Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jan 28, 2016; 8(1): 109-116
Published online Jan 28, 2016. doi: 10.4329/wjr.v8.i1.109
Incremental value of magnetic resonance neurography of Lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: A prospective study
Avneesh Chhabra, Sahar J Farahani, Gaurav K Thawait, Vibhor Wadhwa, Allan J Belzberg, John A Carrino
Avneesh Chhabra, Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9178, United States
Avneesh Chhabra, Sahar J Farahani, Gaurav K Thawait, Vibhor Wadhwa, John A Carrino, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
Vibhor Wadhwa, Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Allan J Belzberg, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
John A Carrino, Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY 10021, United States
Author contributions: Chhabra A guarantor of integrity of the entire study, study concepts and design, manuscript editing; Farahani SJ data collection, manuscript editing; Thawait GK data collection, manuscript preparation; Wadhwa V literature search, manuscript preparation; Belzberg AJ manuscript editing; Carrino JA study concepts and design, manuscript editing.
Institutional review board statement: Approval was taken from Institutional Review Board, Johns Hopkins University, No. IRB# JHM IRB NA_00050163.
Clinical trial registration statement: There is no Clinical trial registration statement.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Dr. Avneesh Chhabra received research grants from GE-AUR (GERRAF), Siemens Medical Solutions and Integra Life Sciences. He also serves as a research consultant with Siemens CAD group. Dr. John A Carrino received patient research grants from Siemens and serves as a speaker for Siemens lectures.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Avneesh Chhabra, MD, Associate Professor of Radiology and Orthopedic Surgery, Section Chief, Musculoskeletal Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9178, United States. avneesh.chhabra@utsouthwestern.edu
Telephone: +1-214-6482122
Received: April 25, 2015
Peer-review started: May 4, 2015
First decision: October 27, 2015
Revised: November 12, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: January 28, 2016
Processing time: 275 Days and 22.7 Hours
Abstract

AIM: To test the incremental value of 3T magnetic resonance neurography (MRN) in a series of unilateral radiculopathy patients with non-contributory magnetic resonance imaging (MRI).

METHODS: Ten subjects (3 men, 7 women; mean age 54 year and range 22-74 year) with unilateral lumbar radiculopathy and with previous non-contributory lumbar spine MRI underwent lumbosacral (LS) plexus MRN over a period of one year. Lumbar spine MRI performed as part of the MRN LS protocol as well as bilateral L4-S1 nerves, sciatic, femoral and lateral femoral cutaneous nerves were evaluated in each subject for neuropathy findings on both anatomic (nerve signal, course and caliber alterations) and diffusion tensor imaging (DTI) tensor maps (nerve signal and caliber alterations). Minimum fractional anisotropy (FA) and mean apparent diffusion coeffcient (ADC) of L4-S2 nerve roots, sciatic and femoral nerves were recorded.

RESULTS: All anatomic studies and 80% of DTI imaging received a good-excellent imaging quality grading. In a blinded evaluation, all 10 examinations demonstrated neural and/or neuromuscular abnormality corresponding to the site of radiculopathy. A number of contributory neuropathy findings including double crush syndrome were observed. On DTI tensor maps, nerve signal and caliber alterations were more conspicuous. Although individual differences were observed among neuropathic appearing nerve (lower FA and increased ADC) as compared to its contralateral counterpart, there were no significant mean differences on statistical comparison of LS plexus nerves, femoral and sciatic nerves (P > 0.05).

CONCLUSION: MRN of LS plexus is useful modality for the evaluation of patients with non-contributory MRI of lumbar spine as it can incrementally delineate the etiology and provide direct objective and non-invasive evidence of neuromuscular pathology.

Keywords: Magnetic resonance imaging, Neurography, Lumbosacral plexus, Radiculopathy

Core tip: Magnetic resonance neurography of the lumbosacral plexus is a useful modality for the evaluation of patients with non-contributory magnetic resonance imaging of the lumbar spine. It can incrementally delineate the etiology and provides direct objective and non-invasive evidence of neuromuscular pathology.