Reliability of MRI findings for Symptomatic Extraforaminal Disc Herniation in Lumbar Spine

Moon, Kyu Pill; Suh, Kuen Tak; Lee, Jung Sub

doi:10.4184/asj.2009.3.1.16

Cited by 16 publications

(22 citation statements)

References 18 publications

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“…Conventional MRI can readily show paramedian and foraminal disc herniation, but extraforaminal herniated discs are easily overlooked using this technique. Moon et al 4 evaluated the dependability of MRI for identification of symptomatic Figure 2. (a) T2-weighted MRI in the sagittal plane was used to aid in localization of L3/L4, (b) The junior surgeon did not find the extraforaminal disc herniation (yellow arrow) in the axial plane of the T2-weighted images, (c) However, the junior surgeon accurately diagnosed the extraforaminal disc herniation (blue arrow) using CMRI and (d) Three-dimensional MRI also clearly showed that the extraforaminal disc (red arrow) compressed the nerve root of L3.…”

Section: Discussionmentioning

confidence: 99%

Coronal magnetic resonance imaging of three-dimensional fast-field echo with water-selective excitation improves the sensitivity and reliability of identification of extraforaminal lumbar disc herniation

Jia

Liu

et al. 2019

J Int Med Res

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Objective The complete view of the nerve root, including the extraforaminal zone, can be displayed by coronal magnetic resonance imaging (MRI) of three-dimensional (3D) fast-field echo with water-selective excitation (CMRI). However, its sensitivity, specificity, and reliability for the diagnosis of extraforaminal lumbar disc herniation are unclear. We compared the sensitivity, specificity, and reliability of conventional MRI, CMRI, and 3D MRI for the identification of extraforaminal lumbar disc herniation. Methods This study involved 140 patients (68 with extraforaminal lumbar disc herniation and 72 with paramedian disc herniation). Their mean age was 44.57 ± 14.59 years. Conventional MRI, CMRI, and 3D MRI of all patients were evaluated by five experts. The reliability, sensitivity, and specificity of the three imaging techniques for identification of extraforaminal lumbar disc herniation were compared using kappa statistics and the chi-squared test. Results CMRI showed higher agreement (0.843) than conventional MRI (0.671) and 3D MRI (0.771) for the identification of extraforaminal lumbar disc herniation. CMRI demonstrated higher sensitivity (95.6% vs. 91.2%) than conventional MRI (85.3% vs. 70.6%) and 3D MRI (92.6% vs. 86.7%) regardless of whether performed by junior or senior surgeons. Conclusions CMRI is helpful for identification of extraforaminal disc herniation by junior and senior orthopedic surgeons.

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Section: Discussionmentioning

confidence: 99%

Coronal magnetic resonance imaging of three-dimensional fast-field echo with water-selective excitation improves the sensitivity and reliability of identification of extraforaminal lumbar disc herniation

Jia

Liu

et al. 2019

J Int Med Res

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“…The recently updated standardized lumbar spine nomenclature should help prevent future confusion (1). Even when they are present, extraforaminal disk herniations are underdiagnosed (28,29). This underdiagnosis can contribute to poor outcomes in patients with sciatica, including unsuccessful or wrong-level surgery.…”

