Oblique MRI as a Useful Adjunct in Evaluation of Cervical Foraminal Impingement

Humphreys, S. Craig; An, Howard S.; Eck, Jason C.; Coppes, Mark A.; Lim, Tae-Hong; Estkowski, Lloyd

doi:10.1097/00002517-199808000-00005

Cited by 30 publications

(21 citation statements)

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“…Oblique sagittal images provide much more information about the foramen than routine sagittal images because oblique images are oriented perpendicular to the course of the cervical neural foramen [5]. Facet overgrowth, herniated lateral discs and uncinate process osteophytes that may induce foraminal stenosis are more easily detectable in the oblique sagittal view [8].…”

Section: Discussionmentioning

confidence: 99%

“…We used T 2 weighted images for the acquisition of oblique sagittal views because T 2 weighted images provide the high tissue contrast required to easily distinguish bone from soft tissue. On T 1 weighted images, fat is enhanced and the cortical bone and cervical spinal fluid are more difficult to distinguish [5]. Our grading system is based on the Wildermuth classification of lumbar foraminal stenosis, modified to provide more objective grading [4].…”

Section: Discussionmentioning

confidence: 99%

“…To acquire oblique sagittal images, the medial edge of the neural foramen was identified and seven images progressing laterally through the foramen at 45°a ngled projections were taken with the following parameters: field of view, 24 cm; matrix, 3703270; slice thickness, 3 mm; interslice gap, 0 mm; repetition time/echo time, 3300-3700/100 ms; signal average, 3. The images included the medial margin of each pedicle, the isthmus of the foramen and the lateral edge of the foramen [5].…”

Section: Mri Parametersmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Mri Parametersmentioning

confidence: 99%

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

Ss²,

Lee³

et al. 2013

BJR

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“…Due to both the anatomic features of the cervical foramen and the limitations of conventional techniques, the use of reformatted angled sagittal images has recently gained acceptance [4]. The additional acquisition of angled sagittal MR images oriented perpendicular to the true course of the neural foramina facilitates the identification of disease laterally by providing a second orthogonal imaging plane in relationship to the diseased area.…”

Section: Discussionmentioning

confidence: 99%

“…It was found that such angled sagittal MRI could provide a clearer view of certain anatomic structures not available in conventional MRI [4,7,16] (Fig. 2b).…”

Section: Introductionmentioning

confidence: 99%

A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen

et al. 2009

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The object of this study is to demonstrate that angled sagittal magnetic resonance imaging (MRI) enables the precise diagnosis of herniated disc and stenosis in the cervical foramen, which is not available with conventional MRI. Due to both the anatomic features of the cervical foramen and the limitations of conventional MR techniques, it has been difficult to identify disease in the lateral aspects of the spinal canal and foramen using only conventional MRI. Angled sagittal MRI oriented perpendicular to the true course of the foramina facilitates the identification of the lateral disease. A review of 43 patients, who underwent anterior cervical discectomy and interbody fusion, is presented with a herniated disc and/or stenosis in the cervical foramen. They all had undergone conventional MRI and angled sagittal MRI. Fifty levels were surgically explored for evidence of foraminal herniated disc and stenosis. The results of each test were correlated with what was found at each explored surgical level. The sensitivity, specificity, and accuracy of both examinations for making the diagnosis of foraminal herniated disc and stenosis were compared. During the diagnosis of foraminal herniated disc, the sensitivity, specificity, and accuracy of angled sagittal MRI were 96.7, 95.0, and 96.0%, respectively, compared with 56.7, 85.0, and 68.0% for conventional MRI. In making the diagnosis of foraminal stenosis, the sensitivity, specificity, and accuracy of angled sagittal MRI were 96.3, 95.7, and 96.0%, respectively, compared with 40.7, 91.3, and 66.0% for conventional MRI. In the above groups, the difference between the tests for making the diagnosis of both foraminal herniated disc and stenosis was found to be statistically significant in sensitivity and accuracy. Angled sagittal MRI was a more accurate test compared to conventional MRI for making the diagnosis of herniated disc and stenosis in the cervical foramen. It can be utilized for the precise diagnosis of foraminal herniated disc and stenosis difficult or ambiguous in conventional MRI.

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Magnetic resonance imaging in the evaluation of cervical foraminal stenosis: comparison of 3D T2 SPACE with sagittal oblique 2D T2 TSE

2022

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Objective The oblique orientation of the cervical neural foramina challenges the implementation of a short MRI protocol with concurrent excellent visualization of the spine. While sagittal oblique T2-weighted sequences permit good evaluation of the cervical neuroforamina, all segments may not be equally well depicted on a single sequence and conspicuity of foraminal stenosis may be limited. 3D T2-weighted sequences can be reformatted in arbitrary planes, including the sagittal oblique. We set out to compare 3D T2w SPACE sequences with sagittal oblique reformations and sagittal oblique 2D T2w TSE sequences for the evaluation of cervical foraminal visibility and stenosis. Materials and methods Sixty consecutive patients who underwent MRI of the cervical spine with sagittal oblique 2D T2w TSE and 3D T2w SPACE sequences were included. Image homogeneity of the sequences was evaluated. Imaging sets were assessed for structure visibility and foraminal stenosis by two independent readers. Results of the sequences were compared by Wilcoxon matched-pairs tests. Interreader agreement was evaluated by weighted κ. Results Visibility of most structures was rated good to excellent on both sequences (mean visibility scores ≥ 4.5 of 5), though neuroforaminal contents were better seen on sagittal oblique T2w TSE (mean scores 4.1–4.6 vs. 3.1–4.1 on 3D T2w SPACE, p < 0.01). Stenosis grades were comparable between sequences (mean 1.1–2.6 of 4), with slightly higher values for 3D T2w SPACE at some levels (difference ≤ 0.3 points). Conclusion 3D T2w SPACE is comparable with sagittal oblique 2D T2w TSE in the evaluation of cervical neural foramina.

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Oblique MRI as a Useful Adjunct in Evaluation of Cervical Foraminal Impingement

Cited by 30 publications

References 0 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

A comparison of angled sagittal MRI and conventional MRI in the diagnosis of herniated disc and stenosis in the cervical foramen

Magnetic resonance imaging in the evaluation of cervical foraminal stenosis: comparison of 3D T2 SPACE with sagittal oblique 2D T2 TSE

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