Clinical Correlation of a New MR Imaging Method for Assessing Lumbar Foraminal Stenosis

Park, Heon-Joon; Kim, S.S.; Lee, S.-Y.; Park, N.-H.; Rho, Myung Ho; Hong, Hyunjoo; Kwag, Hyon Joo; Kook, Shin Ho; Choi, Seung-Yi

doi:10.3174/ajnr.a2870

Cited by 49 publications

(28 citation statements)

References 6 publications

(6 reference statements)

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“…A second limitation was the single posture used for C-spine MRI, as the C-spine posture affects the dimensions of the neural foramen [10]. Bartlett et al [11] reported that cervical neural foramina are more likely to appear abnormal if the spine is extended and the foramina become narrowed.…”

Section: Discussionmentioning

confidence: 99%

A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images

Ss²,

Lee³

et al. 2013

BJR

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Objective: To propose a new and practical MRI grading method for cervical neural foraminal stenosis and to evaluate its reproducibility. Methods:We evaluated 50 patients (37 males and 13 females, mean age 49 years) who visited our institution and underwent oblique sagittal MRI of the cervical spine. A total of 300 foramina and corresponding nerve roots in 50 patients were qualitatively analysed from C4-5 to C6-7. We assessed the grade of cervical foraminal stenosis at the maximal narrowing point according to the new grading system based on T 2 weighted oblique sagittal images. The incidence of each of the neural foraminal stenosis grades according to the cervical level was analysed by x 2 tests. Intra-and interobserver agreements between two radiologists were analysed using kappa statistics. Kappa value interpretations were poor (k,0.1), slight (0.1#k#0.2), fair (0.2,k#0.4), moderate (0.4,k#0.6), substantial (0.6,k#0.8) and almost perfect (0.8,k#1.0).Results: Significant stenoses (Grades 2 and 3) were rarely found at the C4-5 level. The incidence of Grade 3 at the C5-6 level was higher than that at other levels, a difference that was statistically significant. The overall intraobserver agreement according to the cervical level was almost perfect. The agreement at each level was almost perfect, except for only substantial agreement at the right C6-7 by Reader 2. No statistically significant differences were seen according to the cervical level.Overall kappa values of interobserver agreement according to the cervical level were almost perfect. In addition, the agreement of each level was almost perfect. Overall intra-and interobserver agreement for the presence of foraminal stenosis (Grade 0 vs Grades 1, 2 and 3) and for significant stenosis (Grades 0 and 1 vs Grades 2 and 3) showed similar results and

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Section: Discussionmentioning

confidence: 99%

A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images

Ss²,

Lee³

et al. 2013

BJR

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“…4 Semi-quantitative methods help eliminate factors leading to variability caused by internal subjective standards. 10 In comparison with previous reports, our study reveals similar CNFS distributions of each grade, according to each grading system (Table 1). 4,5 In the Park system, .70% of patients were Grade 0 (68% in the previous study, Park et al 4 ) and in the Kim and mKim systems, between 56% and 72% of patients were Grade 0 (53-72% in previous studies, Park et al 5 ).…”

Section: Discussionmentioning

confidence: 36%

Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations

Lee¹,

Park²,

Lee³

et al. 2016

BJR

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Objective: To compare the reliability of two recently reported MR grading systems of cervical neural foraminal stenosis (CNFS) and their correlation with clinical manifestations. Methods: We evaluated 188 patients (male : female 5 80 : 108; mean age of 41 years) who visited our institution and underwent oblique sagittal MRI of the cervical spine. Two radiologists evaluated the MRI findings for the presence and grade of CNFS at the narrowest point, with the grading systems (Park, Kim and mKim systems) suggested by Park et al and Kim et al. More than one positive neurologic sign and more than one neurologic clinical symptom was considered a positive neurologic manifestation of each foraminal stenosis. Interobserver agreement between the two readers was analyzed using kappa statistics. Non-parametric correlation analysis (Spearman's correlation) was used to evaluate the correlation coefficients (R) to assess the relationship between CNFS grade and clinical manifestations.Results: Both the Park and mKim systems demonstrated a relatively high correlation (R 5 0.714-0.764) between the CNFS grade and clinical manifestation, while the Kim system yielded a moderate correlation (by Reader 2). The Park and mKim systems demonstrated higher correlation values at the level of C6-7 than C4-5, while the Kim system showed no difference in correlation at the cervical spine level. Conclusion: Both the Park and mKim systems provide a reliable, reproducible CNFS diagnosis, while the Kim system has a slightly inferior reliability. The Park and mKim systems had a similar, relatively high clinical correlation. Advances in knowledge: Grades 2 and 3 of the Park system and Grade 2 in the Kim and mKim systems exhibited a similar clinical significance. Patients with a grade of 0 (using each system) consistently exhibit negative neurologic manifestation.

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“…Day-to-day as well as diurnal change of the intra-individual disc height and volume have been described in the literature [9,15,16] and could have contributed to the fact, that we had 10 (4.2 %) individuals with nerve root contact to disc material in the 3 T scan but not in corresponding 1.5 T images. Varying personal activities before and MRI scanning at different times of the day can be other reasons for minor mismatches between disc and nerve root classification in 1.5 and 3 T images.…”

Section: Discussionmentioning

confidence: 83%

“…A severity grading system for lumbar nerve root compromise within the spinal canal and/or neuroforamen was applied as published by Pfirrmann and coworkers [7]: Grade 0 (normal-no compromise), Grade 1 (contact-there is visible contact of disc material with the nerve root), Grade 2 (deviation-the nerve root is displaced by disc material), Grade 3 (compression--the nerve root is compressed between disc material and the wall of the spinal canal). Lee et al's grading system was used to assess lumbar foraminal stenosis [8,9] Axial ADC maps and coronal, and sagittal reformatted DWI images were used to identify the appropriate level and side of a particular nerve root and its ganglion. Using ImageJ 1 axial ADC maps and coronal reformats were analyzed to obtain the following bilateral linear measurements within axial ADC maps at the lumbar spinal levels (L1-S1): length of dorsal root ganglia (DRG) (mm), and width of DRG (mm).…”

Section: Methodsmentioning

confidence: 99%

Diffusion-weighted magnetic resonance imaging for the diagnosis of patients with lumbar nerve root entrapment syndromes: results from a pilot study

et al. 2014

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For the first time, we have established data for the DRG and DSN in human lumbosacral spinal nerves (L1-S1), using diffusion-weighted magnetic resonance imaging techniques. 3 T ADC maps have a higher signal to noise ratio, thus offering better image quality. Results from this study suggest that DWI has added value as new diagnostic tools for patients with symptomatic lumbar nerve root entrapment syndromes as well.

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Clinical Correlation of a New MR Imaging Method for Assessing Lumbar Foraminal Stenosis

Cited by 49 publications

References 6 publications

A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images

A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images

Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations

Diffusion-weighted magnetic resonance imaging for the diagnosis of patients with lumbar nerve root entrapment syndromes: results from a pilot study

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