title: Gadolinium-DTPA enhancement of symptomatic nerve roots in MRI of the lumbar spine.
abstract: Disc prolapse presenting with sciatica may be associated with enhancement of the symptomatic nerve root following magnetic resonance imaging (MRI) with intravenous gadolinium (Gd)-DTPA. Previous studies have shown, however, that this does not occur in all cases. The aim of this study was to assess the incidence of nerve root enhancement in patients with sciatica and disc prolapse and to try to identify any specific features that might be associated with the phenomenon. A total of 227 patients presenting with low back pain and/or sciatica underwent a MRI study of the lumbar spine with intravenous contrast enhancement. Nineteen of 81 (23.5 %) patients with disc prolapse demonstrated nerve root enhancement. Nerve root enhancement had a highly significant association with sequestrated disc lesions (13/19, 68 %; P < 0.0005), and was primarily seen in the symptomatic ipsilateral nerve root (16/19, 84 %). The sensitivity of nerve root enhancement associated with disc prolapse was 23.5 % with a specificity of 95.9 %, a positive predictive value of 76 % and a negative predictive value of 69.3 %. Nerve root enhancement may be indicative of the symptomatic level but its poor sensitivity negates the routine use of Gd-DTPA in MRI for sciatica.
authors.affiliation: Department of Diagnostic Imaging, The Institute of Orthopaedics, The Robert Jones & Agnes Hunt Orthopaedic & District Hospital NHS Trust, Oswestry, Shropshire SY10 7AG, UK.
authors.forename: P N
authors.initials: PN
authors.lastname: Tyrrell
authors.forename: V N
authors.initials: VN
authors.lastname: Cassar-Pullicino
authors.forename: I W
authors.initials: IW
authors.lastname: McCall
mesh_terms: D003287:Contrast Media / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007275:Injections, Intravenous; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D012585:Sciatica / Q000150:complications / Q000175:diagnosis; D013126:Spinal Nerve Roots / Q000473:pathology*
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA