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Neuroforaminal Stenosis; The Importance Of The Sagittal Plane 2004

Goud, Ajay, M.D., Sattenberg, Ronald, M.D., Romero, Miriam, M.D., Hinz, Brian, R.T., Bergman, Alan, M.D., Bettman, Michael, M.D.

Purpose:
Many lumbosacral spine MRI examinations are interpreted utilizing the axial plane of imaging as a heavily weighted contributor for neuroforaminal evaluation (in particular for stenosis). In a series of cases, it has become evident that there is a scenario in which the axial images can look perfectly normal, and yet there can be significant neuroforaminal nerve impingement as appreciated on the sagittal plane images.

Methods and Materials:
A review of a case series was performed to assess for neuroforaminal nerve compression/ impingement, which appeared undetected on the axial ima ges, and was only detected on the sagittal plane imaging. Such a particular scenario was detected and is demonstrated and illustrated in the exhibit.

Results and Conclusions:
Neuroforaminal stenosis should be sought for in both the sagittal and axial planes on MRI imaging. If only the axial plane of imaging is evaluated, tight stenoses can be missed, as is demonstrated. This is primarily a function of the fact that the axial plane assesses for narrowing in the anteroposterior plane (which is the most common plane of neuroformainal narrowing), however, the craniocaudal plane can also be a vector for narrowing as the exhibit demonstrates. Hence, it should be kept in mind that both the axial and sagittal planes of imaging are necessary for an adequate evaluation for neuroforaminal stenosis.