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J Neurosurg Spine. 2019 Feb 22:1-9. doi: 10.3171/2018.10.SPINE181172. [Epub ahead of print]

T2 mapping of lumbosacral nerves in patients suffering from unilateral radicular pain due to degenerative disc disease.

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1Department of Diagnostic and Interventional Neuroradiology.
2TUM-Neuroimaging Center.
3Department of Neurosurgery, and.
4Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich; and.
5Philips Healthcare, Hamburg, Germany.


OBJECTIVELumbosacral radicular syndrome (LRS) is a very common condition, often requiring diagnostic imaging with the aim of elucidating a structural cause when symptoms are longer lasting. However, findings on conventional anatomical MRI do not necessarily correlate with clinical symptoms, and it is primarily performed for the qualitative evaluation of surrounding compressive structures, such as herniated discs, instead of to evaluate the nerves directly. The present study investigated the performance of quantitative imaging by using magnetic resonance neurography (MRN) in patients with LRS.METHODSEighteen patients (55.6% males, mean age 64.4 ± 10.2 years), with strict unilateral LRS matching at least one dermatome and suspected disc herniation, underwent high-resolution 3-T MRN using T2 mapping. On T2 maps, the presumably affected and contralateral unaffected nerves were identified; subsequent regions of interest (ROIs) were placed at preganglionic, ganglionic, and postganglionic sites; and T2 values were extracted. Patients then underwent an epidural steroid injection (ESI) with local anesthetic agents at the site of suspected nerve affection. T2 values of the affected nerves were compared against the contralateral nerves. Furthermore, receiver operating characteristics were calculated based on the measured T2 values and the responsiveness to ESI.RESULTSThe mean T2 value was 77.3 ± 1.9 msec for affected nerves and 74.8 ± 1.4 msec for contralateral nerves (p < 0.0001). In relation to ESI performed at the site of suspected nerve affection, MRN with T2 mapping had a sensitivity/specificity of 76.9%/60.0% and a positive/negative predictive value of 83.3%/50.0%. Signal alterations in affected nerves according to qualitative visual inspection were present in only 22.2% of patients.CONCLUSIONSAs one of the first of its kind, this study revealed elevated T2 values in patients suffering from LRS. T2 values of lumbosacral nerves might be used as more objective parameters to directly detect nerve affection in such patients.


BMRC = British Medical Research Council; ESI = epidural steroid injection; FN = false negative; FOV = field of view; FP = false positive; LBP = low back pain; LRS = lumbosacral radicular syndrome; LSP = lumbosacral plexus; MRN = magnetic resonance neurography; NPV = negative predictive value; PPV = positive predictive value; ROC = receiver operating characteristic; ROI = region of interest; T2 mapping; TN = true negative; TP = true positive; TSE = turbo spin echo; VAS = visual analog scale; degenerative disc disease; epidural steroid injection; lumbar; lumbosacral plexus; lumbosacral radicular syndrome; magnetic resonance neurography; sacral

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