Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Root Images between Post-Myelographic Computed Tomography and Magnetic Resonance Imaging in Patients with Lumbar Radiculopathy

  • Park, Chun-Kun (Good Doctor Teun Teun Hospital) ;
  • Lee, Hong-Jae (Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ryu, Kyeong-Sik (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2016.09.26
  • Accepted : 2017.02.21
  • Published : 2017.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : To evaluate the diagnostic value of computed tomography-myelography (CTM) compared to that of magnetic resonance imaging (MRI) in patients with lumbar radiculopathy. Methods : The study included 91 patients presenting with radicular leg pain caused by herniated nucleus pulposus or lateral recess stenosis in the lumbar spine. The degree of nerve root compression on MRI and CTM was classified into four grades. The results of each imaging modality as assessed by two different observers were compared. Visual analog scale score for pain and electromyography result were the clinical parameters used to evaluate the relationships between clinical features and nerve root compression grades on both MRI and CTM. These relationships were quantified by calculating the receiver-operating characteristic curves, and the degree of relationship was compared between MRI and CTM. Results : McNemar's test revealed that the two diagnostic modalities did not show diagnostic concurrence (p<0.0001). Electromyography results did not correlate with grades on either MRI or CTM. The visual analog pain scale score results were correlated better with changes of the grades on CTM than those on MRI (p=0.0007). Conclusion : The present study demonstrates that CTM could better define the pathology of degenerative lumbar spine diseases with radiculopathy than MRI. CTM can be considered as a useful confirmative diagnostic tool when the exact cause of radicular pain in a patient with lumbar radiculopathy cannot be identified by using MRI. However, the invasiveness and potential complications of CTM are still considered to be pending questions to settle.

Keywords

References

  1. Bartynski WS, Lin L : Lumbar root compression in the lateral recess: MR imaging, conventional myelography, and CT myelography comparison with surgical confirmation. AJNR Am J Neuroradiol 24 : 348-360, 2003
  2. Bischoff RJ, Rodriquez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS : A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis. J Spinal Disord 6 : 289-295, 1993 https://doi.org/10.1097/00002517-199306040-00002
  3. Botwin KP, Gruber RD : Lumbar spinal stenosis: anatomy and pathogenesis. Phys Med Rehabil Clin N Am 14 : 1-15, v, 2003 https://doi.org/10.1016/S1047-9651(02)00063-3
  4. Breivik EK, Bjornsson GA, Skovlund E : A comparison of pain rating scales by sampling from clinical trial data. Clin J Pain 16 : 22-28, 2000 https://doi.org/10.1097/00002508-200003000-00005
  5. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB : Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res 157 : 191-199, 1981
  6. Chiodo A, Haig AJ, Yamakawa KS, Quint D, Tong H, Choksi VR : Needle EMG has a lower false positive rate than MRI in asymptomatic older adults being evaluated for lumbar spinal stenosis. Clin Neurophysiol 118 : 751-756, 2007 https://doi.org/10.1016/j.clinph.2006.12.004
  7. Colosimo C, Gaudino S, Alexandre AM : Imaging in degenerative spine pathology. Acta Neurochir Suppl 108 : 9-15, 2011
  8. Emch TM, Modic MT : Imaging of lumbar degenerative disk disease: history and current state. Skeletal Radiol 40 : 1175-1189, 2011 https://doi.org/10.1007/s00256-011-1163-x
  9. Fardon DF, Milette PC; Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology : Nomenclature and classification of lumbar disc pathology. Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976) 26 : E93-E113, 2001 https://doi.org/10.1097/00007632-200103010-00006
  10. Grams AE, Gempt J, Forschler A : Comparison of spinal anatomy between 3-Tesla MRI and CT-myelography under healthy and pathological conditions. Surg Radiol Anat 32 : 581-585, 2010 https://doi.org/10.1007/s00276-009-0601-0
  11. Greiner M, Pfeiffer D, Smith RD : Principals and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med 45 : 23-41, 2000 https://doi.org/10.1016/S0167-5877(00)00115-X
  12. Harreld JH, McMenamy JM, Toomay SM, Chason DP : Myelography: a primer. Curr Probl Diagn Radiol 40 : 149-157, 2011 https://doi.org/10.1067/j.cpradiol.2010.06.003
  13. Jackson RP, Cain JE Jr, Jacobs RR, Cooper BR, McManus GE : The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. A comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging. Spine (Phila Pa 1976) 14 : 1362-1367, 1989 https://doi.org/10.1097/00007632-198912000-00013
  14. Janssen ME, Bertrand SL, Joe C, Levine MI : Lumbar herniated disk disease: comparison of MRI, myelography, and post-myelographic CT scan with surgical findings. Orthopedics 17 : 121-127, 1994
  15. Jindal G, Pukenas B : Normal spinal anatomy on magnetic resonance imaging. Magn Reson Imaging Clin N Am 19 : 475-488, 2011 https://doi.org/10.1016/j.mric.2011.05.013
  16. Kang SH, Choi SH, Seong NJ, Ko JM, Cho ES, Ko KP : Comparative study of lumbar magnetic resonance imaging and myelography in young soldiers with herniated lumbar disc. J Korean Neurosurg Soc 48 : 501-505, 2010 https://doi.org/10.3340/jkns.2010.48.6.501
  17. Kang YS, Kang JH, Kim MC, Yu BY, Sung EJ, Lee SY, et al. : Cutoff of percent body fat to predict obesity and metabolic risk in children and adolescents: 2007 children and adolescent physical growth standard. Korean J Fam Med 30 : 887-894, 2009 https://doi.org/10.4082/kjfm.2009.30.11.887
  18. Kent DL, Haynor DR, Larson EB, Deyo RA : Diagnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography. AJR Am J Roentgenol 158 : 1135-1144, 1992 https://doi.org/10.2214/ajr.158.5.1533084
  19. Mondelli M, Aretini A, Arrigucci U, Ginanneschi F, Greco G, Sicurelli F : Clinical findings and electrodiagnostic testing in 108 consecutive cases of lumbosacral radiculopathy due to herniated disc. Neurophysiol Clin 43 : 205-215, 2013 https://doi.org/10.1016/j.neucli.2013.05.004
  20. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N : MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology 230 : 583-588, 2004 https://doi.org/10.1148/radiol.2302021289
  21. Price DD, McGrath PA, Rafii A, Buckingham B : The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17 : 45-56, 1983 https://doi.org/10.1016/0304-3959(83)90126-4
  22. Sandow BA, Donnal JF : Myelography complications and current practice patterns. AJR Am J Roentgenol 185 : 768-771, 2005 https://doi.org/10.2214/ajr.185.3.01850768
  23. Song KJ, Choi BW, Kim GH, Kim JR : Clinical usefulness of CT-myelogram comparing with the MRI in degenerative cervical spinal disorders: is CTM still useful for primary diagnostic tool? J Spinal Disord Tech 22 : 353-357, 2009 https://doi.org/10.1097/BSD.0b013e31817df78e
  24. Wildermuth S, Zanetti M, Duewell S, Schmid MR, Romanowski B, Benini A, et al. : Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology 207 : 391-398, 1998 https://doi.org/10.1148/radiology.207.2.9577486

Cited by

  1. The Clinical Diagnostic Value of Lumbar Intervertebral Disc Herniation Based on MRI Images vol.2021, pp.None, 2017, https://doi.org/10.1155/2021/5594920