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Neuroradiology

, Volume 53, Issue 9, pp 633–641 | Cite as

Diffusion-weighted magnetic resonance imaging of symptomatic nerve root of patients with lumbar disk herniation

  • Yawara EguchiEmail author
  • Seiji Ohtori
  • Masaomi Yamashita
  • Kazuyo Yamauchi
  • Munetaka Suzuki
  • Sumihisa Orita
  • Hiroto Kamoda
  • Gen Arai
  • Tetsuhiro Ishikawa
  • Masayuki Miyagi
  • Nobuyasu Ochiai
  • Shunji Kishida
  • Gen Inoue
  • Yoshitada Masuda
  • Shigehiro Ochi
  • Takashi Kikawa
  • Tomoaki Toyone
  • Masashi Takaso
  • Yasuchika Aoki
  • Kazuhisa Takahashi
Diagnostic Neuroradiology

Abstract

Introduction

Diffusion-weighted imaging (DWI) can provide valuable structural information that may be useful for evaluating pathological changes of the lumbar nerve root. Diffusion-weighted magnetic resonance (MR) neurography has recently been introduced as an alternative way to visualize nerves, but to date, quantitative DWI and MR neurography have not been applied to evaluate the pathology of lumbar nerve roots.

Methods

Our purpose was to visualize lumbar nerve roots and to analyze their morphology by MR neurography, and to measure the apparent diffusion coefficient (ADC) of lumbar nerve roots compressed by herniated disks using 1.5-T MR imaging. Ten consecutive patients (median age, 48.0 and range, 20–72 years) with monoradicular symptoms caused by a lumbar herniated disk and 14 healthy volunteers were studied. Regions of interests were placed on the lumbar roots at dorsal root ganglia (DRG) and distal spinal nerves on DWI to quantify mean ADC values. The spinal nerve roots were also visualized by MR neurography.

Results

In the patients, mean ADC values were significantly greater in the compressed DRG and distal spinal nerves than in intact nerves. MR neurography also showed abnormalities such as nerve swelling at and below the compression in the symptomatic nerve root. Increased ADC values were considered to be because of edema and Wallerian degeneration of compressed nerve roots.

Conclusion

DWI is a potential tool for analysis of the pathophysiology of lumbar nerve roots compressed by herniated disks.

Keywords

Diffusion-weighted imaging Apparent diffusion coefficient Nerve roots Herniated lumbar disk Magnetic resonance imaging 

Notes

Conflict of Interest

We declare that we have no conflict of interest.

