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MR myelography in patients with radicular pain: diagnostic value and technique

MR myelography in patients with radicular pain: diagnostic value and technique. Jan T. Wilmink, neuroradiologist MRI Centre The Netherlands. Problem: clinical relevance of MRI findings. 98 asymptomatic, 27 symptomatic subjects. L4-L5: protrusion. L5-S1 extrusion.

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MR myelography in patients with radicular pain: diagnostic value and technique

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

  2. Problem: clinical relevance of MRI findings

  3. 98 asymptomatic, 27 symptomatic subjects

  4. L4-L5: protrusion L5-S1 extrusion

  5. protruded discs are frequently asymptomaticextruded discs usually cause symptoms(???) So:

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

  7. L5-S1 extrusion S1 root L5-S1 extrusion

  8. So: let’s think root:myelography radiculography caudography

  9. T2W MR myelogram X-ray myelogram

  10. 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

  11. Rapid acquisition by single shot imaging

  12. multishot 6:30min single shot 1.5sec

  13. multishot single shot

  14. single shot x 10 32.5sec multishot 6:30min

  15. 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 256- scan matrix 256, reconstruction matrix 512- scan percentage 75- FOV 150mm, rectangular 75%- acquisition time 32.5secper projection, total 65sec

  16. 1. Patient with left sciatica Illustrative cases

  17. midsagittal left lateral T1W SE sagittal

  18. upper disc level lower disc level herniation, no root compression herniation, root compression?? T1W axial, L4-L5

  19. L5 root compressed normal S1 root and root sleeve

  20. 2. Patient with backache irradiating to left buttock Illustrative cases

  21. root compression?? !! !!

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

  23. ? left L5-S1 extrusion, S1 root compression?

  24. S1 root somewhat displaced, not compressed

  25. in 43 patients MR myelography reduces diagnostic uncertainty from 19 cases to 6 cases

  26. 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

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