title: Impact of MR Neurography in Patients with Chronic Cauda Equina Syndrome Presenting as Chronic Pelvic Pain and Dysfunction.
abstract: Chronic cauda equina syndrome, defined as persistent damage of the cauda equina nerve roots within the spinal canal can be a challenging diagnosis with varied presentations. MR neurography imaging is more commonly being used to evaluate the lumbosacral spine of patients suspected of having subacute or chronic cauda equina syndrome. Our aim was to evaluate the impact of lumbosacral plexus MR neurography in the diagnostic thinking and therapeutic management of patients presenting with chronic pelvic pain and dysfunction and suspected chronic cauda equina syndrome.
  
  
  
  Consecutive MR neurography lumbosacral plexus examinations at our institution were reviewed retrospectively. Relevant data collected included the following: patient demographics, clinical history, pertinent physical examination findings, preimaging diagnostic impression, prior MR imaging lumbar spine findings, MR neurography findings, postimaging diagnosis, and postimaging treatment plan. The impact of imaging on the preimaging clinical diagnosis and therapeutic management was evaluated.
  
  
  
  Of 185 studies of patients who presented with chronic pelvic pain and/or dysfunction, 23 with clinically suspected chronic cauda equina syndrome and imaging findings were included in the study (2 subjects were lost to follow-up). The mean ages were 53 ± 12 years and 53 ± 16 years for men and women, respectively. The common etiologies included arachnoiditis (n= 8), tethered cord (n= 2), and simple/Tarlov cysts (n= 3). Eighteen of 23 (78%) subjects had a change in diagnosis resulting from MR neurography findings, and 5/23 (22%) had no change. Seventeen of 21 (81%) subjects had a change in management, and 4/21 (19%) had no change.
  
  
  
  MR neurography impacts the diagnosis and therapeutic management of patients with suspected chronic cauda equina syndrome.
authors.affiliation: From the Departments of Physical Medicine and Rehabilitation (J.R.P., K.M.S.).
authors.forename: J R
authors.identifier: 0000-0003-1230-7360
authors.initials: JR
authors.lastname: Petrasic
authors.affiliation: Radiology (A.C.), University of Texas Southwestern Medical Center, Dallas, Texas avneesh.chhabra@utsouthwestern.edu.|Department of Radiology (A.C.), Johns Hopkins University, Baltimore, Maryland.
authors.forename: A
authors.identifier: 0000-0002-0718-3802
authors.initials: A
authors.lastname: Chhabra
authors.affiliation: From the Departments of Physical Medicine and Rehabilitation (J.R.P., K.M.S.).
authors.forename: K M
authors.identifier: 0000-0002-7905-1606
authors.initials: KM
authors.lastname: Scott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D006801:Humans; D008160:Lumbosacral Plexus / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009436:Neural Tube Defects / Q000150:complications / Q000000981:diagnostic imaging; D059906:Neuroimaging / Q000379:methods*; D017699:Pelvic Pain / Q000000981:diagnostic imaging* / Q000628:therapy*; D011128:Polyradiculopathy / Q000000981:diagnostic imaging* / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D052958:Tarlov Cysts / Q000150:complications / Q000000981:diagnostic imaging