Section: Extreme Lateral Lumbar Disk Herniationmentioning

confidence: 99%

Uncommon Manifestations of Intervertebral Disk Pathologic Conditions

Diehn¹,

Maus²,

Morris³

et al. 2016

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Beyond the familiar disk herniations with typical clinical features, intervertebral disk pathologic conditions can have a wide spectrum of imaging and clinical manifestations. The goal of this review is to illustrate and discuss unusual manifestations of intervertebral disk pathologic conditions that radiologists may encounter, including disk herniations in unusual locations, those with atypical imaging features, and those with uncommon pathophysiologic findings. Examples of atypical disk herniations presented include dorsal epidural, intradural, symptomatic thoracic (including giant calcified), extreme lateral (retroperitoneal), fluorine 18 fluorodeoxyglucose-avid, acute intravertebral (Schmorl node), and massive lumbar disk herniations. Examples of atypical pathophysiologic conditions covered are discal cysts, fibrocartilaginous emboli to the spinal cord, tiny calcified disks or disk-level spiculated osteophytes causing spinal cerebrospinal fluid (CSF) leak and intracranial hypotension, and pediatric acute calcific discitis. This broad gamut of disease includes a variety of sizes of disk pathologic conditions, from the tiny (eg, the minuscule calcified disks causing high-flow CSF leaks) to the extremely large (eg, giant calcified thoracic intradural disk herniations causing myelopathy). A spectrum of clinical acuity is represented, from hyperacute fibrocartilaginous emboli causing spinal cord infarct, to acute Schmorl nodes, to chronic intradural herniations. The entities included are characterized by a range of clinical courses, from the typically devastating cord infarct caused by fibrocartilaginous emboli, to the usually spontaneously resolving pediatric acute calcific discitis. Several conditions have important differential diagnostic considerations, and others have relatively diagnostic imaging findings. The pathophysiologic findings are well understood for some of these entities and poorly defined for others. Radiologists' knowledge of this broad scope of unusual disk disease is critical for accurate radiologic diagnoses. Online supplemental material is available for this article. (©)RSNA, 2016.

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“…However, there are many cases of incorrect diagnoses or unmatched clinical and radiological findings. Moon et al9) studied the reliability of MRI findings in detecting symptomatic lesions and they reported the most reliable findings of symptomatic lesions, which is the focal eccentricity of the disc. However, this study has a limitation of confirming the symptomatic lesion owing to not adding and comparing with the other imaging protocols.…”

Section: Discussionmentioning

confidence: 99%

“…Especially, the diagnosis of foraminal and extaforaminal stenosis at L5-S1 is also difficult because of bony and ligament structures surrounding this level4). Many radiological modalities were reported to diagnose foraminal and extraforaminal stenosis at L5-S1, such as computed tomography (CT), magnetic resonance image (MRI)8,9,11), magnetic resonance myelography (MRM)6) and so on. If some diagnostic modalities have high concordance between clinical symptoms and radiologic findings, these have high sensitivity for diagnosing foraminal and extraforminal stenosis at L5-S1.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Three Dimensional Proset MR Images for Diagnosis of Symptomatic L5-S1 Foraminal and Extraforaminal Stenosis

Kim

Kim²,

Kim

et al. 2013

J Korean Neurosurg Soc

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ObjectiveTo suggest a new useful diagnostic technique, principles of the selective excitation technique-magnetic resonance images (Proset-MRI), and to know the precise radiologic findings that can prove symptomatic foraminal and extraforaminal stenosis at L5-S1.MethodsNineteen patients with symptomatic L5-S1 stenosis were checked by Proset-MRI. Four patients were performed decompressive surgery and 15 patients were performed selective nerve root block (SNRB) at L5. The pain scale of patients was checked by Visual Analogue Scale (VAS) scores at the pre- and post-treatment state.ResultsProset-MRI findings of patients with symptomatic stenosis are root swelling (RS) and indentation. The comparisons with VAS scores had a meaningful statistical result at each RS (p<0.01) and indentation (p<0.01). However, the findings of RS combined with indentation lacked statistical significance (p=0.0249). In addition, according to a comparison with the treatment modalities, reducing of VAS scores had statistical meaningful significance in decompressive surgery cases (p<0.01), and also in SNRB cases (p<0.01) after a 3-month follow-up period.ConclusionThe three dimensional Proset-MRI is very useful and sensitive technique to diagnose the symptomatic foraminal and extraforaminal stenosis at L5-S1.

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Reliability of MRI findings for Symptomatic Extraforaminal Disc Herniation in Lumbar Spine

Cited by 16 publications

References 18 publications

Coronal magnetic resonance imaging of three-dimensional fast-field echo with water-selective excitation improves the sensitivity and reliability of identification of extraforaminal lumbar disc herniation

Coronal magnetic resonance imaging of three-dimensional fast-field echo with water-selective excitation improves the sensitivity and reliability of identification of extraforaminal lumbar disc herniation

Uncommon Manifestations of Intervertebral Disk Pathologic Conditions

Usefulness of Three Dimensional Proset MR Images for Diagnosis of Symptomatic L5-S1 Foraminal and Extraforaminal Stenosis

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