AzM Radiologie Jan T. Wilmink, neuroradiologist MRI Centre The Netherlands MR myelography in patients with radicular pain: diagnostic value and technique.

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Presentation transcript:

azM Radiologie Jan T. Wilmink, neuroradiologist MRI Centre The Netherlands MR myelography in patients with radicular pain: diagnostic value and technique

azM Radiologie Problem: clinical relevance of MRI findings

azM Radiologie 98 asymptomatic, 27 symptomatic subjects

azM Radiologie L4-L5: protrusion L5-S1 extrusion

azM Radiologie protruded discs are frequently asymptomatic extruded discs usually cause symptoms (???) So:

azM Radiologie rating scales assessing only disk displacement fail to take into account size of spinal canal Problem:

azM Radiologie L5-S1 extrusion S1 root

azM Radiologie So: let’s think root: myelography radiculography caudography

azM Radiologie X-ray myelogram T2W MR myelogram

azM Radiologie Sequence for T2 FSE MR myelography - heavy T2 weighting TR/TE 6000/450 - slice thickness 4mm, overcontiguous - echo train length 65 - FOV small: 150mm - MIP postprocessing to produce virtual image of dural sac - long acquisition time 6:30mins per projection

azM Radiologie Rapid acquisition by single shot imaging

azM Radiologie single shot 1.5secmultishot 6:30min

azM Radiologie multishotsingle shot

azM Radiologie multishot 6:30min single shot x sec

azM Radiologie Single-shot single-slice T2 FSE MR myelography with multiple excitations - heavy T2 weighting TR/TE 6500/1270, 10 excitations - single slice, thickness 30mm, oblique x2, no MIP needed - echo train length scan matrix 256, reconstruction matrix scan percentage 75 - FOV 150mm, rectangular 75% - acquisition time 32.5sec per projection, total 65sec

azM Radiologie 1. Patient with left sciatica Illustrative cases

azM Radiologie T1W SE sagittal midsagittalleft lateral

azM Radiologie T1W axial, L4-L5 upper disc levellower disc level herniation, no root compressionherniation, root compression??

azM Radiologie

azM Radiologie L5 root compressed normal S1 root and root sleeve

azM Radiologie 2. Patient with backache irradiating to left buttock Illustrative cases

azM Radiologie

azM Radiologie root compression?? !!

azM Radiologie 3. Patient with backache and some irradiation to both legs Illustrative cases

azM Radiologie ? left L5-S1 extrusion, S1 root compression?

azM Radiologie S1 root somewhat displaced, not compressed

azM Radiologie

azM Radiologie in 43 patients MR myelography reduces diagnostic uncertainty from 19 cases to 6 cases

azM Radiologie Conclusions - MR myelography (MRM)is valuable add-on but cannot replace standard MR examination - MRM is useful in cases when disc lesion is seen but effect on root is uncertain (compressed or not) - MRM findings must always be matched against standard MR images and clinical presentation - with acquisition time of only 1-2 mins, the MRM sequence should be included in standard spinal study

azM Radiologie