Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis

Abstract

Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging (DTI) for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy volunteers and 31 patients with lumbosacral stenosis. T2WI showed that the residual dural sac area was less than two-thirds that of the corresponding normal area in patients from L3 to S1 stenosis. On T1WI and T2WI, 74 lumbosacral spinal nerve roots from 31 patients showed compression changes. DTI showed thinning and distortion in 36 lumbosacral spinal nerve roots (49%) and abruption in 17 lumbosacral spinal nerve roots (23%). Moreover, fractional anisotropy values were reduced in the lumbosacral spinal nerve roots of patients with lumbosacral stenosis. These findings suggest that DTI can objectively and quantitatively evaluate the severity of lumbosacral spinal nerve root compression.

Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Dffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography

“…A total of 683 subjects were studied across 24 DTI articles. 177 patients with lumbar spinal canal stenosis (LSCS) in 5 articles 11,12,16,17,20) , 143 patients with lumbar disc herniation (LDH) in 7 articles 7,13,15,20,21,23,29) , 112 patients with lumbar radiculopathy in 3 articles 10,19,22) , 36 patients with foraminal stenosis (FS) in 6 articles 9,11,16,20,27,28) , 2 patients with lower back pain in one article 20) , 3 cases with diastematomyelia and one case with tethered cord in one article 30) , and one case with spina bifida in one article 26) were included. 7 post mortem subjects were investigated in one article 8) .…”

“…7 post mortem subjects were investigated in one article 8) . 201 healthy volunteers were also investigated in 15 articles 8,11,14,[16][17][18][19][22][23][24][25][26][28][29][30] .…”

“…All 17 articles 7,[9][10][11][12][13][15][16][17]19,20,22,23,[27][28][29][30] . Except for one continued.…”

Identifying lumbosacral plexus nerve root abnormalities in patients with sciatica using 3T readout-segmented echo-planar diffusion weighted MR neurography

“…Although we did not compare different MR neurography sequences, we believe that lumbosacral nerve changes are more evident on DWI-RESOLVE than on other DWI-based sequences previously assessed in the literature e.g., 3D DW steady-state free precession [27] and EPI-DWI [13]. Earlier work has more commonly investigated diffusion tensor imaging (DTI), rather than DWI, for evaluating lumbosacral nerve abnormalities [28][29][30]. Compared to DWI, DTI images can suffer from loss of directional information when multiple axonal fibers cross within the same voxel [30].…”

Lumbar Spinal Stenosis – From Epidemiology to Rehabilitation

“…diffusion tensor imaging), kojom se prikazuju neuralne strukture na temelju difuzije molekula vode, uz mogućnost razlikovanja i prikaza komprimiranih korjenova živaca. 64 Zbog nemogućnosti MR-a da prikaže kalcifi cirani koštani matriks, detaljna analiza koštanih promjena ovom metodom ne zadovoljava. Zato nisu rijetki slučajevi da je uz MR potrebno kao komplementarnu metodu učiniti i CT, primjerice, kod spondilolize sa spon- dilolistezom, gdje se CT-pregledom detaljno prikazuju koštane promjene, odnosno rascjep luka kralješka, a MR služi za pogled u strukture spinalnog kanala.…”