Asian Spine J.  2021 Aug;15(4):472-480. 10.31616/asj.2020.0133.

Can Conventional Magnetic Resonance Imaging Substitute Three-Dimensional Magnetic Resonance Imaging in the Diagnosis of Lumbar Foraminal Stenosis?

Affiliations
  • 1Department of Orthopaedic Surgery, Osaka City University, Osaka, Japan
  • 2Department of Orthopaedic Surgery, Fuchu Hospital, Osaka, Japan
  • 3Division of Central Radiology, Osaka City University, Osaka, Japan

Abstract

Study Design: Retrospective radiological comparative design. Purpose: To investigate whether conventional magnetic resonance imaging (MRI) could substitute three-dimensional (3D)-MRI for the calculation of the foraminal stenotic ratio (FSR) and clarification of which patients can be assessed more accurately using 3D-MRI. Overview of Literature: Previous studies have indicated that 3D-MRI is useful for diagnosing lumbar foraminal stenosis. The FSR obtained using 3D-MRI, described as the ratio of stenosis length, characterized by perineural fat obliteration, to the length of the entire foramen, could indicate the stenosis severity; however, this method is time-consuming and expensive. The FSR also can be calculated using conventional MRI.
Methods
We investigated 154 foramina at L5–S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed.
Results
In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI.
Conclusions
FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.

Keyword

Lumbar foraminal stenosis; Three-dimensional magnetic resonance imaging; Perineural fat obliteration; Surgery; Conservative treatment
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