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

Reinhold, M.; Ederer, Christian; Henninger, Benjamin; Eberwein, Alexandra; Kremser, Christian

doi:10.1007/s00586-014-3602-6

Cited by 15 publications

(10 citation statements)

References 14 publications

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“…Studies have found that ADC is significantly higher in compressed nerve roots than in contralateral uncompressed nerve roots. [ 18 – 20 ] However, other studies have found that the ADC value of compressed nerve roots is similar to that of normal nerve roots in LDH patients. [ 9 , 10 ] The present study found that in compressed nerve roots, the ADC value before surgery was significantly higher than that after surgery.…”

Section: Discussionmentioning

confidence: 99%

Microstructural changes in compressed nerve roots treated by percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation

Liang²,

Chen³

et al. 2016

Medicine

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To investigate the microstructural changes in compressed nerves using diffusion tensor imaging (DTI) of herniated disc treated with percutaneous transforaminal endoscopic discectomy.Diffusion tensor imaging has been widely used to visualize peripheral nerves, and the microstructure of compressed nerve roots can be assessed using DTI. However, the microstructural changes after surgery are not well-understood in patients with lumbar disc herniation.Thirty-four consecutive patients with foraminal disc herniation affecting unilateral sacral 1 (S1) nerve roots were enrolled in this study. DTI with tractography was performed on S1 nerve roots before and after surgery. The mean fractional anisotropy (FA) and apparent diffusion coefficient values were calculated from tractography images.In compressed nerve roots, the FA value before surgery was significantly lower than that after surgery (P = 0.000). A significant difference in FA values was found between the compressed and normal sides before surgery (P = 0.000). However, no significant difference was found between the compressed and normal sides after surgery (P = 0.057). A significant difference in apparent diffusion coefficient values was found before and after surgery at the compressed side (P = 0.023). However, no significant difference was found between the compressed and normal sides after surgery (P = 0.203).We show that the diffusion parameters of compressed nerve roots were not significantly different before and after percutaneous transforaminal endoscopic discectomy, indicating that the microstructure of the nerve root recovered after surgery.

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Section: Discussionmentioning

confidence: 99%

Microstructural changes in compressed nerve roots treated by percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation

Liang²,

Chen³

et al. 2016

Medicine

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“…DWIs and ADC maps of spinal nerve roots, ganglions, and nerves with generation of tractography [ 13 , 14 ] were shown to add value for the preoperative assessment of spinal nerve root lesions [ 15 , 16 ]. However, ADC values from the dorsal root ganglion in symptomatic patients were found to be inconsistent, but correlate with recovery from pain and numbness [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, we believe that further larger study is warranted to determine the specificity and sensitivity of ADC maps for the assessment of radicular symptoms and nerve root compression. Sagittal ADC maps were used in this study for the nerve root assessment, while previous studies used axial ADC maps [ 15 , 16 ]. Axial ADC maps may be easier to identify nerve roots, but weather the quantitative ADC measurements from the axial and sagittal scans are different remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Apparent diffusion coefficient maps in the assessment of surgical patients with lumbar spine degeneration

et al. 2017

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PurposeTo assess the utility of apparent diffusion coefficient (ADC) maps for the assessment of patients with advanced degenerative lumbar spine disease and describe characteristic features of ADC maps in various degenerative lumbar spinal conditions.MethodsT1-weighted, T2-weighted and diffusion weighted (DWI) MR images of 100 consecutive patients admitted to the spinal surgery service were assessed. ADC maps were generated from DWI images using Osyrix software. The ADC values and characteristic ADC maps were assessed in the regions of interest over the different pathological entities of the lumbar spine.ResultsThe study included 452 lumbar vertebral segments available for analysis of ADCs. Characteristic ADC map features were identified for protrusion, extrusion and sequester types of lumbar disk herniations, spondylolisthesis, reactive Modic endplate changes, Pfirrmann grades of IVD degeneration, and compromised spinal nerves. Compromised nerve roots had significantly higher mean ADC values than adjacent (p < 0.001), contralateral (p < 0.001) or adjacent contralateral (p < 0.001) nerve roots. Compared to the normal bone marrow, Modic I changes showed higher ADC values (p = 0.01) and Modic 2 changes showed lower ADC values (p = 0.02) respectively. ADC values correlated with the Pfirrmann grading, however differed from herniated and non-herniated disks of the matched Pfirrmann 3 and 4 grades.ConclusionQuantitative and qualitative evaluation of ADC mapping may provide additional useful information regarding the fluid dynamics of the degenerated spine and may complement standard MRI imaging protocol for the comprehensive assessment of surgical patients with lumbar spine pathology. ADC maps were advantageous in differentiating reactive bone marrow changes, and more precise assessment of the disk degeneration state. ADC mapping of compressed nerve roots showed promise but requires further investigation on a larger cohort of patients.

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“…22 The DWI technique promises a noninvasive diagnostic assessment of early changes associated with degenerative compression of spinal nerves. 23 Our patient presented with acute low back pain, and the diagnosis was CLDCS. No surgery was indicated because of the minimal neurologic findings.…”

Section: Discussionmentioning

confidence: 78%

Redundant Nerve Root in a Patient With Chronic Lumbar Degenerative Canal Stenosis

Villafañe

Harvey

Kettner

2017

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe the diagnostic imaging features of redundant nerve roots caused by chronic lumbar degenerative canal stenosis (CLDCS). Clinical Features: A 56-year-old male presented with severe low back pain. He experienced pain during minimal active lumbar range of motion. The patient demonstrated weakness of the right iliopsoas and hypoesthesia of the L-2 dermatome. A working diagnosis of CLDCS was established. The patient's worsening severe low back pain warranted magnetic resonance imaging of the lumbar spine, which was performed for further evaluation. Magnetic resonance imaging demonstrated disk protrusion and canal stenosis with tortuosity of the cauda equina consistent with redundant nerve root appearance. Intervention and Outcome: The patient was treated with chiropractic flexion distraction, which was followed by a course of acupuncture and spinal manipulation. The patient self-discharged following clinical improvement. Conclusions: This case demonstrated CLDCS with associated redundant nerve roots. Conservative treatment included chiropractic diversified lumbar spinal manipulation, acupuncture, and electrical stimulation. The patient selfdischarged following clinical improvement in 3 months. (J Chiropr Med 2017;16:236-241)

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

Cited by 15 publications

References 14 publications

Microstructural changes in compressed nerve roots treated by percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation

Microstructural changes in compressed nerve roots treated by percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation

Apparent diffusion coefficient maps in the assessment of surgical patients with lumbar spine degeneration

Redundant Nerve Root in a Patient With Chronic Lumbar Degenerative Canal Stenosis

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