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MR Imaging of Facet Synovitis and Facet-Related Pain in the Cervical and Lumbar Spine: The Diagnostic Value of Fat-Saturated Magnetic Resonance Imaging 2005

Interventional Spine

Leo F Czervionke, MD
Douglas S Fenton , MD, ASSR Member

Purpose

The application of fat suppression technique for the diagnosis of facet synovitis is not widely used presently in imaging practice. We report the use of fat saturated MR imaging techniques for spine imaging, used to highlight signal alterations in the zygapophysial (facet) joints, adjacent bone marrow, and in the soft tissues adjacent to the facets, an imaging pattern which most likely reflects inflammatory facet osteoarthropathy (facet synovitis). The purpose of this paper is to illustrate the MR imaging pattern of facet synovitis in the lumbar and cervical region.

Methods & Materials

We retrospectively reviewed medical records studies of 50 patients, whose MR imaging studies showed evidence of T2 signal hyperintensity and/or contrast enhancement of the facets on fat saturated MR images of the spine. These cases were randomly selected from hundreds of clinical cases with this MR appearance obtained over the past 4 years during routine MR imaging of the spine, using a standard frequency selective fat suppression technique.

Results

Clinical presentation and MR imaging patterns of patients with facet synovitis in the cervical and lumbar region are reported and illustrated using selected case studies. All 50 patients reviewed had back pain, neck pain or radicular pain referable to the level of facet synovitis, as indicated on the MR images. 24 of 50 patients received facet injections based on their clincal findings and on the MR imaging findings of facet synovitis. 22 of the 24 facet injections were performed by the authors of this paper using a combined intraarticular and periarticular facet injection method, using anesthetic and steroid injection mixture. Of 20 injected patients that were followed up, 18 of these 20 patients (90%) reported subjectively a significant reduction or complete resolution of their back pain and/or leg pain following the facet injections. 2 of the 20 patients (10%) reported no improvement in their back pain following injection. One of these 2 patients had severe central canal stenosis at 2 lumbar levels in addition to the facet synovitis; the other patient, who reported no relief post injection, had evidence of extensive edema or myositis of the multifidus muscle on pre-injection MR study. The majority of patients followed reported a return of their symptoms 3 weeks to 3 months following the facet injections.

Conclusion

Detection of active inflammation within and surrounding the facet joints (facet synovitis) is possible with MR imaging using a frequency selective fat saturation technique with or without the use of paramagnetic contrast agent. It is not possible to reliably detect active inflammation in the facets on routine MR imaging, without the use of fat suppression. The characteristic MR appearance correlates with the patient�s pain. MR imaging with fat saturation is a valuable tool in choosing the appropriate level or levels for facet injection. It is recommended that MR imaging sequences with fat suppression be implemented in the routine protocol for MR imaging of the spine.

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