Spinal Magnetic Resonance Imaging Examinations Research Articles

The Role of Electrophysiology in the Diagnosis of Radiculopathy and Its Comparison with Magnetic Resonance Imaging

Objectives: Patients are frequently referred to electrophysiology laboratories by physicians from various specialties with a presumptive diagnosis of radiculopathy. Recent advances in spinal imaging techniques have led to an increase in magnetic resonance imaging (MRI) studies in the diagnosis of radiculopathy. This study aimed to compare these two techniques in the diagnosis of radiculopathy. Subjects and Methods: Data of 170 patients who were diagnosed as having radiculopathy using electrophysiologic studies in our laboratory by defining a myotome level and who had spinal MRI examinations in our hospital database were included in the study. Results: Among the 170 patients in our study, 40% (n = 68) had cervical radiculopathy and 60% (n = 102) had lumbar radiculopathy. In the electrophysiologic diagnosis of radiculopathy, the most sensitive root level of electromyography (EMG) was the C7 radix level in the cervical region and the L5 level in the lumbar region. Correlations between radiologic grading based on foraminal assessments for radicular involvement at the cervical region using MRI and EMG data showed fair agreement in C5, C7, and C8 radix levels (κ: 0.21–0.40), and the lumbar region showed fair agreement in L4 and L5 radix levels (κ: 0.21–0.40). Conclusion: Although EMG has indisputable importance in the diagnosis of radiculopathy, its use with MRI significantly increases the diagnostic power at most spinal levels.

Prevalence and Predictive Factors of Asymptomatic Spondylotic Cervical Spinal Stenosis in Patients with Symptomatic Lumbar Spinal Stenosis

We performed a retrospective cohort study to investigate the prevalence of and risk factors for asymptomatic spondylotic cervical spinal stenosis (ASCSS) in the setting of lumbar spinal stenosis (LSS). A total of 114 patients with a diagnosis of LSS without cervical myelopathy and radiculopathy were grouped into ASCSS and non-ASCSS groups. The medical data and radiological parameters, including age, sex, body mass index, Charlson comorbidity index, symptom duration, redundant nerve roots, dural sac cross-sectional area (DCSA), facet joint angle, lumbar lordosis angle (LLA), pelvic incidence (PI), Torg-Pavlov ratio, and lumbosacral transitional vertebrae, were analyzed. The lumbar stenosis index and cervical stenosis index of the 114 patients were also analyzed. ASCSS occurred in 70 of the 114 patients with LSS (61.4%). The two groups showed significant differences in symptom duration, redundant nerve roots, LLA, DCSA, and PI. On multivariate logistic regression analysis, an LLA >35.85° (P < 0.001) and a DCSA <84.50 mm2 (P= 0.003) were independently associated with ASCSS. The multi-index receiver operating characteristic curve showed that the area under the curve for predicted probability was 0.805 (P < 0.001). Linear regression analysis revealed that cervical stenosis index significantly and positively correlated with the lumbar stenosis index (r= 0.430; P < 0.001). Our findings suggest that an LLA >35.85° and a DCSA <84.50 mm2 are risk factors for the development of ASCSS. For LSS patients with an enlarged LLA and reduced DSCA, a whole spinal magnetic resonance imaging examination should be performed.

Spinal Perineural Cysts among European Patients.

A perineural (Tarlov) cyst is a fluid-filled lesion occurring between the perineurium and the endoneurium of spinal nerve roots. The aim of the study was to evaluate the prevalence and morphology of perineural cysts, detected incidentally in patients with symptomatic degenerative disk disease. The study was based on the retrospective data gathered during magnetic resonance imaging (MRI) examinations. Out of 3,128 spinal MRI examinations, perineural cysts were detected in 286 patients (9%). The cysts were most commonly observed in the sacral region, followed by thoracic, cervical, and lumbar regions. Cysts were more common in women than in men and the average age of patients was 54.8 years. In the majority, a single cyst was found. The average longest dimension of the lesion was 11.72 mm.

Magnetic resonance imaging of the spine in a pediatric population: incidental findings.

ObjectiveTo determine the prevalence of incidental findings on magnetic resonance imaging (MRI) scans of the cervical, thoracic and lumbar spine in a paediatric population.Materials and MethodsWe evaluated 190 spinal MRI examinations of patients aged ≤ 18 years of age. The study included only patients for whom complete medical records were available and who underwent complete MRI examination of the cervical, thoracic or lumbar spine, including whole-spine sagittal T2-weighted sequences. Imaging findings not related to the symptom or indication for MRI were considered incidental findings.ResultsOf the 190 MRI examinations evaluated, 110 were in women and 80 were in men. The mean age of the study population was 12.46 ± 3.68 years. The main clinical indications for MRI in the sample were lumbago, scoliosis, dorsalgia and cervicalgia. Incidental findings were detected in the cervical, thoracic and lumbar spine in 40 (21.05%), 26 (13.83%) and 43 (22.63%) of the patients, respectively. The most common were (in the cervical spine) reversal/correction of the normal curvature; (in the thoracic spine) intravertebral disc herniation (Schmorl’s node) and disc dehydration; and (in the lumbar spine) disc protrusion (12 cases), Schmorl’s node (5 cases) and spondylolysis (4 cases).ConclusionIncidental findings on MRI of the spine are less common in the paediatric population than in the adult population. Nevertheless, careful clinical evaluation of paediatric patients with complaints of axial and radiating pain is necessary in order to determine the correlation between symptoms and imaging findings.

