Abstract
ObjectiveThe oblique orientation of the cervical neural foramina challenges the implementation of a short MRI protocol with concurrent excellent visualization of the spine. While sagittal oblique T2-weighted sequences permit good evaluation of the cervical neuroforamina, all segments may not be equally well depicted on a single sequence and conspicuity of foraminal stenosis may be limited. 3D T2-weighted sequences can be reformatted in arbitrary planes, including the sagittal oblique. We set out to compare 3D T2w SPACE sequences with sagittal oblique reformations and sagittal oblique 2D T2w TSE sequences for the evaluation of cervical foraminal visibility and stenosis.Materials and methodsSixty consecutive patients who underwent MRI of the cervical spine with sagittal oblique 2D T2w TSE and 3D T2w SPACE sequences were included. Image homogeneity of the sequences was evaluated. Imaging sets were assessed for structure visibility and foraminal stenosis by two independent readers. Results of the sequences were compared by Wilcoxon matched-pairs tests. Interreader agreement was evaluated by weighted κ.ResultsVisibility of most structures was rated good to excellent on both sequences (mean visibility scores ≥ 4.5 of 5), though neuroforaminal contents were better seen on sagittal oblique T2w TSE (mean scores 4.1–4.6 vs. 3.1–4.1 on 3D T2w SPACE, p < 0.01). Stenosis grades were comparable between sequences (mean 1.1–2.6 of 4), with slightly higher values for 3D T2w SPACE at some levels (difference ≤ 0.3 points).Conclusion3D T2w SPACE is comparable with sagittal oblique 2D T2w TSE in the evaluation of cervical neural foramina.
Highlights
Degenerative diseases of the spine are highly prevalent and account for a large proportion of cases examined in daily clinical practice [1]
T2w sequences have been shown to permit good evaluation of the cervical neural foramina, these sequences are added to the conventional sequences, increasing examination time. 3D sequences allow for reformation in arbitrary planes, including perpendicular to the axis of the neural foramina and adaptable to each level, and offer coverage of the foramina of both sides and the spinal canal in a single sequence at reasonable acquisition times. 3D T2w SPACE sequences have been used for imaging of the knee [11], lumbar [12], and cervical spine [13, 14] and have been evaluated in comparison with conventional 2D sequences, with a focus on structure visibility and comparison to conventional sagittal and axial sequences in the cervical spine [13,14,15,16]
The current study demonstrates comparability of 3D T2w SPACE and sagittal oblique 2D T2w TSE sequences in the evaluation of cervical neural foramina
Summary
Degenerative diseases of the spine are highly prevalent and account for a large proportion of cases examined in daily clinical practice [1]. While standard examination planes—mostly sagittal and axial—allow for evaluation of both spinal canal contents and neural foramina in the lumbar. An ideal protocol would allow excellent visualization of the spine, its contents and its surroundings, combined with a fast acquisition time to avoid patient discomfort and motion and provide enough imaging slots in a context of high demand. 3D sequences allow for reformation in arbitrary planes, including perpendicular to the axis of the neural foramina (i.e., sagittal oblique) and adaptable to each level, and offer coverage of the foramina of both sides and the spinal canal in a single sequence at reasonable acquisition times. The purpose of this study was to compare sagittal oblique 2D T2w TSE sequences of the spine and 3D T2w SPACE sequences with sagittal oblique reformations for the evaluation of the cervical neural foramina T2w sequences have been shown to permit good evaluation of the cervical neural foramina, these sequences are added to the conventional sequences, increasing examination time. 3D sequences allow for reformation in arbitrary planes, including perpendicular to the axis of the neural foramina (i.e., sagittal oblique) and adaptable to each level, and offer coverage of the foramina of both sides and the spinal canal in a single sequence at reasonable acquisition times. 3D T2w SPACE sequences have been used for imaging of the knee [11], lumbar [12], and cervical spine [13, 14] and have been evaluated in comparison with conventional 2D sequences, with a focus on structure visibility and comparison to conventional sagittal and axial sequences in the cervical spine [13,14,15,16].
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