axial loading during lumbar spine mr imaging can influence ... · axial loading during lumbar spine...
TRANSCRIPT
Axial Loading During Lumbar Spine MR Imaging Can Influence Treatment Decision
for Spinal Stenosis
Barbro Danielson MD, PhD
Göteborg, Sweden
Akio Hiwatashi MD, Toshio Moritani, MD, P-L Westesson MD, PhD, DDS
Rochester NY, USA
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 1 of 12
PAIN and NEUROLOGICAL SYMPTOMS are often accentuated when WALKING and STANDING
Patients are often symptom free in supine position This device simulates the upright patient position
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 2 of 12
Axial loading during Lumbar Spine MR imaging accentuates spinal stenosis
Neurogenic claudication, sciatica
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 3 of 12
Purpose Evaluate if this information
influences treatment decision
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 4 of 12
Patients 20 (6 female, 14 male)
Diagnosis neurogenic claudication, LBP, and/or sciatica,
Mean age 54 yrs (32–75 yrs)
MR scanner 1 Tesla Siemens Sequences Axial T2 without loading
Axial T2 with axial loading
Material and Methods
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 5 of 12
MRI OF THE LUMBAR SPINE
in supine
without and with axial loading
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 6 of 12
Two neurosurgeons
reviewed images
with clinical history
treatment decision?
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 7 of 12
Treatment decision was changed due to decrease in dural cross sectional area
No load Axial load
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 8 of 12
Treatment decision was changed due to worsening lateral recess stenosis
No load Axial load
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 9 of 12
Treatment decision was changed due to increase in size of synovial cyst
No load Axial load
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 10 of 12
Treatment decision
changed from
conservative to operative
6 /20 patients - 30 %
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 11 of 12
Axial loading during MRI of the lumbar spine
• increases the sensitivity for spinal stenosis
• influences the treatment decision
Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 12 of 12