Lane J I, Koeller K K, Atkinson J L
Department of Radiology, Naval Hospital, Oakland, Calif. 94627-5000.
AJNR Am J Neuroradiol. 1994 Aug;15(7):1317-25.
To evaluate the clinical significance of continuous intradural lumbosacral nerve root enhancement in symptomatic patients without prior lumbar surgery.
Fifty-three patients without prior back surgery, referred to our institution for evaluation of low-back pain and radiculopathy, were studied with gadolinium-enhanced MR (0.1 mmol/kg) of the lumbar spine. Scans were reviewed for the presence of lumbosacral nerve root enhancement and any associated nerve root compression. Results were correlated with clinical history and physical examinations.
Seventeen continuously enhancing nerve roots and two enhancing fila terminale were observed in 13 patients. Eight of 17 (47%) had no referable symptoms. Nine of these nerve roots (53%) were not associated with any degree of nerve root compression. Seven cases (41%) were noted to have flow-related enhancement on the entry section of the T1-weighted axial sequence.
Lumbosacral nerve root enhancement correlates poorly with clinical radiculopathy. The use of contrast enhancement to detect lumbosacral nerve root enhancement in cases in which the unenhanced scan is less than diagnostic is not warranted. The high association between lumbosacral nerve root enhancement and entry-section flow-related enhancement suggests that these enhancing structures within the cauda equina are vessels. It is likely that lumbosacral nerve root enhancement represents intravascular enhancement of radicular veins and not a breakdown in the blood-nerve barrier.
评估在未接受过腰椎手术的有症状患者中，腰骶神经根持续强化的临床意义。
53例未接受过背部手术、因腰痛和神经根病前来我院评估的患者接受了腰椎钆增强磁共振成像（0.1 mmol/kg）检查。对扫描结果进行回顾，以确定腰骶神经根强化情况及是否存在相关神经根受压。结果与临床病史和体格检查结果相关。
13例患者中观察到17条持续强化的神经根和2条强化的终丝。17条神经根中有8条（47%）无相关症状。其中9条神经根（53%）与任何程度的神经根受压均无关联。7例（41%）在T1加权轴位序列的入口段可见血流相关强化。
腰骶神经根强化与临床神经根病的相关性较差。在平扫扫描诊断不明确的情况下，使用对比增强来检测腰骶神经根强化并无必要。腰骶神经根强化与入口段血流相关强化之间的高度关联表明，马尾内这些强化结构为血管。腰骶神经根强化可能代表神经根静脉的血管内强化，而非血神经屏障的破坏。
