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A Novel Technique Using Magnetic Resonance Imaging in the Supine and Prone Positions for Diagnosing Lumbar Adhesive
Rikuhei Tsuchida1, Masahiko Sumitani1,2, Kenji Azuma2
1Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.
Background:
Lumbar adhesive arachnoiditis is a debilitating neuropathic condition and is difficult to diagnose owing to lack of definitive diagnostic criteria. By focusing on the intrathecal mobility of nerve roots, we assessed whether useful diagnostic criteria could be established using MRI.
Methods:
Seventeen patients with a high risk for lumbar adhesive arachnoiditis and 18 no-risk patients with chronic low back pain and/or leg pain participated in this study. The patients underwent MRI in both the supine and prone positions. Eleven axial T2-weighted images between the L2 and L5/S levels were obtained, and the proportion of the low-intensity area in the dorsal half to the total low-intensity area in the dural sac was calculated for each axial view.
Results:
At some lumbar levels, the low-intensity area in the dorsal half of the dural sac was relatively larger in patients with a high risk for lumbar adhesive arachnoiditis than in the no-risk patients. In the no-risk group, the proportion of the low-intensity area in the dorsal half in the supine position was significantly higher than that in the prone position at all lumbar levels. However, in the high-risk group, at some levels, the proportions were not significantly different in the dorsal half of the dural sac between the supine and prone positions.
Conclusion:
In patients with a known risk for lumbar adhesive arachnoiditis, nerve roots lose their potential to migrate in the dural sac in the gravitational force direction on MRI.
Insights
Magnetic resonance imaging (MRI) can help diagnose lumbar adhesive arachnoiditis by assessing nerve root mobility. Reduced nerve root movement in the dural sac on MRI indicates this debilitating condition.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Lumbar adhesive arachnoiditis is a challenging neuropathic condition with no definitive diagnostic criteria.
- Diagnosis is often difficult due to the lack of specific markers.
Purpose of the Study:
- To investigate if MRI-based assessment of intrathecal nerve root mobility can establish diagnostic criteria for lumbar adhesive arachnoiditis.
- To evaluate the utility of MRI in diagnosing this condition by analyzing nerve root movement.
Main Methods:
- Compared MRI findings in 17 patients at high risk for lumbar adhesive arachnoiditis with 18 control patients.
- Acquired T2-weighted axial MRI images in supine and prone positions from L2 to L5/S.
- Calculated the proportion of low-intensity area in the dorsal dural sac to assess nerve root mobility.
Main Results:
- A larger dorsal low-intensity area was observed in high-risk patients compared to controls at certain lumbar levels.
- In controls, dorsal area proportion significantly decreased from supine to prone positions.
- In high-risk patients, this positional change was not significant at some levels, indicating restricted mobility.
Conclusions:
- Nerve roots in patients with lumbar adhesive arachnoiditis exhibit reduced mobility within the dural sac.
- MRI can reveal this loss of mobility, aiding in the diagnosis of lumbar adhesive arachnoiditis.
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