Radiological diagnosis of drop metastases from paediatric brain tumours using combination of 2D and 3D MRI sequences

To evaluate spinal magnetic resonance imaging (MRI) examinations using a combination of two-dimensional (2D) and three-dimensional (3D) MRI sequences for diagnosis of drop metastases. Fifty-five paediatric patients with primary brain tumours wereevaluated for drop metastases at initial presentation using spinal MRI including sagittal 2D T1-weighted (W) contrast-enhanced (+C), axial 3D T1W+C volumetric interpolated breath-hold (VIBE), and sagittal 3D T2W SPACE (Sampling Perfection with Application optimised Contrasts using different flip angle Evolutions). The MRI false-negative rate was 4%, and cerebrospinal fluid (CSF) false-negative rate was 16% (p=0.07). The 3D T1W+C VIBE increased the number of drop metastases detected in 42% of patients. Drop metastases were more conspicuous in 25% of patients on 3D T2W SPACE. Spinal MRI examinations including 2D and 3D sequences demonstrate characteristics that may improve radiological diagnosis of drop metastases.

Spinal magnetic resonance imaging with reduced specific absorption rate in patients harbouring a spinal cord stimulation device - A single-centre prospective study analysing safety, tolerability and image quality

Spinal cord stimulation (SCS) is an accepted treatment in patients with failed back surgery (FBS), complex regional pain syndrome (CRPS) and persistent radicular pain following surgery. In order to avoid patient hazards or device malfunction manufacturers advise to abstain from magnetic resonance imaging (MRI) in patients with implanted electrodes or pulse generators. In a prospective study, 13 patients harbouring an implanted Medtronic Spinal Cord Stimulation (SCS) device underwent MRI (1.5 T) of the lumbar (n=13), the cervical (n=2) or the thoracic spine (n=1) following the development of new spinal symptoms. An adapted MRI protocol was used limiting the transmitted energy and specific absorption rate. Tolerability and safety were assessed by means of a standardized patient evaluation form documenting pain on a visual analogue scale (0-10), neurologic deficit, and discomfort during the scan. In addition, overall satisfaction with the examination procedure was rated on a Likert scale (1-5). Image quality was rated independently and blinded to the presence of a SCS device by the radiologist and the surgeon as equivalent, superior or inferior compared to the standard spine MRI examination. None of the 13 patients investigated by the modified spinal MRI protocol experienced new neurological deficits, worsening of symptoms or a defect/malfunction of the implant device. Three patients (23.1 %) reported transient warm sensation in the location of the electrode and in one case intermittent slight tingling in the lower extremities. Overall satisfaction with the examination was 1.13 ± 0.34 according to Likert scale (1-5). The image quality was rated - not statistically significant - slightly inferior to standard lumbar spine imaging (0.82 ± 0.54) with a kappa value of 0.68 between the two investigators. MRI examinations detected relevant and new lesions in 9 (69.2 %) patients which affected treatment in 8 (61.5 %) individuals. Using a protocol with a reduced specific energy absorption rate, spinal MRI examinations in patients with SCS can be considered safe. The current view that neurostimulators are a general contraindication to MR examinations has to be reconsidered in patients with new or progressive spinal symptoms.

Study of the left renal variations by means of magnetic resonance imaging

A prospective study was designed to figure out the percentages of the left renal vein variations using routine lumbar spinal magnetic resonance imaging (MRI) in patients with neurological problems. Between March 2010 and October 2010, the study population was recruited from a total of 2,644 consecutive patients who would undergo a routine lumbar spinal MRI examination. In addition to the routine MRI sequences, axial, balanced turbo field echo sequence (BTFE-BH SENSE) was applied after detection of a left renal vein variation. As the left renal vein variations, retroaortic left renal vein (RLRV) and circumaortic left renal vein were detected. The number of cases with the correspondent percentages of the total left renal vein variations, RLRV and circumaortic left renal vein were 71/2,644 (2.68%), 44/2,644 (1.66%) and 27/2,644 (1.02%), respectively. In cases with RLRV, the numbers of males and females with their correspondent percentages were 19/44 (43.2%) and 25/44 (56.8%), respectively. In cases with circumaortic left renal vein, the numbers of males and females with their correspondent percentages were 13/27 (48.1%) and 14/27 (51.9%), respectively. With Chi-square test, no statistically significant gender difference was found between the percentages of left renal vein variations (P = 0.83). MRI is useful in detecting RLRV and circumaortic left renal vein. If a left renal vein variation is detected, an additional BTFE-BH SENSE sequence is suggested to confirm whether it is retroaortic or circumaortic.

