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Differentiating epidural fibrosis from disc herniation on contrast-enhanced and unenhanced MRI in the postoperative

Zita Passavanti1,2, Sebastian Leschka3,4, Simon Wildermuth3,4

  • 1Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH 9007, St. Gallen, Switzerland. Zita.Passavanti@kssg.ch.

Skeletal Radiology
|June 12, 2020
PubMed
Abstract

Insights

Gadolinium-enhanced MRI (Gad-MRI) significantly improves diagnostic confidence in differentiating epidural fibrosis from disc herniation in the early months after lumbar spine surgery. However, this benefit diminishes after 18 months post-surgery.

Area of Science:

  • Radiology
  • Medical Imaging
  • Neurosurgery

Background:

  • Postoperative complications after lumbar spine surgery, such as epidural fibrosis and recurrent disc herniation, can be challenging to differentiate using conventional MRI.
  • Gadolinium-based contrast agents (Gad-MRI) may enhance the visualization of these pathologies.

Purpose of the Study:

  • To compare the diagnostic confidence and inter-observer/intra-observer agreement of Gad-MRI versus unenhanced MRI in differentiating epidural fibrosis from disc herniation and assessing lumbar spinal stenosis parameters in postoperative lumbar spines.
  • To evaluate the impact of time elapsed since surgery on the effectiveness of Gad-MRI.

Main Methods:

  • 124 lumbar spine MRI examinations from patients at varying intervals (1-6, 7-18, 19-36, >37 months) post-surgery were reviewed.
  • Two radiologists assessed both Gad-MRI and unenhanced MRI scans, evaluating diagnostic confidence and agreement for specific findings.
  • Statistical analysis included Fisher's exact test and Cohen's kappa to assess agreement.

Main Results:

  • Diagnostic confidence in differentiating epidural fibrosis from disc herniation was significantly higher with Gad-MRI compared to unenhanced MRI within the first 18 months post-surgery.
  • Inter-observer agreement for epidural fibrosis identification was notably better with Gad-MRI in the early postoperative period (1-6 months).
  • Agreement for disc herniation and lumbar spinal stenosis assessment showed inconsistent results, with no clear advantage for Gad-MRI over unenhanced MRI after 18 months.

Conclusions:

  • Gad-MRI enhances diagnostic confidence and agreement for differentiating epidural fibrosis from disc herniation in the initial 6-18 months following lumbar spine surgery.
  • The diagnostic utility of Gad-MRI in this context appears limited beyond 18 months postoperatively.
  • Unenhanced MRI may suffice for evaluating disc herniation and spinal stenosis beyond the early postoperative period.
Keywords:
Epidural fibrosisGadolinium-based contrast agentLumbar spinal stenosisMagnetic resonance imagingPostoperative

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