References

  1. 1.
    Mixter WJ, Barr JS (1934) Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–215CrossRefGoogle Scholar
  2. 2.
    Howe JF, Loeser JD, Calvin WH (1977) Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression. Pain 3:25–41PubMedCrossRefGoogle Scholar
  3. 3.
    Rydevik BL, Myers RR, Powell HC (1989) Pressure increase in the dorsal root ganglion following mechanical compression. Closed compartment syndrome in nerve roots. Spine 14:574–576PubMedCrossRefGoogle Scholar
  4. 4.
    Weinstein J (1986) Report of the 1985 ISSLS Traveling Fellowship. Mechanisms of spinal pain. The dorsal root ganglion and its role as a mediator of low-back pain. Spine 11:999–1001PubMedCrossRefGoogle Scholar
  5. 5.
    Basser PJ, Jones DK (2002) Diffusion tensor MRI: theory, experimental design and data analysis-a technical review. NMR Biomed 15:456–467PubMedCrossRefGoogle Scholar
  6. 6.
    Beaulieu C, Allen PS (1994) Determinants of anisotropic water diffusion in nerves. Magn Reson Med 31:394–400PubMedCrossRefGoogle Scholar
  7. 7.
    Beaulieu C, Does MD, Snyder RE, Allen PS (1996) Changes in water diffusion due to Wallerian degeneration in peripheral nerve. Magn Reson Med 36:627–631PubMedCrossRefGoogle Scholar
  8. 8.
    Basser PJ, Pierpaoli C (1996) Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B 111:209–219PubMedCrossRefGoogle Scholar
  9. 9.
    Minematsu K, Fisher M, Li L, Davis MA, Knapp AG, Cotter RE, McBurney RN, Sotak CH (1992) Diffusion-weighted magnetic resonance imaging: rapid and quantitative detection of focal brain ischemia. Neurology 42:235–240PubMedGoogle Scholar
  10. 10.
    Ohgiya Y, Oka M, Hiwatashi A, Liu X, Kakimoto N, Westesson PA, Sven E, Ekholm SE (2007) Diffusion tensor MR imaging of the cervical spinal cord in patients with multiple sclerosis. Eur Radiol 17:2499–2504PubMedCrossRefGoogle Scholar
  11. 11.
    Lin X, Tench CR, Morgan PS, Constantinescu CS (2008) Use of combined conventional and quantitative MRI to quantify pathology related to cognitive impairment in multiple sclerosis. J Neurol Neurosurg Psychiatry 79:437–441PubMedCrossRefGoogle Scholar
  12. 12.
    Hiltunen J, Suortti T, Arvela S, Seppa M, Joensuu R, Hari R (2005) Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T. Clin Neurophysiol 116:2315–2323PubMedCrossRefGoogle Scholar
  13. 13.
    Khalil C, Hancart C, Le Thuc V, Chantelot C, Chechin D, Cotton A (2008) Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results. Eur Radiol 18:2283–2291PubMedCrossRefGoogle Scholar
  14. 14.
    Kabakci N, Gürses B, Firat Z, Bayram A, Uluğ AM, Kovanlıkaya A, Kovanlıkaya İ (2007) Diffusion tensor imaging and tractography of median nerve: normative diffusion values. Am J Roentgenol 189:923–927CrossRefGoogle Scholar
  15. 15.
    MacDonald CL, Dikranian K, Bayly P, Holtzman D, Brody D (2007) Diffusion tensor imaging reliably detects experimental traumatic axonal injury and indicates approximate time of injury. J Neurosci 27:11869–11876CrossRefGoogle Scholar
  16. 16.
    Fujiyoshi K, Yamada M, Nakamura M, Yamane J, Katoh H, Kitamura K, Kawai K, Okada S, Momoshima S, Toyama Y, Okano H (2007) In vivo tracing of neural tracts in the intact and injured spinal cord of marmosets by diffusion tensor tractography. J Neurosci 27:11991–11998PubMedCrossRefGoogle Scholar
  17. 17.
    Yamashita T, Kwee TC, Takahara T (2009) Whole-body magnetic resonance neurography. N Engl J Med 361:538–539PubMedCrossRefGoogle Scholar
  18. 18.
    Tsuchiya K, Imai M, Tateishi H, Nitatori T, Fujikawa A, Takemoto S (2007) Neurography of the spinal nerve roots by diffusion tensor scanning applying motion-probing gradients in six directions. Magn Reson Med Sci 6:1–5PubMedCrossRefGoogle Scholar
  19. 19.
    Eguchi Y, Ohtori S, Yamashita M, Yamauchi K, Suzuki M, Orita S, Kamoda H, Arai G, Ishikawa T, Miyagi M, Ochiai N, Kishida S, Masuda Y, Ochi S, Kikawa T, Takaso M, Aoki Y, Toyone T, Suzuki T, Takahashi K (2010) Clinical applications of diffusion magnetic resonance imaging of the lumbar foraminal nerve root entrapment. Eur Spine J 19:1874–1882Google Scholar
  20. 20.
    Verbiest H (1954) A radicular syndrome from developmental narrowing of the lumbar vertebral canal. J Bone Joint Surg Br 36-B:230–237PubMedGoogle Scholar
