The Value of 3D SPACE MRI in Differentiating between Sequestrated Lumbar Disc Herniation and Tumors: Two Cases and Literature

Authors

  • Hissein M. Fadoul Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
  • Nadeer M. Gharaibeh Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
  • Gang Wu Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China
  • Xiaoming Li Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China

DOI:

https://doi.org/10.3941/jrcr.v18i1.5195

Abstract

Background: Intervertebral disc herniation, defined as the protrusion or extrusion of the disc mass outside the disc space, is common and easy to diagnose on conventional Magnetic Resonance imaging (MRI) or Computed Tomography (CT) scans. However, the sequestrated disc fragments are challenging to detect, and intervertebral disc mass displacement into the dural sac, which can lead to serious neurological problems such as Cauda equina syndrome (CES). The sequestrated disc fragments do not have specific clinical or radiological characteristics that can differentiate an atypical disc mass from a tumor, making the diagnosis difficult preoperatively. Herein, we describe the use of Sampling Perfection with Application Optimized Contrast using different flip angle Evolution in Magnetic Resonance Imaging (3D SPACE MRI) in the diagnosis of the intervertebral disc fragment that mimicked a tumor.

Case presentation: In this study, we report two cases of sequestered lumbar disc herniation. The first case was a 37-year-old patient with a 2-year history of intermittent left lower limb pain that aggravates with exercise and is relieved at rest, while the second case was a 42-year-old patient with a history of 40 days of numbness and pain in the left lower limb.

Conclusion: 3D SPACE MRI is a beneficial diagnostic imaging tool for discriminating between disc mass that mimics a tumor and a tumor before surgery. If the disc fragment mimicking a tumor can be identified before the operation, open surgical treatment won't be necessary for all patients.

(D) Axial T1-weighted MRI with fat suppression of the lower third level of the L4 vertebral body. It can be seen that the left nerve running area has massive low-signal soft tissue (indicated by arrows), and the peripheral fat space disappears. (E) Sagittal T2-weighted MRI with fat suppression.

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Published

2024-01-31

Issue

Section

Musculoskeletal Radiology