Department of College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Spine (Phila Pa 1976). 2012 May 1;37(10):840-4. doi: 10.1097/BRS.0b013e3182374465.
Retrospective analysis of lumbosacral radiculography using 3-dimensional (3D) magnetic resonance (MR) rendering in patients with extraforaminal disc herniation.
To investigate the significance of lumbosacral radiculography as depicted by 3D MR rendering in the diagnosis of symptomatic extraforaminal disc herniation with or without foraminal extension.
Given that accurate evaluation of the extraforaminal zones on routine axial and sagittal images is difficult, extraforaminal disc herniations tend to be sometimes overlooked. In addition, oblique coronal images along intervertebral foramina and MR myelography may not clearly demonstrate a detailed full view of nerve root changes. Furthermore, the detection of the morphologic changes of the nerve root is very important for the diagnosis of symptomatic extraforaminal disc herniation. Thus, a useful method for evaluating the nerve root in order to diagnose symptomatic extraforaminal disc herniation is required.
Twenty-four patients with extraforaminal and combined (extraforaminal with foraminal) lumbar disc herniations were included in this study. Conventional spin-echo sequence and 3D coronal fast-field echo sequences with selective water excitation by using the principles of the selective excitation technique (Proset imaging) were acquired. Indentation and swelling of the nerve roots and dorsal root ganglion (DRG) in the symptomatic sides and levels were evaluated on the basis of 3D MR rendering images of the lumbar spine. The tilting angle of the nerve root in the symptomatic side was compared with those in the asymptomatic contralateral side again on the basis of the 3D MR rendering images.
Dorsal root ganglion indentation without swelling of the nerve roots was found in 7 patients whereas that with swelling of the nerve roots was observed in 6 patients. Swelling of the entire segment of the nerve from nerve root to spinal nerve (n = 9) or only the spinal nerve (n = 2) was observed in 11 patients. Compared with the contralateral nerve root, 7 patients exhibited a tilting angle abnormality of the ipsilateral nerve root.
Based on lumbosacral radiculography through 3D MR rendering, important findings related to the diagnosis of symptomatic extraforaminal disc herniation include swelling of DRG and/or nerve roots and DRG indentation. Ultimately, 3D MR lumbosacral radiculography is a very useful method in the diagnosis of the symptomatic extraforaminal disc herniation.
使用三维（3D）磁共振（MR）渲染对椎间孔外椎间盘突出症患者进行腰骶神经根造影的回顾性分析。
探讨 3D MR 渲染腰骶神经根造影在诊断有或无椎间孔外延伸的症状性椎间孔外椎间盘突出症中的意义。
由于在常规轴位和矢状位图像上准确评估椎间孔外区域较为困难，因此有时会忽略椎间孔外椎间盘突出症。此外，沿椎间孔的斜冠状图像和 MR 脊髓造影可能无法清楚显示神经根变化的详细全貌。此外，检测神经根的形态变化对于诊断症状性椎间孔外椎间盘突出症非常重要。因此，需要一种有用的方法来评估神经根，以诊断症状性椎间孔外椎间盘突出症。
本研究纳入了 24 例有椎间孔外和（椎间孔外合并椎间孔内）腰椎间盘突出症的患者。采集常规自旋回波序列和基于选择性激发技术（Proset 成像）的选择性水激发三维冠状快速回波序列。根据腰椎 3D MR 渲染图像评估症状侧和水平的神经根和背根神经节（DRG）的受压和肿胀。再次根据 3D MR 渲染图像比较症状侧神经根的倾斜角度与无症状对侧的倾斜角度。
7 例患者发现神经根无肿胀的 DRG 受压，6 例患者发现神经根肿胀。11 例患者观察到神经根从神经根到脊神经的整个节段肿胀（n=9）或仅脊神经肿胀（n=2）。与对侧神经根相比，7 例患者出现同侧神经根倾斜角度异常。
基于 3D MR 渲染的腰骶神经根造影，与症状性椎间孔外椎间盘突出症诊断相关的重要发现包括 DRG 和/或神经根肿胀和 DRG 受压。最终，3D MR 腰骶神经根造影是诊断症状性椎间孔外椎间盘突出症的一种非常有用的方法。
