Comparison of Root Images Between Post-Myelographic Computed Tomography and Magnetic Resonance Imaging in Patients with Lumbar Radiculopathy

Overview

Journal J Korean Neurosurg Soc

Date 2017 Sep 8

PMID 28881117

Citations 6

Authors

Chun-Kun Park

Hong-Jae Lee

Kyeong-Sik Ryu

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the diagnostic value of computed tomography-myelography (CTM) compared to that of magnetic resonance imaging (MRI) in patients with lumbar radiculopathy.

Methods: The study included 91 patients presenting with radicular leg pain caused by herniated nucleus pulposus or lateral recess stenosis in the lumbar spine. The degree of nerve root compression on MRI and CTM was classified into four grades. The results of each imaging modality as assessed by two different observers were compared. Visual analog scale score for pain and electromyography result were the clinical parameters used to evaluate the relationships between clinical features and nerve root compression grades on both MRI and CTM. These relationships were quantified by calculating the receiver-operating characteristic curves, and the degree of relationship was compared between MRI and CTM.

Results: McNemar's test revealed that the two diagnostic modalities did not show diagnostic concurrence (p<0.0001). Electromyography results did not correlate with grades on either MRI or CTM. The visual analog pain scale score results were correlated better with changes of the grades on CTM than those on MRI (p=0.0007).

Conclusion: The present study demonstrates that CTM could better define the pathology of degenerative lumbar spine diseases with radiculopathy than MRI. CTM can be considered as a useful confirmative diagnostic tool when the exact cause of radicular pain in a patient with lumbar radiculopathy cannot be identified by using MRI. However, the invasiveness and potential complications of CTM are still considered to be pending questions to settle.

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References

Chiodo A, Haig A, Yamakawa K, Quint D, Tong H, Choksi V . Needle EMG has a lower false positive rate than MRI in asymptomatic older adults being evaluated for lumbar spinal stenosis. Clin Neurophysiol. 2007; 118(4):751-6. DOI: 10.1016/j.clinph.2006.12.004. View

Kang S, Choi S, Seong N, Ko J, Cho E, Ko K . Comparative study of lumbar magnetic resonance imaging and myelography in young soldiers with herniated lumbar disc. J Korean Neurosurg Soc. 2011; 48(6):501-5. PMC: 3053544. DOI: 10.3340/jkns.2010.48.6.501. View

Mondelli M, Aretini A, Arrigucci U, Ginanneschi F, Greco G, Sicurelli F . Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc. Neurophysiol Clin. 2013; 43(4):205-15. DOI: 10.1016/j.neucli.2013.05.004. View

Kent D, Haynor D, Larson E, Deyo R . Diagnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography. AJR Am J Roentgenol. 1992; 158(5):1135-44. DOI: 10.2214/ajr.158.5.1533084. View

Jackson R, Cain Jr J, Jacobs R, Cooper B, McManus G . The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. A comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging. Spine (Phila Pa 1976). 1989; 14(12):1362-7. DOI: 10.1097/00007632-198912000-00013. View

Song K, Choi B, Kim G, Kim J . Clinical usefulness of CT-myelogram comparing with the MRI in degenerative cervical spinal disorders: is CTM still useful for primary diagnostic tool?. J Spinal Disord Tech. 2009; 22(5):353-7. DOI: 10.1097/BSD.0b013e31817df78e. View

Breivik E, Bjornsson G, Skovlund E . A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain. 2000; 16(1):22-8. DOI: 10.1097/00002508-200003000-00005. View

Jindal G, Pukenas B . Normal spinal anatomy on magnetic resonance imaging. Magn Reson Imaging Clin N Am. 2011; 19(3):475-88. DOI: 10.1016/j.mric.2011.05.013. View

Botwin K, Gruber R . Lumbar spinal stenosis: anatomy and pathogenesis. Phys Med Rehabil Clin N Am. 2003; 14(1):1-15, v. DOI: 10.1016/s1047-9651(02)00063-3. View

10.

Harreld J, McMenamy J, Toomay S, Chason D . Myelography: a primer. Curr Probl Diagn Radiol. 2011; 40(4):149-57. DOI: 10.1067/j.cpradiol.2010.06.003. View

11.

Fardon D, Milette P . Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 2001; 26(5):E93-E113. DOI: 10.1097/00007632-200103010-00006. View

12.

Pfirrmann C, Dora C, Schmid M, Zanetti M, Hodler J, Boos N . MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2003; 230(2):583-8. DOI: 10.1148/radiol.2302021289. View

13.

Wildermuth S, Zanetti M, Duewell S, Schmid M, Romanowski B, Benini A . Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology. 1998; 207(2):391-8. DOI: 10.1148/radiology.207.2.9577486. View

14.

Greiner M, Pfeiffer D, Smith R . Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med. 2000; 45(1-2):23-41. DOI: 10.1016/s0167-5877(00)00115-x. View

15.

BURTON C, Kirkaldy-Willis W, Yong-Hing K, Heithoff K . Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res. 1981; (157):191-9. View

16.

Janssen M, Bertrand S, Joe C, Levine M . Lumbar herniated disk disease: comparison of MRI, myelography, and post-myelographic CT scan with surgical findings. Orthopedics. 1994; 17(2):121-7. DOI: 10.3928/0147-7447-19940201-07. View

17.

Colosimo C, Gaudino S, Alexandre A . Imaging in degenerative spine pathology. Acta Neurochir Suppl. 2010; 108:9-15. DOI: 10.1007/978-3-211-99370-5_3. View

18.

Bartynski W, Lin L . Lumbar root compression in the lateral recess: MR imaging, conventional myelography, and CT myelography comparison with surgical confirmation. AJNR Am J Neuroradiol. 2003; 24(3):348-60. PMC: 7973614. View

19.

Grams A, Gempt J, Forschler A . Comparison of spinal anatomy between 3-Tesla MRI and CT-myelography under healthy and pathological conditions. Surg Radiol Anat. 2009; 32(6):581-5. DOI: 10.1007/s00276-009-0601-0. View

20.

Sandow B, Donnal J . Myelography complications and current practice patterns. AJR Am J Roentgenol. 2005; 185(3):768-71. DOI: 10.2214/ajr.185.3.01850768. View