION
3D MR lumbosacral radiculography by Proset was useful for the detection of morphologic changes of the nerve root for the diagnosis of symptomatic foraminal stenosis.

MeSH Terms

Constriction, Pathologic
Humans
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Water
Water

Figure

• 

  Fig. 1 Sixty-five-year-old female with left leg pain. A. Sagittal T2-weighted image shows a stenotic foramen (arrow) at L5-S1. B. On 3D MR lumbosacral radiculography by Proset imaging, the swelling of the nerve root and dorsal root ganglion is demonstrated (arrows). Note.-MR = magnetic resonance, Proset = principles of the selective excitation technique, 3D = three-dimension

• 

  Fig. 2 Thirty-two-year-old female with right leg pain. A. Sagittal T2-weighted image shows a stenotic foramen (arrow) at L5-S1. B. On 3D MR lumbosacral radiculography by Proset imaging, the indentation of the nerve root is demonstrated (arrow). Note.-MR = magnetic resonance, Proset = principles of the selective excitation technique, 3D = three-dimension

• 

  Fig. 3 Seventy-nine-year-old female with left leg pain. A. Sagittal T2-weighted image shows a stenotic foramen (arrow) at L5-S1. B. On a 3D MR lumbosacral radiculography by Proset imaging, the swelling and tilting angle abnormality of the nerve root are demonstrated (arrows). Note.-MR = magnetic resonance, Proset = principles of the selective excitation technique, 3D = three-dimension

• 

  Fig. 4 Seventy-three-year-old female with back pain without radiculopathy. A. Sagittal T2-weighted image shows a stenotic foramen (arrow) at L5-S1. B. On 3D MR lumbosacral radiculography by Proset imaging, the morphologic change of the nerve root is not demonstrated (arrow). Note.-MR = magnetic resonance, Proset = principles of the selective excitation technique, 3D = three-dimension

Reference

1. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB. Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res. 1981; 191–199.

2. Cramer GD, Cantu JA, Dorsett RD, Greenstein JS, McGregor M, Howe JE, et al. Dimensions of the lumbar intervertebral foramina as determined from the sagittal plane magnetic resonance imaging scans of 95 normal subjects. J Manipulative Physiol Ther. 2003; 26:160–170.

3. Jenis LG, An HS. Spine updateLumbar foraminal stenosis. Spine (Phila Pa 1976). 2000; 25:389–394.

4. Kunogi J, Hasue M. Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine (Phila Pa 1976). 1991; 16:1312–1320.

5. Grenier N, Kressel HY, Schiebler ML, Grossman RI, Dalinka MK. Normal and degenerative posterior spinal structures: MR imaging. Radiology. 1987; 165:517–525.

6. Heithoff KB. Computed tomography and plain film diagnosis of the lumbar spine. In : Weinstein JN, Wiesel SW, editors. The Lumbar Spine. Philadelphia: Saunders;1990. p. 283–319.

7. Aota Y, Niwa T, Yoshikawa K, Fujiwara A, Asada T, Saito T. Magnetic resonance imaging and magnetic resonance myelography in the presurgical diagnosis of lumbar foraminal stenosis. Spine (Phila Pa 1976). 2007; 32:896–903.

8. Shen J, Wang HY, Chen JY, Liang BL. Morphologic analysis of normal human lumbar dorsal root ganglion by 3D MR imaging. AJNR Am J Neuroradiol. 2006; 27:2098–2103.

9. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977; 33:159–174.

10. Hasegawa T, An HS, Haughton VM, Nowicki BH. Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera. J Bone Joint Surg Am. 1995; 77:32–38.

11. Herron LD. Selective nerve root block in patient selection for lumbar surgery: surgical results. J Spinal Disord. 1989; 2:75–79.

12. Wildermuth S, Zanetti M, Duewell S, Schmid MR, Romanowski B, Benini A, et al. Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology. 1998; 207:391–398.

13. Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, et al. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol. 2010; 194:1095–1098.

14. Hasue M, Kunogi J, Konno S, Kikuchi S. Classification by position of dorsal root ganglia in the lumbosacral region. Spine (Phila Pa 1976). 1989; 14:1261–1264.

15. Olmarker K, Rydevik B, Holm S. Edema formation in spinal nerve roots induced by experimental, graded compression An experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression. Spine (Phila Pa 1976). 1989; 14:569–573.

16. Rydevik BL, Myers RR, Powell HC. Pressure increase in the dorsal root ganglion following mechanical compression Closed compartment syndrome in nerve roots. Spine (Phila Pa 1976). 1989; 14:574–576.