The Correlation Studies Of The Cervical Transforaminal Ligaments And The Nerve Entrapment Of Cervical Radiculopathy Based On Magnetic Resonance Imaging

Purpose:To evaluate the utility of MR 3D-FIESTA sequence to study cervical transforaminal ligaments(TFLs)using the anatomical results of cadavers as the gold standard.To evaluate the correlation between TFLs compressing brachial plexus and cervical radiculopathy by showing TFLs in vivo cervical vertebra with 3D-FIESTA sequence.Combined with the IDEAL displaying brachial plexus,to evaluate the application value of DTI parameter for never entrapment.Methods:The cervical regions of five embalmed adult cadavers were scanned using the MR 3D-FIESTA sequence.The TFLs structures in the intervertebral foraminas(IVFs)between C4 and T1 in the MRI scans were identified by a radiologist.The TFLs were affirmed in the IVFs between C4 and T1 in the specimens by an anatomist.Using the anatomical results of the cadavers as the gold standard,the utility of the MR 3D-FIESTA sequence for distinguishing cervical TFLs was calculated.We selected 10 patients with cervical radiculopathy and 10 individuals of healthy subjects,and the 10 patients without herniation of the intervertebral disc,facet joint spondylosis and trauma.The IVFs between C4 and T1 were scanned by 3D-FIESTA sequence.Display rate of TFLs was calculated.The correlations were evaluate between TFLs and cervical radiculopathy.We selected 8 patients with cervical radiculopathy whose nerve roots were compressed from anterior 10 patients with cervical radiculopathy.The patients were scanned by IDEAL and DTI,separately,and made by DTT post-processing.The entrapment positions of the brachial plexuses were determined through the above technicals.FA values and ADC values were measureed respectively in the entrapment positions and the same level contralateral positions for brachial plexuses.Results:MR 3D-FIESTA sequences could clearly show cervical TFLs.The results obtained by the radiologist using the MR 3D-FIESTA sequence to identify TFLs were as follows:specificity 96.2%,sensitivity 76.5%,PPV 92.9%,NPV 86.2%,and accuracy 88.4%.20 cases of the research object with C4-T1 included 160 IVFs,and display rate of TFLs was approximately 18.8%.10 patients of cervical radiculopathy with C4-T1 included 80 IVFs.Among them,there were 17 TFLs,10 TFLs proliferous hypertrophy caused nerves entrapment,and the symptoms being produced with 8 TFLs compressing nerve was consistent with cervical radiculopathy.The correlations between TFLs and cervical radiculopathy were as follows:specificity 96.8%,sensitivity 80.0%,PPV 80.0%,NPV 96.8%.10 individuals of healthy subject with C4-T1 included 80 IVFs,and among them,there were 13 TFLs in the IVFs,10 TFLs proliferous hypertrophy caused nerves entrapment.IDEAL could clearly show brachial plexuses.DTT could display the neural anatomy,and nerve distortion,partial interrupt in the entrapment positions.FA values and ADC values were 0.232±0.046 and 1.958±0.327e-9mm2/s,respectively,in the entrapment positions for brachial plexuses.FA values and ADC values were 0.284±0.045 and 1.950±0.308e-9mm2/s,respectively,in the same level contralateral positions for brachial plexuses.Conclusion:MR 3D-FIESTA sequences could affirm cervical TFLs that has high clinical value.In the 3D-FIESTA sequence scans that the radiologist believed to indicate the presence of a cervical TFLs,the probability that the TFLs existed was approximately 93%.In the same way,if no TFLs was present,the probability that TFLs existed was 14%.MR 3D-FIESTA sequences could clearly display cervical TFLs in vivo cervical vertebra and the relation between TFLs and nerve roots.If 3D-FIESTA sequence scans display that the TFLs compressed nerves,the probability that the TFLs caused nerves entrapment was approximately 80.0%.In the same way,if no nerves entrapment,the probability that a cervical radioculopathy existed was 3.2%.IDEAL displaying brachial plexuses could hint the position of entrapment nerves.DTI could quantitative evaluat entrapment of the nerve roots.DTT could display the neural anatomy and the entrapment positions.DTI has potential clinical application ability for evaluating the nerve entrapment in cervical radiculopathy.