Abstract
Radiculopathy can be caused by nerve root irritation and nerve root compression at the level of the lateral recess or at the level of the intervertebral foramen. T2-weighted (T2w) MRI is considered essential to evaluate the nerve root and its course, starting at the lateral recess through the intervertebral foramen to the extraforaminal space. With the introduction of novel MRI acceleration techniques such as compressed SENSE, standard-resolution 2D T2w turbo spin echo (TSE) sequences with a slice-thickness of 3–4 mm can be replaced with high-resolution isotropic 3D T2w TSE sequences with sub-millimeter resolution without prolonging scan time. With high-resolution 3D MRI, the course of the nerve root can be visualized more precisely due to a detailed depiction of the anatomical situation and less partial volume effects, potentially allowing for a better detection of nerve root compromise. In this intra-individual comparison study, 55 patients with symptomatic unilateral singular nerve root radiculopathy underwent MRI with both 2D standard- and 3D high-resolution T2w TSE MRI sequences. Two readers graded the degree of lumbar lateral recess stenosis and lumbar foraminal stenosis twice on both image sets using previously validated grading systems in an effort to quantify the inter-readout and inter-sequence agreement of scores. Inter-readout agreement was high for both grading systems and for 2D and 3D imaging (Kappa = 0.823–0.945). Inter-sequence agreement was moderate for both lumbar lateral recess stenosis (Kappa = 0.55–0.577) and lumbar foraminal stenosis (Kappa = 0.543–0.572). The percentage of high degree stenosis with nerve root deformity increased from 16.4%/9.8% to 41.8–43.6%/34.1% from 2D to 3D images for lateral recess stenosis/foraminal stenosis, respectively. Therefore, we show that while inter-readout agreement of grading systems is high for both standard- and high-resolution imaging, the latter outperforms standard-resolution imaging for the visualization of lumbar nerve root compromise.
Highlights
Lumbar nerve root radiculopathy is a common condition in clinical practice
Radiculopathy can be caused by nerve root irritation and nerve root compression at the level of the lateral recess or at the level of the intervertebral foramen [1]
Patients referred for MRI of the lumbar spine due to symptomatic unilateral singular nerve root radiculopathy were enrolled at two centers between May and September 2021
Summary
Lumbar nerve root radiculopathy is a common condition in clinical practice. Radiculopathy can be caused by nerve root irritation and nerve root compression at the level of the lateral recess or at the level of the intervertebral foramen [1]. The nerve root passes through the lateral recess and enters the intervertebral foramen where the nerve root is surrounded by perineural fat, protecting the nerve root from compression of the adjacent osseous, ligamentous, and discal structures. In patients with narrowing of the lateral recess or narrowing of the intervertebral foramen, the space surrounding the nerve root is diminished either by bulging/herniation of the adjacent disc, hypertrophy of the adjacent flavum ligament, or by hypertrophy and osteophyte formation of the adjacent facet joint. Nerve root contact, displacement, deformity, and compression may develop, depending on the severity of the lateral recess or intervertebral foramen narrowing. Often, these processes lead to the typical clinical symptomatology of radiculopathy [2,3,4]
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