Clinical impact of coronal-STIR sequence in a routine lumbar spine MR imaging protocol to investigate low back pain

Abstract

Aim of this study is to assess the clinical impact of coronal short tau inversion recovery (STIR)-weighted magnetic resonance (MR) sequence, when acquired in a lumbar spine MR imaging protocol, in detecting significant extraspinal imaging findings in patients with low back pain (LBP).We retrospectively evaluated 931 lumbar spine MR examinations of patients with LBP. Extraspinal MR imaging findings were categorized as: probably related to LBP (Category 1), not related to LBP but with relevant implications on patient's care (Category 2), and not related to LBP without significant implications on patient's care (Category 3). For each MR imaging finding was also assessed if it was detectable or not on the conventional sagittal and axial acquisition planes.Of the 931 evaluated MR examinations, 60 (6.4%) showed additional extraspinal MR imaging findings, categorized as follows: 55% (33/60) probably related to LBP (Category 1), 22% (13/60) not related to LBP but with relevant implications on patient's care (Category 2), and 23% (14/60) not related to LBP and without significant implications on patient's care (Category 3). Among categories 1 and 2 (n = 46), the 72% (33/46) of imaging findings were detected only on coronal plane. Coronal-STIR sequence significantly changed patients’ diagnostic work-flow in 3.5% (33/931) of cases.Coronal STIR sequence, acquired in a lumbar spine MR imaging protocol to investigate LBP, may aid radiologists in detecting additional extraspinal MR imaging findings that could be related to LBP, addressing to the most appropriate clinical management.

Diagnostic Value of an Additional Sequence (Large-Field Coronal Stir) in a Routine Lumbar Spine MR Imaging Protocol to Investigate Lumbar Radiculopathy

“…Moe [recently, Romeo et al [18]] studied the coroSTIR sequence in the assessment of isolated low back pain (without radiculopathy) with less convincing results, detecting ESA in only 3.5% (35/931) of cases. This underlines the relevance of performing coroSTIR when low back pain is associated with radiculopathy, probably even more so for cruralgia pain than for lumbosciatica pain because differential diagnoses are more frequent in routine care (hip conditions sometimes resulting in clinical pictures of pseudo-cruralgia).…”

Added value of coronal-T1W sequence to the lumbar MR imaging protocol for low back pain

“…They reported that coronal-STIR imaging may provide an additional diagnosis in 6.8% of patients and should be included in the routine lumbar spine MRI protocol (17). Similarly, other studies evaluating the diagnostic efficacy of the coronal-STIR sequence added to the conventional lumbar MR imaging have reported extraspinal incidental findings including vascular, genitourinary, gastrointestinal, musculoskeletal, and oncological pathologies (18)(19)(20)(21)(22)(23). In these studies, the coronal-STIR sequence was performed for the backbone region.…”