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Radiculopathy or sacroiliac arthritis?

Case Study
Tanji, Hajime Northern Fukushima Medical Center • Japan
Yabuki, Shoji, MD, DMSc Fukushima Medical University School of Medecine • Japan

Patient history

In this patient with left hip pain as main complaint, a combination of left sacroiliac arthritis and left S1 radiculopathy was considered. Pain temporarily improved by the left S1 nerve root block, so nerve root disease was suspected to be the cause.

MR examination

The patient underwent MRI with 3D NerveVIEW on Achieva 3.0T dStream at Northern Fukushima Medical Center.

Images

Click on an image to enlarge
Radiculography, nerve root block
Radiculography, nerve root block
T2W TSE sagittal NerveVIEW MIP
T2W TSE sagittal
NerveVIEW MIP

Diagnosis

There were no obvious findings in routine MRI. With 3D NerveVIEW imaging, the left S1 nerve root is well visualized from proximal to distal. No abnormality seen in the nerve root (arrows), so pain is not due to radiculopathy.

Diagnosis is sacroiliac arthritis.

Impact of NerveVIEW

Pain due to nerve injury and arthritis can show similar symptoms. Since part of this patient’s pain is in the sacroiliac joint, the pain ceased when a root block was done, but often recurred, so the patient underwent many block treatments.

Finally, the entire nerve was well depicted with NerveVIEW, and no significant abnormalities were observed. In conclusion, the nerve root block relieved pain only by blocking the place to convey the pain, and the actual cause was not there. This case illustrates that NerveVIEW can be useful not only in identifying lesions but also for ruling out lesions..

 

 

Read more in

FieldStrength article: Direct visualization on the nerves can influence surgery descisions.

 

 

 

 

Results from case studies are not predictive of results in other cases. Results in other cases may vary.



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Oct 25, 2018

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Case Study
Achieva 3.0T dStream
arthritis, dStream, Lumbar spine, MR neurography, Musculoskeletal, Nerve, nerve root, NerveVIEW, Neuro, radiculopathy, sacroiliac joint, Spine
 

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