Significance of Perianular Enhancement Associated With Anular Tears on Magnetic Resonance Imagings in Diagnosis of Radiculopathy

Retrospective analysis of magnetic resonance imaging (MRI) and clinical findings about chemical radiculitis-associated anular tear in patients with radiculopathy. To investigate MRI findings of the chemical radiculitis caused by anular tears and to determine whether chemical radiculitis detected by...

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Bibliographic Details
Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2008-10, Vol.33 (22), p.2440-2443
Main Authors: WOO MOK BYUN, SANG HO AHN, AHN, Myun-Whan
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Cerebrospinal fluid. Meninges. Spinal cord
Contrast Media - administration & dosage
Female
Humans
Injections, Epidural
Intervertebral Disc - diagnostic imaging
Intervertebral Disc - pathology
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Nervous system
Nervous system (semeiology, syndromes)
Neurology
Pain - etiology
Pain - pathology
Pain Measurement
Predictive Value of Tests
Radiculopathy - complications
Radiculopathy - diagnostic imaging
Radiculopathy - pathology
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Retrospective Studies
Rupture
Spinal Nerve Roots - diagnostic imaging
Spinal Nerve Roots - pathology
Tomography, X-Ray Computed
Young Adult
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Description
Summary:Retrospective analysis of magnetic resonance imaging (MRI) and clinical findings about chemical radiculitis-associated anular tear in patients with radiculopathy. To investigate MRI findings of the chemical radiculitis caused by anular tears and to determine whether chemical radiculitis detected by MRI is the cause of radiculopathy. Many studies document that irritation of adjacent nerve roots by a chemical mediator of inflammation from the nucleus pulposus may result in radiculopathy. Computed tomography (CT) discography may be the best examination for diagnosing discogenic chemical radiculitis but is too invasive. A reliable imaging method for replacing invasive provocative CT discography and diagnosing chemical radiculitis is required. The study population consisted of 12 patients with pain referred to leg(s) with or without low back pain who underwent lumbar spine MRI. All cases of our study demonstrated perianular enhancement caused by chemical radiculitis associated with anular tears. Patterns and locations of perianular enhancement adjacent to anular tears on MRI were assessed. MRI findings were compared with clinical symptoms and/or provocative transforaminal epidural injection (n = 6). For documentation of the relationship between perianular enhancement and radiculopathy, provocative CT discography was performed in 2 cases. Perianular enhancement associated with anular tears revealed thick linear patterns (2.5-7 mm thickness) along margins of anular tears on contrast enhanced axial T1-weighted images with fat suppression. Locations of perianular enhancement adjacent to anular tears were at foraminal (n = 6) and extraforaminal portions (n = 6). CT discography showed a leak of contrast from anular tear to the perianular regions. Pain reproduction at contrast leak level during discography showed concordant pain. There was an apparent correlation between perianular enhancement on MRI and clinical symptoms or provocative epidural nerve root injection in all cases. The perianular enhancement adjacent to anular tears on MRI may be relevant in the diagnosis of symptomatic chemical radiculitis.
ISSN:0362-2436
1528-1159
DOI:10.1097/BRS.0b013e318188b9a8