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MR Diskography and CT Diskography with Gadodiamide–Iodinated Contrast Mixture for the Diagnosis of Foraminal Impingement

Jae Sung Myung1, Joon Woo Lee1, Geon Woo Park2, Jin Sup Yeom2, Ja-Young Choi3, Sung Hwan Hong3 and Heung Sik Kang1,3

1 Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-si, Gyeonggi-Do 463-707, Korea.
2 Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi-Do, Korea.
3 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.


Figure 1
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  		Fig. 1A —Simultaneous MR diskography and CT diskography performed in 60-year-old woman with pain radiating to left leg. Axial fat-saturated T1-weighted image shows excellent contrast between gadodiamide of bright signal intensity and adjacent tissues. Note bright signal intensity of gadodiamide shows protruded disk extending to left foraminal zone (arrow) at L4–5.

 

Figure 2
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  		Fig. 1B —Simultaneous MR diskography and CT diskography performed in 60-year-old woman with pain radiating to left leg. Coronal fat-saturated T1-weighted image reveals left foraminal disk protrusion (long arrow); protruding disk directly abuts left L4 nerve root (short arrow) at L4–5.

 

Figure 3
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  		Fig. 1C —Simultaneous MR diskography and CT diskography performed in 60-year-old woman with pain radiating to left leg. Simultaneous postdiskographic CT images reveal no visible disk protrusion at left foraminal zone of L4–5 (arrow) where protrusion is accurately shown on previous MR diskography images (A and B).

 

Figure 4
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  		Fig. 1D —Simultaneous MR diskography and CT diskography performed in 60-year-old woman with pain radiating to left leg. Simultaneous postdiskographic CT images reveal no visible disk protrusion at left foraminal zone of L4–5 (arrow) where protrusion is accurately shown on previous MR diskography images (A and B).

 

Figure 5
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  		Fig. 2A —68-year-old woman with pain radiating to right leg. Coronal MR diskography scan shows disk protrusion (arrow) accurately. Disk height is less than half that of adjacent normal disk, which suggests severe disk degeneration.

 

Figure 6
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  		Fig. 2B —68-year-old woman with pain radiating to right leg. CT diskography scan reveals no visible disk protrusion. It is difficult to differentiate protruded disk from vertebral osteophyte on CT diskography.

 

Figure 7
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  		Fig. 3A —66-year-old woman with pain radiating to right leg. Coronal MR diskography scan reveals right foraminal disk protrusion (arrow) at L5–S1 level. Although foraminal disk protrusion is also clearly certified on CT diskography (B), contrast between protruded disk filled with gadodiamide and adjacent vertebra is excellent on MR diskography.

 

Figure 8
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  		Fig. 3B —66-year-old woman with pain radiating to right leg. Reformatted coronal CT diskography image reveals right foraminal disk protrusion (arrow) at L5–S1 level.

 

Figure 9
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  		Fig. 4A —64-year-old woman with pain radiating to left leg. L5–S1 disk has vacuum (arrow) that interfered with depiction of disk morphology and detailed foraminal structure on axial MR diskography scan.

 

Figure 10
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  		Fig. 4B —64-year-old woman with pain radiating to left leg. Axial CT diskography image shows intervertebral vacuum (short arrow). Difference between vertebral margin (long arrow) and vacuum is clearly seen when compared with MR diskography.

 

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