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Differentiation between contained and noncontained lumbar disk hernias by CT and MR imaging
R Dullerud1, J G Johansen, U L Johnsen
1Department of Radiology, Ullevaal University Hospital, Oslo, Norway.
Acta Radiologica (Stockholm, Sweden : 1987)
|September 1, 1995
Summary
Computed tomography (CT) is more accurate than magnetic resonance (MR) imaging for determining if disk hernias are contained by the posterior longitudinal ligament (PLL). This is vital for selecting patients for percutaneous nucleotomy.
Area of Science:
- Radiology
- Medical Imaging
- Spinal Diagnostics
Background:
- Percutaneous nucleotomy is an effective treatment for contained disk hernias.
- Accurate assessment of posterior longitudinal ligament (PLL) integrity is crucial for patient selection for this procedure.
Purpose of the Study:
- To compare the accuracy of CT and MR imaging in evaluating PLL containment of disk hernias.
- To determine the optimal imaging modality for patients considered for percutaneous nucleotomy.
Main Methods:
- Retrospective analysis of 124 pathologic disks in 114 patients.
- Comparison of CT and MR imaging findings regarding PLL integrity.
- Correlation with clinical presentation and treatment outcomes.
Main Results:
- CT demonstrated higher accuracy than MR imaging in 7 cases, correctly identifying PLL containment.
- MR imaging misinterpreted PLL integrity in 7 cases, leading to erroneous classification as noncontained.
- Both CT and MR imaging had limitations, including overstaging contained hernias and failing to identify noncontained ones.
Conclusions:
- CT is recommended as the primary imaging modality due to its superior accuracy and sensitivity to calcifications, which are contraindications for percutaneous nucleotomy.
- MR imaging may be considered as a secondary examination when CT results are equivocal or inconsistent with clinical findings.