Patriat Quentin, Prigent François-Victor, Aho Serge, Lenfant Marc, Ramon André, Loffroy Romaric, Lambert Aurelien, Ornetti Paul
Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 21079 Dijon, France.
Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, 21079 Dijon, France.
J Clin Med. 2023 Sep 28;12(19):6250. doi: 10.3390/jcm12196250.
Lumbar radiculopathy mainly originates in the spine (lumbar disc herniation or spine osteoarthritis) but can sometimes be explained by extra-spinal nerve compression or confused with referred pain mimicking radiculopathy. Our main objective was to demonstrate the clinical benefit of the large-field coronal STIR (coroSTIR) sequence in the etiological assessment of lumbar radiculopathy with a duration of more than six weeks.
Six hundred consecutive lumbar MRI scans performed using the same protocol were retrospectively reviewed. Two musculoskeletal radiologists independently assessed the coroSTIR sequence for the presence of extra-spinal anomalies (ESA) that could explain or contribute to the lumbar radiculopathy. The presence of an ESA was then correlated with sex, age, topography and lateralization of radiculopathy, history of vertebral surgery, as well as the presence of a spinal cause explaining the symptoms. Extra-spinal incidentalomas (ESI) with potential clinical impact visible only on the coroSTIR sequence were also systematically reported.
An extra-spinal cause was detected on the coroSTIR sequence in 68 cases (11.3%), mainly gluteal tendinobursitis (30.9%), congestive hip osteoarthritis (25%), degenerative sacroiliac arthropathy (14.7%), or inflammatory sacroilitis (7.3%). Their prevalence was significantly correlated in multivariate regression with age (58 years vs. 53 years, = 0.01), but not with the type of radiating pain (sciatica or cruralgia). The presence of ESI was also frequent (70 cases, 11.7%), including some potentially severe diagnoses (38% of tumor or pseudo-tumor mass requiring further assessment or monitoring).
Considering its acceptable acquisition time, the detection of a significant number of potentially symptom-related extra-spinal anomalies, and the discovery of a non-negligible number of extra-spinal incidentalomas with potential clinical impact, the coronal STIR should be performed systematically in routine MRI for lumbar radiculopathy.
腰椎神经根病主要起源于脊柱（腰椎间盘突出症或脊柱骨关节炎），但有时可由脊柱外神经受压引起，或与模拟神经根病的牵涉痛相混淆。我们的主要目的是证明大视野冠状面短反转恢复（coroSTIR）序列在病程超过六周的腰椎神经根病病因评估中的临床益处。
回顾性分析连续600例采用相同方案进行的腰椎MRI扫描。两名肌肉骨骼放射科医生独立评估coroSTIR序列，以确定是否存在可解释或导致腰椎神经根病的脊柱外异常（ESA）。然后将ESA的存在与性别、年龄、神经根病的部位和侧别、脊柱手术史以及解释症状的脊柱病因的存在情况进行关联分析。还系统报告了仅在coroSTIR序列上可见的具有潜在临床影响的脊柱外偶发瘤（ESI）。
在68例（11.3%）患者的coroSTIR序列上检测到脊柱外病因，主要为臀肌腱囊炎（30.9%）、充血性髋骨关节炎（25%）、退行性骶髂关节炎（14.7%）或炎性骶髂关节炎（7.3%）。在多因素回归分析中，它们的患病率与年龄显著相关（58岁对53岁，P = 0.01），但与放射痛类型（坐骨神经痛或股神经痛）无关。ESI的存在也很常见（70例，11.7%），包括一些可能需要进一步评估或监测的潜在严重诊断（38%为肿瘤或假肿瘤肿块）。
考虑到其可接受的采集时间、能检测到大量可能与症状相关的脊柱外异常以及发现数量不可忽视的具有潜在临床影响的脊柱外偶发瘤，在腰椎神经根病的常规MRI检查中应系统地进行冠状面STIR序列扫描。
