Nerve root infiltration of the first sacral root with MRI guidance

The purpose of this clinical trial was to describe the methodology and evaluate the accuracy of optical tracking-based magnetic resonance (MR)-guided infiltration of the first sacral (S1) root. Thirty-five infiltrations were performed on 34 patients with a 0. 23-T open C-arm magnet installed in a fully equipped operation room with large-screen (36 inches) display and optical navigator utilizing infrared passive tracking. T1 and T2 fast spin-echo (FSE) images were used for localizing the target and fast field echo for monitoring the procedure. Saline as contrast agent in single-shot (SS)FSE images gave sufficient contrast-to-noise ratio. Twenty-four patients had unoperated L5/S1 disc herniation, and 10 had S1 root irritation after failed back surgery. Needle placement was successful in 97% of the cases, and no complications occurred. Outcome was evaluated 1-6 months (mean 2.2 months) after the procedure and was comparable to that of other studies using fluoroscopy or computed tomography guidance. MR-guided placement of the needle is an accurate technique for first sacral root infiltration.     

Percutaneous extraction of an osteoid osteoma of the lumbar spine under CT guidance

We report one case of percutaneous extraction of an osteoid osteoma of the lumbar spine under CT guidance. We describe the procedure of nidus extraction. This technique allows precise removal of the nidus with pathologic verification after extraction.     

Synovial cysts of the lumbar spine: CT and MRI correlations

Intraspinal synovial cysts were diagnosed in six patients during a 5-year period and retrospectively studied. Plain films of the lumbar spine showed degenerative changes in all patients. Lumbar myelography showed a posterior and lateral defect caused by extradural compression. Using CT without constrast enhancement established the diagnosis in five of the six-patients. in four cases MRI was performed, three before and after injection of gadolinium diethyline-triamine penta-acetic acid )Gd-DTPA). Including the patient with a false negative CT, MRI was positive in all patients.     

Myelography,CT and MRI in leukaemic infiltration of the lumbar theca

A 25-year-old woman with acute lymphoblastic leukaemia, while in remission, developed paraparesis, with faecal and urinary incontinence. CT demonstrated increased density of the lumbar theca and enlargement of the nerve roots. Myelography showed complete obstruction below the L3 level. MRI showed increased signal intensity in the lumbar sac on T1 weighting, and the cauda equina enhanced with gadolinium-DTPA. Lymphoblasts were seen in the lumbar spinal fluid. After chemotherapy, these abnormalities resolved, as did the paraparesis and incontinence.     

3-D MRI/CT fusion imaging of the lumbar spine

Objective  

The objective was to demonstrate the feasibility of MRI/CT fusion in demonstrating lumbar nerve root compromise.     

Gadolinium-DTPA enhancement of symptomatic nerve roots in MRI of the lumbar spine

Disc prolapse presenting with sciatica may be associated with enhancement of the symptomatic nerve root following magnetic resonance imaging (MRI) with intravenous gadolinium (Gd)-DTPA. Previous studies have shown, however, that this does not occur in all cases. The aim of this study was to assess the incidence of nerve root enhancement in patients with sciatica and disc prolapse and to try to identify any specific features that might be associated with the phenomenon. A total of 227 patients presenting with low back pain and/or sciatica underwent a MRI study of the lumbar spine with intravenous contrast enhancement. Nineteen of 81 (23.5 %) patients with disc prolapse demonstrated nerve root enhancement. Nerve root enhancement had a highly significant association with sequestrated disc lesions (13/19, 68 %; P < 0.0005), and was primarily seen in the symptomatic ipsilateral nerve root (16/19, 84 %). The sensitivity of nerve root enhancement associated with disc prolapse was 23.5 % with a specificity of 95.9 %, a positive predictive value of 76 % and a negative predictive value of 69.3 %. Nerve root enhancement may be indicative of the symptomatic level but its poor sensitivity negates the routine use of Gd-DTPA in MRI for sciatica. Received 7 October 1996; Accepted 2 May 1997     

腰椎峡部裂并脊椎滑脱的MRI表现及影像学比较

目的 :探讨MRI在腰椎峡部裂并脊椎滑脱症中的诊断价值。方法 :分析总结 5 3例腰椎峡部裂并脊椎滑脱症的传统X线片、CT、MR扫描表现并进行比较。结果 :传统X线平片表现为腰椎滑脱、峡部裂、局部骨质增生硬化 ;CT表现为峡部裂、局部骨质增生硬化、韧带肥厚、椎管狭窄及矢状径增大 (双管征 )、椎间盘变形 ;MRI表现为峡部骨髓信号连续性中断、局部骨质呈T1、T2 低信号、韧带肥厚、腰椎滑脱、椎间孔变形 (双叶征 )、神经根卡压、节段性椎管扩张和狭窄。结论 :MR扫描对腰椎峡部裂并脊椎滑脱症的诊断具有重要的临床应用价值     

Intradural nerve root hematoma in the lumbar spine. A case report

Intradural nerve root hematoma of the lumbar spine is extremely rare and can cause compression of the cauda equina. This case, which presented with low back pain and radiation to both lower extremities, diagnosed as an intradural hematoma of nerve root by magnetic resonance imaging (MRI) and was totally removed successfully. Intradural nerve root hematoma can present with or without a history of trauma or blood dyscrasia, where MRI is the best imaging modality, and can be well treated by surgery.     

