Compared with the Conventional MR Imaging, Do the Constructive Interference Steady State Sequence and Diffusion Weighted Imaging Aid in the Diagnosis of Lumbar Disc Hernias?

Abstract

Objective: Our aim was to evaluate the efficacy of Diffusion Weighted Imaging (DWI) and Constructive Interference Steady State(CISS) sequences in the depiction of lumbar disc hernias, including sequestrated and extruded discs. Materials and Methods: 100 patients; 35 males and 65 females, with 3 sequestration -16 extruded and 81 protruded all together 100 herniated discs were involved in this study. If a patient had more than one herniated disc, then the more precise herniation was included. All the MRI procedures were handled in Siemens Symphony Power 1.5 T. magnet. DWI-Apparent diffusion coefficient (ADC mapping) and CISS sequences were obtained in axial planes. Statistical analysis of CISS and DWI results were analysed by fischer's test, chi square statistics.Results: CISS sequence had a 89% sensitivity, 100% specificity for all lumbar disc hernias, had 100% sensitivity and specificity in the evaluation of sequestrated and extruded discs. DWI had a 77% sensitivity and %100 specificity, had 100% sensitivity and 50% specificity in the evaluation of extrusion, 100% sensitivity and specificity in the evaluation of sequestration. Conclusion:CISS sequence and quantitative DWI may be alternative imaging modalities to the routine MR imaging sequences in the depiction of lumbar disc hernias, including sequestration and extruded discs. Key Words: CISS, DWI, Extruded discs, Lumbar disc hernias, MRI, Sequestration ÖzetAmaç: Amacımız sekestre ve ekstrüde disklerinde ilavesiyle, lomber fıtıkların tanınmasında Diffüzyon ağırlıklı görüntüleme (DAG) ve Konstrüktif interferans sabit faz(CISS) sekanslarının etkinliğini araştır-maktır. Gereç ve Yöntem:35 erkek-65 kadın, 100 hastada 3 sekestrasyon-16 ekstrüde ve 81 protrüde, 100 lomber fıtık vakası çalışmaya dahil edildi. Bir hastada birden fazla fıtık mevcut ise daha belirgin olan analiz edildi. Tüm MRG sekansları Siemens Symphony Power 1.5 T magnet ile yapıldı. DAG-ADC haritalama-CISS sekansları aksiyal düzlemlerde gerçekleştirildi. CISS ve DAG istatistiksel analizleri Fisher test ve kikare testi ile analiz edildi. Bulgular: CISS sekansı tüm lomber fıtıklarda, %89 sensitivite ve 100% spesifisite gösterdi, sekestre ve ekstrüde disk analizlerinde %100 sensitivite ve spesifisiteye sahipti. DAG tüm fıtıklarda %77 sensitivit e ve %100 spesifisite gösterirken, ekstrüzyon analizinde %100 sensitivite ve %50 spesifisite-sekestrasyon analizinde %100 sensitivite ve spesifisite saptandı.Sonuç: CISS sekansı ve kuantitatif DAG sekestre ve ekstrüde disklerinde dahil edildiği, lomber disk fıtıklarının tanınmasında rutin MR görün-tüleme sekanslarına alternatif bir görüntüleme metodları olabilir.

Agreement between transverse T2‐weighted and three‐dimensional constructive interference in steady state sequences in the evaluation of spinal cord disease in dogs

“…This range of results is likely representative of the diferent levels of radiological experience and diferent backgrounds between the 15 In people, the CISS sequence has been shown to be highly sensitive and speciic in the evaluation of lumbar disc herniations, especially for the extruded and sequestrated discs. 16 Although this sequence cannot diferentiate properly disc material from osteophytes, it easily revealed the site of injury and relationship of the herniated fragment to the dural sac, nerve roots and bulged discs. 1 In our study, although the intraobserver agreement between T2W and CISS sequences for nerve root compression was moderate to substantial, in some studies the T2W was insuicient for detailed analysis of nerve roots, especially in cases of disc herniation.…”

“…In people, the CISS sequence has been shown to be highly sensitive and specific in the evaluation of lumbar disc herniations, especially for the extruded and sequestrated discs 16 . Although this sequence cannot differentiate properly disc material from osteophytes, it easily revealed the site of injury and relationship of the herniated fragment to the dural sac, nerve roots and bulged discs 1 .…”

Three-dimensional turbo spin-echo sequence versus conventional two-dimensional turbo spin-echo sequences in the evaluation of lumbar intervertebral discs

“…Tins et al [2] claimed that a 3D SPACE sequence in conjunction with sagittal T1W images was sufficient for routine spinal imaging with increased diagnostic confidence. Aydin et al [12] studied a CISS sequence, which is a gradient-echo technique with steady-state free precession, and quantitative diffusion-weighted imaging for routine lumbar disc imaging, and the authors found that these sequences may be alternative imaging approaches to conventional MRI approaches for assessing lumbar disc hernias [12].…”

Intradural lumbar disc herniation detected by 3D CISS MRI

“… 2 3 When contrast media is used, which has not been done in our case, a ring enhancement of the herniated portion can be seen, caused by granulation tissue. 1–5 While 3D CISS sequence performance is similar to standard T2-weighted images for the depiction of extradural lumbar disc herniation, 6 the use of 3D high-resolution CISS sequence in IDH has not been reported yet. However, several studies have demonstrated the potential of 3D high-resolution CISS to assess other intradural diseases such as redundant nerve root syndrome of the cauda equina 7 or thoracic anterior spinal cord adhesion syndrome.…”