  21. 21.
    Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282PubMedGoogle Scholar
  22. 22.
    Kwee TC, Takahara T, Ochiai R, Nievelstein RAJ, Luijten PR (2008) Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol 18:1937–1952PubMedCrossRefGoogle Scholar
  23. 23.
    Olmarker K, Rydevik B, Holm S (1989) Edema formation in spinal nerve roots induced by experimental, graded compression: an experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression. Spine 14:569–573PubMedCrossRefGoogle Scholar
  24. 24.
    Suzuki K, Takatsu T, Inoue H, Teramoto T, Ishida Y, Ohmori K (1992) Redundant nerve roots of the cauda equina caused by lumbar spinal canal stenosis. Spine 17:1337–1342PubMedCrossRefGoogle Scholar
  25. 25.
    Takata K, Inoue S, Takahashi K, Ohtsuka Y (1988) Swelling of the cauda equina in patients who have herniation of a lumbar disc. A possible pathogenesis of sciatica. J Bone Joint Surg Am 70:361–368PubMedGoogle Scholar
  26. 26.
    Toyone T, Takahashi K, Kitahara H, Yamagata M, Murakami M, Moriya H (1993) Visualisation of symptomatic nerve roots. Prospective study of contrast-enhanced MRI in patients with lumbar disc herniation. J Bone Joint Surg Br 75:529–533PubMedGoogle Scholar
  27. 27.
    Kobayashi S, Yoshizawa H, Hachiya Y, Ukai T, Morita T (1993) Vasogenic edema induced by compression injury to the spinal nerve root. Distribution of intravenously injected protein tracers and gadolinium-enhanced magnetic resonance imaging. Spine 18:1410–1424PubMedGoogle Scholar
  28. 28.
    Jinkins JR (1993) Gd-DTPA enhanced MR of the lumbar spinal canal in patients with claudication. J Comput Assist Tomogr 17:555–562PubMedCrossRefGoogle Scholar
  29. 29.
    Lane JI, Koeller KK, Atkinson JL (1995) Contrast-enhanced radicular veins on MR of the lumbar spine in an asymptomatic study group. AJNR Am J Neuroradiol 16:269–273PubMedGoogle Scholar
  30. 30.
    Boden SD, Davis DO, Dina TS, Parker CP, O’Malley S, Sunner JL, Wiesel SW (1992) Contrast-enhanced MR imaging performed after successful lumbar disk surgery: prospective study. Radiology 182:59–64PubMedGoogle Scholar
  31. 31.
    Taneichi H, Abumi K, Kaneda K, Terae S (1994) Significance of Gd-DTPA-enhanced magnetic resonance imaging for lumbar disc herniation: the relationship between nerve root enhancement and clinical manifestations. J Spinal Disord 7:153–160PubMedCrossRefGoogle Scholar
  32. 32.
    Aota Y, Onari K, An HS, Yoshikawa K (2001) Dorsal root ganglia morphologic features in patients with herniation of the nucleus pulposus: assessment using magnetic resonance myelography and clinical correlation. Spine 26:2125–2132PubMedCrossRefGoogle Scholar
  33. 33.
    Inada Y, Matsuki M, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Yamada T, Tsuji M (2009) Body diffusion-weighted MR imaging of uterine endometrial cancer: is it helpful in the detection of cancer in nonenhanced MR imaging? Eur J Radiol 70:122–127PubMedCrossRefGoogle Scholar
  34. 34.
    Cohen M, Wall E, Brown R, Rydevik B, Garfin S (1990) Cauda equina anatomy. Part II: extrathecal nerve roots and dorsal root ganglia. Spine 15:1248–1251PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Yawara Eguchi
    • 1
    Email author
  • Seiji Ohtori
    • 1
  • Masaomi Yamashita
    • 1
  • Kazuyo Yamauchi
    • 1
  • Munetaka Suzuki
    • 1
  • Sumihisa Orita
    • 1
  • Hiroto Kamoda
    • 1
  • Gen Arai
    • 1
  • Tetsuhiro Ishikawa
    • 1
  • Masayuki Miyagi
    • 1
  • Nobuyasu Ochiai
    • 1
  • Shunji Kishida
    • 1
  • Gen Inoue
    • 1
  • Yoshitada Masuda
    • 2
  • Shigehiro Ochi
    • 2
  • Takashi Kikawa
    • 2
  • Tomoaki Toyone
    • 3
  • Masashi Takaso
    • 4
  • Yasuchika Aoki
    • 5
  • Kazuhisa Takahashi
    • 1
  1. 1.Department of Orthopaedic Surgery, Graduate School of MedicineChiba UniversityChibaJapan
  2. 2.Department of RadiologyChiba University HospitalChibaJapan
  3. 3.Department of Orthopaedic SurgeryTeikyo University Chiba Medical CenterChibaJapan
  4. 4.Department of Orthopaedic Surgery, School of MedicineKitasato UniversitySagamihara CityJapan
  5. 5.Department of Orthopedic SurgeryChiba Rosai HospitalIchiharaJapan

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