MRI of the post-discectomy lumbar spine

Laminectomy and discectomy are common procedures in the management of symptomatic lumbar disc herniation. Complications of such surgery include recurrent/residual disc herniation, epidural scar formation, discitis, arachnoiditis and pseudo-meningocele. Gadolinium-enhanced MRI is the technique of choice for investigating recurrent symptoms following discectomy. This article reviews the normal early and late post-laminectomy MR appearances, as well as the pathological findings associated with the above-mentioned complications.     

Percutaneous biopsies of the thoracic spine under CT guidance: transcostovertebral approach

Twenty-seven percutaneous trephine biopsies of thoracic vertebral bodies were performed under CT guidance using a new intertransversocostal approach avoiding the pleura and nerve roots. Accurate diagnosis was obtained in 25 of 27 cases. No complications were encountered.     

MRI of degenerative lumbar spine disease: comparison of non-accelerated and parallel imaging

Introduction Parallel imaging techniques such as GRAPPA have been introduced to optimize image quality and acquisition time. For spinal imaging in a clinical setting no data exist on the equivalency of conventional and parallel imaging techniques. The purpose of this study was to determine whether T1- and T2-weighted GRAPPA sequences are equivalent to conventional sequences for the evaluation of degenerative lumbar spine disease in terms of image quality and artefacts. Methods In patients with clinically suspected degenerative lumbar spine disease two neuroradiologists independently compared sagittal GRAPPA (acceleration factor 2, time reduction approximately 50%) and non-GRAPPA images (25 patients) and transverse GRAPPA (acceleration factor 2, time reduction approximately 50%) and non-GRAPPA images (23 lumbar segments in six patients). Comparative analyses included the minimal diameter of the spinal canal, disc abnormalities, foraminal stenosis, facet joint degeneration, lateral recess, nerve root compression and osteochondrotic vertebral and endplate changes. Image inhomogeneity was evaluated by comparing the nonuniformity in the two techniques. Image quality was assessed by grading the delineation of pathoanatomical structures. Motion and aliasing artefacts were classified from grade 1 (severe) to grade 5 (absent). Results There was no significant difference between GRAPPA and non-accelerated MRI in the evaluation of degenerative lumbar spine disease (P > 0.05), and there was no difference in the delineation of pathoanatomical structures. For inhomogeneity there was a trend in favour of the conventional sequences. No significant artefacts were observed with either technique. Conclusion The GRAPPA technique can be used effectively to reduce scanning time in patients with degenerative lumbar spine disease while preserving image quality.     

Axial loaded MRI of the lumbar spine

Magnetic resonance imaging is established as the technique of choice for assessment of degenerative disorders of the lumbar spine. However, it is routinely performed with the patient supine and the hips and knees flexed. The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion-extension, in the erect position or by using axial loading. This article reviews the literature relating to the above techniques.     

Upright positional MRI of the lumbar spine

Supine magnetic resonance imaging (MRI) is routinely used in the assessment of low back pain and radiculopathy. However, imaging findings often correlate poorly with clinical findings. This is partly related to the positional dependence of spinal stenosis, which reflects dynamic changes in soft-tissue structures (ligaments, disc, dural sac, epidural fat, and nerve roots). Upright MRI in the flexed, extended, rotated, standing, and bending positions, allows patients to reproduce the positions that bring about their symptoms and may uncover MRI findings that were not visible with routine supine imaging. Assessment of the degree of spinal stability in the degenerate and postoperative lumbar spine is also possible. The aim of this review was to present the current literature concerning both the normal and symptomatic spine as imaged using upright MRI and to illustrate the above findings using clinical examples.     

Selective lumbar nerve root blocks with CT fluoroscopic guidance: technique, results, procedure time, and radiation dose

CT fluoroscopy may be used as a rapid and effective means of guiding needle placement when performing selective lumbar nerve root blocks. In this set of patients, the average external radiation dose was 0.73 mrem per procedure, with an average of 2 seconds of CT-fluoroscopy time and four images per procedure. Average physician room time was 7 minutes. Use of intermittent CT fluoroscopy during lumbar selective nerve root blocks can result in minimal radiation dose levels and procedure times that are comparable to fluoroscopic guidance.     

Plain CT of the degenerative lumbar spine

Degenerative processes of the lumbar spine consist of several disorders of various etiologies with different radiological manifestations. Computed tomography (CT) is well suited for evaluation of these processes since contours of soft tissues, subtle bone structure changes and small calcifications are easily demonstrated with this technique. Spiral CT scanning provides fast data acquisitions, and volumes of high quality for multiplanar reformatting. This review article describes the CT scanning techniques and diagnostic findings of the most common degenerative processes of the lumbar spine.     

MRI of degenerative cysts of the lumbar spine

Degenerative cysts of the lumbar spine encompass a heterogeneous group of cystic lesions that are presumed to share a common aetiology. Some of these cysts may be incidental findings, whereas others may produce acute or chronic symptoms. These cysts have been categorized using various combinations of topographic and pathological characteristics and by their attachment to or communication with a specific spinal structure.