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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

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Abstract

Purpose

Lumbar nerve root entrapment syndromes cause radicular signs and symptoms in the affected leg. The applicability of diffusion-weighted imaging (DWI) for the assessment of lower lumbar nerves (L4–S1) has been demonstrated. The purpose of this pilot study was to establish DWI reference data for the all lumbosacral nerve roots (L1–S1) in a healthy, asymptomatic study population and to determine its potential as a diagnostic tool for patients with lumbar radicular syndromes.

Methods

20 asymptomatic healthy volunteers were included (average age 39 years (24–59 years; n = 10 female, n = 10 male). The lumbosacral spine was scanned twice in a standardized fashion (1.5 T Magnetom Avanto and 3 T Magnetom Skyra, Siemens AG Healthcare, Erlangen, Germany). A spin-echo type echo-planar (SE-EPI) sequence was used to determine axial ADC maps and measurements (length, width, and angulation) of the dorsal root ganglion (DRG) and distal spinal nerves (DSN). Disc pathology, lumbar foraminal stenosis and nerve root compromise were classified.

Results

Using 3 T images 218 (91 %) lumbar nerve roots had no pathologic finding [1.5 T: 226 (94 %)]. All DRG and DSN could be visualized and identified on axial apparent diffusion coefficient (ADC). On average we measured ADC values of 1,231 mm2/s (SD 308 mm2/s) at the DRG for the 1.5 T scanner and 1,756 mm2/s (SD 465 mm2/s) for the 3 T scanner. There were no statistically significant gender or side differences in the 1.5 and 3 T images (p > 0.05). We noted an increase of the ADC values starting from cranial (L1: 1,444 mm2/s) to caudal (S1: 1,918 mm2/s). The average ADC value at the DSN was 1,018 mm2/s for the 1.5 T scanner compared to 1,589 mm2/s for the 3 T scanner (p < 0.001).

Conclusions

For the first time, we have established data for the DRG and DSN in human lumbosacral spinal nerves (L1–S1), using diffusion-weighted magnetic resonance imaging techniques. 3 T ADC maps have a higher signal to noise ratio, thus offering better image quality. Results from this study suggest that DWI has added value as new diagnostic tools for patients with symptomatic lumbar nerve root entrapment syndromes as well.

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Notes

  1. Abramoff MD et al (2004) Biophotonics International 11:36–42

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Correspondence to Maximilian Reinhold.

Appendix

Appendix

Appendix 1

See Figs. 1, 2, 3, 4 5.

Fig. 2
figure 2

a L3 dorsal root ganglia in 3 T axial DWI image with a b value of 50 s/mm2. b Sample of L3 dorsal root ganglia in 3 T axial DWI image with a b value of 600 s/mm2

Fig. 3
figure 3

a 3 T coronal diffusion-weighted image of L4–L5 nerve roots with a better signal to noise ratio (SNR) but higher degree of distortion artifacts, e.g., presumed “kinking” of distal lumbar nerve, b Corresponding 1.5 T diffusion-weighted image with lower SNR, e.g., slightly more “diffuse” image appearance

Fig. 4
figure 4

a Numbers of disc pathology (yes/no) and level according to Transfeldt et al. [6], b Numbers of nerve root compromise (yes/no) and level according to Pfirrmann et al. [7], c Numbers of foraminal stenosis (yes/no) and level according to Lee et al. [8]

Fig. 5
figure 5

a ADC values (mean) of dorsal root ganglia (DRG) (mm2/s) and level (L1–S1). b ADC values (mean) of distal spinal nerve (DSN) (mm2/s) and level (L1–S1)

Appendix 2

See Tables 1, 2, 3, 4

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Reinhold, M., Ederer, C., Henninger, B. et al. Diffusion-weighted magnetic resonance imaging for the diagnosis of patients with lumbar nerve root entrapment syndromes: results from a pilot study. Eur Spine J 24, 319–326 (2015). https://doi.org/10.1007/s00586-014-3602-6

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