European Radiology

, Volume 29, Issue 4, pp 1855–1862 | Cite as

Evaluation of osseous cervical foraminal stenosis in spinal radiculopathy using susceptibility-weighted magnetic resonance imaging

  • Guenther EngelEmail author
  • Yvonne Y. Bender
  • Lisa C. Adams
  • Sarah M. Boker
  • Ute L. Fahlenkamp
  • Moritz Wagner
  • Gerd Diederichs
  • Bernd Hamm
  • Marcus R. Makowski



The aim of this study was to evaluate the diagnostic performance of susceptibility-weighted magnetic resonance imaging (SW-MRI) for the evaluation of osseous foraminal stenosis (FS) of the cervical spine compared to conventional MRI-sequences, using computed tomography (CT) as a reference standard.

Materials and methods

Twenty-one patients with suspected radiculopathy of the cervical spine were prospectively included. CT and MRI data sets were available for all patients. As standard of reference, 280 neuroforamina of the cervical spine, including 58 foraminal stenosis, were identified on sagittal CT images. T1-, T2-, and SW-MRI of the cervical spine were performed. The presence of foraminal stenosis was assessed on sagittal views in all sequences. Sensitivity and specificity were calculated and differences in detection rate and severity scoring of foraminal stenosis between the different sequences were tested. CT was used as reference standard for all analysis.


Fifty-six of 58 osseous foraminal stenosis could be correctly identified on SW-MR magnitude images. SW-MRI achieved a sensitivity of 96.6% and specificity of 99.5% for the identification of foraminal stenosis. In comparison, conventional T1-weighted MRI sequences achieved a sensitivity and specificity of 43.1% and 100% respectively. T2-weighted MRI sequences achieved a sensitivity and specificity of 65.5% and 99.1%, respectively. The overall detection rate was significantly (p < 0.05) higher on SW-MRI and there was no significant difference (p > 0.05) in severity scoring compared to CT. T1- and T2-weighted MRI underestimated the degree of foraminal stenosis. Intermodality and interobserver agreements were highest for SW-MRI.


SW-MRI enables the reliable detection of osseous foraminal stenosis of the cervical spine in patients with spinal radiculopathy with a higher sensitivity compared to conventional T1- and T2-MRI sequences, with CT as a reference standard.

Key Points

• Susceptibility-weighted magnetic resonance imaging enables the reliable detection of osseous foraminal stenosis of the cervical spine with CT as a reference standard.

• This could be relevant for younger patients in order to prevent unnecessary radiation exposure.

• This may also facilitate a one-stop-shop approach and speed up diagnostic work-up.


Magnetic resonance imaging Diagnostic imaging Spine Radiculopathy 



Computed tomography


Field of view


Gradient echo


Multi echo data image combination


Magnetic resonance


Magnetic resonance imaging




Standard deviation


Short tau inversion recovery


Susceptibility-weighted magnetic resonance imaging


Echo time


Repetition time


Turbo spin echo



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Yvonne Y. Bender.

Conflict of interest

The authors of this manuscript declare a relationship with Siemens Healthineers AG. Siemens Heathineers AG provided financial and technical support for conducting the study. Siemens Heathineers AG did not have control over the study conduct or data analysis.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Diagnostic or prognostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyCharité – University Medicine BerlinBerlinGermany

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