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Oblique fast spin-echo T1 MRI improved diagnostic accuracy of lumbar foraminal stenosis
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SAN FRANCISCO — Use of oblique fast spin-echo T1 MRI sequencing improves consistency in the diagnosis of lumbar foraminal stenosis in patients with radiculopathy, according to a speaker here.
“Inter-rater and intra-rater reliability were significantly better with oblique T1 MRI that provided en face views of the lumbar nerve roots,” David B. Bumpass, MD, said at the North American Spine Society Annual Meeting. “The improvements were small in magnitude. Oblique scans were more likely to be useful to clinicians when more degeneration and foraminal stenosis was present.”
During a 2-year period, Bumpass and colleagues at Washington University prospectively studied 22 consecutive adult patients who had numbness, leg pain and weakness of a suspected lumbar etiology. Mean patient age was 48 years.
Patients underwent standard non-contrast T1 and T2 imaging of the lumbar nerve root in the axial and sagittal planes. The researchers also imaged patients with a novel T1 fast spin-echo MRI sequence oblique to the sagittal axis in the plane of lumbar foramina.
Both right and left oblique series were performed for each patient, and the researchers used a 1.5-T MRI scanner for all patients. Three spine surgeons and one neuroradiologist independently used a validated four-part grading scale to access foraminal stenosis.
The researchers found eight patients had multi-level degenerative foraminal stenosis and three patients had lumbar scoliosis with a Cobb angle up to 28°. On average, reviewers found the oblique series improved the diagnosis of foraminal stenosis in 56% of the patients studied, Bumpass said.
At least three reviewers found the oblique fast spin-echo T1 MRI sequences improved the diagnosis for 11 patients. Patients who underwent the oblique series MRIs had a 13.5° mean angle from the sagittal plane. — by Kristine Houck, MA, ELS
Reference:
Bumpass DB. Abstract #192. Presented at: North American Spine Society Annual Meeting. Nov. 12-15, 2014; San Francisco.
Disclosure: The research was supported by a grant from the Orthopaedic Research and Education Foundation.