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Updated: Jun 12, 2025
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Utilization, detection rate, and pathologies on lumbosacral plexus MRI: a 25-year institutional experience
Saeed Rahmani1, Christopher Hamilton2, Jeffers K Nguyen2
1Tu Lab for Diagnostic Research, Yale School of Medicine, New Haven, CT Tompkin's East 2, New Haven, CT 06510, United States of America; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America.
Background And Purpose:
Lumbosacral plexus magnetic resonance imaging is infrequently performed, and there is often insufficient exposure for radiologists to confidently recognize pathologies and high-yield imaging trends. Lumbosacral plexopathies frequently present with vague, overlapping, or confounding clinical features that mimic lumbar radiculopathy. This study aimed to describe the frequency and spectrum of plexus-specific pathologies identified on lumbosacral plexus MRI over a 25-year period and to evaluate clinical indications associated with abnormal imaging findings.
Materials And Methods:
This retrospective study reviewed 25 years (2000-2024) of lumbosacral plexus MRI exams performed at a Northeast tertiary referral center. Patient demographics, clinical indications, and reported imaging findings were reviewed, and lumbosacral pathologies were categorized based on etiology. Cases with only lumbar spondylosis were classified as no plexus abnormality to ensure detection rates reflect plexus-specific pathology. Descriptive statistics, chi-square analysis, and univariable and multivariable logistic regression were performed to evaluate factors associated with abnormal MRI findings.
Results:
In 25 years a total of n = 233 lumbosacral plexus MRI exams were performed (representing 0.024 % of all MRIs, 233/968,077). Mean patient age was 52.7 years (SD = 18.4), 57 % of patients were female, 43 % were male. Radiographic abnormalities were identified in 27.9 % (n = 67) of cases. The most frequent pathologies included nerve sheath tumors (n = 12, 5.2 %), other primary neoplasia or metastases (n = 15, 6.4 %), and non-neoplastic compressive neuropathies (n = 11, 4.6 %). Less common notable pathologies included trauma sequelae (n = 5, 2.1 %) and infectious/inflammatory etiologies (n = 6, 2.6 %). The analysis revealed no significant demographic or temporal predictors of abnormal findings, though motor deficits, neuropathy, and trauma were significantly associated with abnormal findings (all, p < 0.05).
Conclusion:
Lumbosacral plexus MRI although an infrequently requested study may reveal abnormal radiologic features in a high percentage of cases. Recognizing lumbosacral plexus MRI trends in yield and clinically relevant pathologies can enhance interpretation and utilization of this specialized examination.
Insights
Lumbosacral plexus MRI, though rarely performed, often reveals abnormalities like tumors and neuropathies. Recognizing these patterns improves diagnosis for conditions mimicking lumbar radiculopathy.
Area of Science:
- Radiology
- Neurology
- Oncology
Background:
- Lumbosacral plexus MRI is infrequently performed, leading to limited radiologist experience with pathologies and imaging trends.
- Lumbosacral plexopathies often present with ambiguous symptoms that can be mistaken for lumbar radiculopathy.
Purpose of the Study:
- To determine the frequency and spectrum of lumbosacral plexus pathologies over 25 years.
- To evaluate clinical indications associated with abnormal lumbosacral plexus MRI findings.
Main Methods:
- Retrospective review of 233 lumbosacral plexus MRI exams from 2000-2024.
- Categorization of pathologies by etiology and analysis of clinical indications and patient demographics.
- Statistical analysis including chi-square and logistic regression to identify predictors of abnormal findings.
Main Results:
- Only 0.024% of all MRIs were lumbosacral plexus exams.
- Abnormalities were found in 27.9% of cases, with nerve sheath tumors, other neoplasms, and compressive neuropathies being most common.
- Motor deficits, neuropathy, and trauma were significantly associated with abnormal findings.
Conclusions:
- Lumbosacral plexus MRI, despite its infrequent use, frequently identifies significant pathologies.
- Understanding imaging trends and common pathologies enhances the interpretation and clinical utility of lumbosacral plexus MRI.