Magnetic Resonance Imaging in the Management of Suspected Spinal Canal Disease in Patients with Known Malignancy

The aim of this study was to examine the spectrum of spinal canal disease in patients with known malignancy using magnetic resonance imaging (MRI). One hundred and fifty-five patients underwent a total of 159 spinal MRI examinations over a three-year period. Patients were examined using a 1.0T magnet and a phased array surface spine coil. Sagittal T1 weighted spin echo and STIR sequences were routinely employed. Axial T1 and T2 weighted spin echo images were obtained at sites of identified pathology. Contrast enhanced sagittal and axial T1 weighted spin echo images were acquired when the unenhanced appearances did not correlate with the clinical findings or when the images suggested intradural or intramedullary disease. Malignant disease affecting the spinal cord or cauda equina was noted in 104/159 (65%) patients (extradural n= 78, intradural n= 20, intramedullary n= 7); one patient had evidence of both intradural and intramedullary deposits. Multiple levels of extradural cord/cauda equina compression were present in 18/78 patients (23%). The thoracic spine was the most frequently affected (74%). Bone elements were the major component of extradural compression in 11/78 patients (14%). Intradural metastases were multiple in 15/20 patients (75%). Four of the six solitary intramedullary metastases were situated in the conus medullaris. Magnetic resonance imaging of the entire spine is the investigation of choice in patients with known malignancy and suspected spinal canal disease. Contrast-enhanced images should be acquired when the unenhanced appearances do not correlate with the clinical findings or when they suggest intradural or intramedullary disease.Loughrey, G. J. (2000). Clinical Radiology55, 849-855.

Spine evaluation in children with anorectal malformations

The value of radiography, ultrasound and magnetic resonance imaging (MRI) in detecting skeletal and intraspinal pathology was assessed in infants with anorectal malformations, and the need for spinal MRI examination in this group of patients was evaluated. Twenty-one infants were examined with radiography, ultrasound and MRI of the lower spine. The detection of skeletal and intraspinal abnormalities was compared for the three imaging modalities. Fifteen patients were normal in all three examinations. Radiography showed bony skeletal abnormalities in six children, although sometimes very subtle. By ultrasound both bony and cartilaginous malformations were detected in all six patients and by MRI in five patients. Five of the six children with skeletal abnormalities had intraspinal pathology, detected in all cases by ultrasound and MRI. However, the abnormalities were more clearly demonstrated by MRI than by ultrasound. Spinal radiographs must be examined carefully for abnormalities, because they can indicate the presence or absence of intraspinal pathology. Normal radiographic and sonographic appearance of spinal anatomy in children with anorectal malformation makes MRI superfluous, but if radiographs or ultrasound are abnormal, MRI should be used to accurately depict possible intraspinal pathology.

Comparing the cost of spinal MR with conventional myelography and radiculography

All spinal magnetic resonance imaging examinations carried out during a three month period were analysed retrospectively in order to determine the clinical reasons for the scan requests. Technical details of the examinations they received and the clinical profiles formed a data set which revealed 10 separate "Clinical groups" for management purposes. Hardware, salary and expendables were costed as though the imaging unit had been sited within a National Health Service radiology department. A spread sheet was designed capable of calculating costs per patient for a variety of types of working week and of different staffing structures, sensitive to the mixture of clinical groups referred for examination. The spreadsheet also accomodated straight line depreciation for hardware value and interest rates for borrowed capital. A second, prospectively observed, sample of spinal MR examinations was used to improve the accuracy of the timing of the length of patient examinations. Costs were compared with those for patients submitted for myelography and radiculography at the adjacent hospital during the same period. The comparison indicated that spinal MR was less costly than myelography and radiculography. The most important element of the extra cost of myelography related to the need to admit patients to hospital for at least one night for this examination because of the likelihood of headache and other common (though usually minor) complications following lumbar puncture and/or the injection of contrast medium. From the limited information that it was possible to obtain in the period of follow up, it appeared that MR had either been superior or equivalent to myelography or radiculography in all the clinical groups of patients where both could be tested. There were a number of groups in which no myelograms had been requested, presumably because clinical suspicions had pointed toward conditions like tumours, developmental abnormalities and demyelinating diseases in which neurologists and neurosurgeons have already made up their minds about the superiority of MR.