Quantification of Lumbar Spinal Canal Stenosis by Quantitative Fat-Suppressed Contrast-Enhanced Magnetic Resonance Imaging.

Yong Jun Jin

doi:10.3390/jcm9103084

Abstract

Fat-suppressed T1-weighted magnetic resonance images (MRIs) enhanced with gadolinium can evaluate the internal vertebral venous plexus and cauda equina. This study compared such findings with clinical situations and discusses whether these are helpful for symptomatic grading and selection at the surgical level in patients with lumbar central stenosis. A total of 263 patients (337 levels < 75 mm2 of dural cross sectional area (DCSA)) were included. The enhancement patterns of dorsal epidural vein (DVCE), periradicular vein (PVCE) and intraradicular vein (IRCE) were assessed qualitatively. The quantification of IRCE was acquired by the ratio (%) (enhancement parameters: MS/P1, MS/P2, WR/P1, WR/P2) of signal intensities between the cauda equina (MS-IRCE: maximal spot rootlet, WR-IRCE: whole rootlets) and psoas muscle (P1, P2). Receiver-operator characteristic curves were plotted to obtain imaginary cutoff values for the prediction of symptomatic appearance or operation decision. All levels were classified into seven groups on the basis of pain distribution and the presence of IRCE. PVCE was significantly related to high incidences of symptoms, unilaterality and operation. DVCE and IRCE were connected with high incidences of symptoms, bilaterality and operation. IRCE was also related to high visual analogue scale (VAS), small DCSA and high enhancement parameters. The order of the group was concordant with the degree of enhancement parameters (p = 0.000). Cutoff values of enhancement parameters for prediction were as follows: symptoms (147/123/140/121), bilaterality (165/139/157/137) and operation (164/139/159/138). Enhancement patterns and parameters could help in stratification, grading and decision-making at the surgical level.

Highlights

Neurogenic intermittent claudication (NIC) in lumbar stenosis can be explained by the venous congestion theory
DCSA was not likely to be a sufficient discriminator of various clinical manifestations
F values increased in the order of MS-intraradicular vein (IRCE), whole rootlets IRCE (WR-IRCE), WR/P1, MS/P1, WR/P2 and MS/P2

Summary

Introduction

Neurogenic intermittent claudication (NIC) in lumbar stenosis can be explained by the venous congestion theory. Kobayashi et al explained that the pathogenesis of NIC was composed of intrathecal consecutive events such as mechanical circumferential compression, the occlusion of subarachnoid space, venous congestion, nerve injury, intraradicular edema, conduction disturbance and ectopic discharge [1]. The internal vertebral venous plexus (IVVP) in the lumbar spine is located between the spinal bony canal and dura mater (Figure 1). It communicates with the basivertebral vein and external vertebral venous plexus (EVVP) through the intervertebral foramen [2,3]. The transdural part of the radicular vein shows extensive venous narrowing at the point

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