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High-resolution metal artifact reduction MR imaging of the lumbosacral plexus in patients with metallic implants

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Abstract

Objective

To assess the quality and accuracy of metal artifact reduction sequence (MARS) magnetic resonance imaging (MRI) for the diagnosis of lumbosacral neuropathies in patients with metallic implants in the pelvis.

Materials and methods

Twenty-two subjects with lumbosacral neuropathy following pelvic instrumentation underwent 1.5-T MARS MRI including optimized axial intermediate-weighted and STIR turbo spin echo sequences extending from L5 to the ischial tuberosity. Two readers graded the visibility of the lumbosacral trunk, sciatic, femoral, lateral femoral cutaneous, and obturator nerves and the nerve signal intensity of nerve, architecture, caliber, course, continuity, and skeletal muscle denervation. Clinical examination and electrodiagnostic studies were used as the standard of reference. Descriptive, agreement, and diagnostic performance statistics were applied.

Results

Lumbosacral plexus visibility on MARS MRI was good (4) or very good (3) in 92% of cases with 81% exact agreement and a Kendall’s W coefficient of 0.811. The obturator nerve at the obturator foramen and the sciatic nerve posterior to the acetabulum had the lowest visibility, with good or very good ratings in only 61% and 77% of cases respectively. The reader agreement for nerve abnormalities on MARS MRI was excellent, ranging from 95.5 to 100%. MARS MRI achieved a sensitivity of 86%, specificity of 67%, positive predictive value of 95%, and negative predictive value of 40%, and accuracy of 83% for the detection of neuropathy.

Conclusion

MARS MRI yields high image quality and diagnostic accuracy for the assessment of lumbosacral neuropathies in patients with metallic implants of the pelvis and hips.

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Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Shivani Ahlawat & Jan Fritz

  2. Bond Business School, Bond University, Gold Coast, QLD, 4229, Australia

    Steven E. Stern

  3. Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Allan J. Belzberg

Authors
  1. Shivani Ahlawat
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  2. Steven E. Stern
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  3. Allan J. Belzberg
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  4. Jan Fritz
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Corresponding author

Correspondence to Shivani Ahlawat.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments, or comparable ethical standards.

Grant support

There was no grand support for this study.

Conflicts of interest

Jan Fritz received institutional research funds and a speaker’s honorarium from Siemens Healthcare USA and is a scientific advisor of Siemens Healthcare USA and Alexion Pharmaceuticals, Inc.

The other authors declare that they have no conflicts of interest.

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Ahlawat, S., Stern, S.E., Belzberg, A.J. et al. High-resolution metal artifact reduction MR imaging of the lumbosacral plexus in patients with metallic implants. Skeletal Radiol 46, 897–908 (2017). https://doi.org/10.1007/s00256-017-2630-9

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  • DOI: https://doi.org/10.1007/s00256-017-2630-9

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