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Updated: Jan 6, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Grading cervical neural foraminal stenosis via 3-T MR nerve/bone fusion imaging compared with T2-weighted imaging
Dongmei Jiang1,2, Shuyi Lei1,2, Junhuan Hong1,2
1Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, P.R. China.
Objectives:
To investigate the value of 3-T MR nerve/bone fusion imaging in grading cervical neural foraminal stenosis (CNFS).
Materials And Methods:
Fifty-eight healthy participants and 23 patients with suspected cervical radiculopathy were prospectively enrolled. MR nerve and bone sequences were 3D-T2-weighted fast field echo (3D-T2-FFE) and fast field echo resembling a CT using restricted echo-spacing (FRACTURE), respectively. The agreements of overall image quality, image artifacts, the width of cervical neural foramen (WCNF), and the width of extraforaminal nerve root (WENR) were assessed on 3D-T2-FFE/FRACTURE fusion images in healthy participants. The detection rate, visibility score of extraforaminal nerve root (ENR), and the CNFS grade were compared for patients between the 3D-T2-FFE/FRACTURE fusion image and the T2-weighted images (T2WI). The correlation between CNFS grade and the neck disability index (NDI) and numerical pain scale (NPS) was assessed.
Results:
The agreements were moderate to good for overall image quality and image artifacts (κ = 0.614-0.867), and good to excellent for WCNF and WENR (ICC = 0.755-0.931). The detection rate of ENR on 3D-T2-FFE/FRACTURE fusion (184/184, 100%) was higher than that on T2WI (116/184, 63.04%). The agreements for CNFS grade were substantial to nearly perfect on 3D-T2-FFE/FRACTURE fusion (κ = 0.774-0.837), and moderate on T2WI (κ = 0.436-0.636). The CNFS grade on 3D-T2-FFE/FRACTURE fusion was moderately correlated with NDI (ρ = 0.49)/NPS (ρ = 0.55), while there was no correlation between T2WI and NDI/NPS.
Conclusion:
Compared with T2WI, 3D-T2-FFE/FRACTURE fusion provides a more reliable and reproducible evaluation of the severity of CNFS. The CNFS grade based on 3D-T2-FFE/FRACTURE fusion is associated with clinical symptoms.
Critical Relevance Statement:
The use of 3-T MR nerve/bone fusion imaging in clinical practice may facilitate a one-stop-shop, radiation-free, and more precise approach to comprehensively evaluate CNFS.
Key Points:
Grading cervical foraminal stenosis is relatively difficult in clinical practice. MR nerve/bone fusion grading of cervical foraminal stenosis is more reliable. MR nerve/bone fusion grading of cervical foraminal stenosis correlates with symptoms.
