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Does postcontrast MR enhancement in lumbar disk herniation have prognostic value?
M Gallucci1, A Bozzao, B Orlandi
1Department of Radiology, University of L'Aquila, Italy.
Objective:
The aim of our study was to evaluate the prognostic value, if any, of Gd-enhanced MR in patients with lumbar disk herniation.
Materials And Methods:
Fifteen patients undergoing conservative treatment for acute lumbar disk herniation were included in a prospective Gd-DTPA follow-up MR study. In each patient, the size of the herniation was measured, and, according to the changes in pathology that occurred, patients were divided into four categories. In addition, on the basis of the clinical outcome patients were divided into three classes.
Results:
In 11 of 15 patients, MR performed in the acute phase of the disease showed Gd-DTPA enhancement around the herniated disk; in all cases, disk herniation was markedly reduced at follow-up MRIs. The clinical outcome was good. In the remaining four cases, no enhancement was evident in the acute phase or at follow-up MRIs; no modification in the size of disk herniation was demonstrated at follow-up in two. Symptoms were unchanged in two patients and mildly improved in one.
Conclusion:
Epidural enhancement, which is likely related to an inflammatory process, seems to play a role in the modification of the size of disk herniation.
Insights
Gadolinium-enhanced MRI can predict outcomes for lumbar disc herniation. Enhancement around the herniated disc indicates a good prognosis and reduction in size.
Area of Science:
- Radiology
- Neurosurgery
- Orthopedics
Background:
- Lumbar disk herniation is a common condition.
- Prognostic indicators for lumbar disk herniation are crucial for treatment planning.
Purpose of the Study:
- To evaluate the prognostic value of Gadolinium-enhanced Magnetic Resonance Imaging (Gd-enhanced MR) in patients with lumbar disk herniation.
Main Methods:
- A prospective study included 15 patients with acute lumbar disk herniation undergoing conservative treatment.
- Gd-DTPA enhanced follow-up MR imaging was performed.
- Patients were categorized based on pathological changes and clinical outcomes.
Main Results:
- 11 out of 15 patients showed Gd-DTPA enhancement around the herniated disc in the acute phase, with marked reduction in size at follow-up and good clinical outcomes.
- The remaining 4 patients had no enhancement, with minimal or no change in herniation size and less favorable clinical outcomes.
Conclusions:
- Epidural enhancement on Gd-enhanced MR imaging, likely due to inflammation, appears to correlate with favorable modification in the size of lumbar disk herniation.