Intrathecal Radiculitis Visualized on MRI
Written by: James Demetrious, DC, DABCO
In their text, “Imaging Painful Spine Disorders,” Mayo Clinic neuroradiologists, Czervionke and Fenton present the MRI findings of a 30-year-old female with imaging evidence of intrathecal radiculitis. 
The authors indicate that the above image A is the unenhanced T1 weighted MR image. Image B is a contrast-enhanced T1-weighted MRI image in which we can visualize the enlarged and enhanced right S1 intrathecal nerve root (small white arrows) due to the large L5 – S1 herniated disc extrusion (large white arrow). 
Axial images of the mid and upper lumbar regions offer visualization of the enlarged and enhanced S1 nerve roots as the noted by the white arrows below. 
Neuroradiologist Jinkins reported contrast enhancement of intrathecal nerve roots occurs in about 5% of patients undergoing spinal MRI of the un-operated spine. 
Differentiation from Intradural Blood Vessels
It is important to differentiate enhancing intradural blood vessels versus enhanced nerve roots. Typically, enhanced blood vessels appear tortuous when compared to the linear appearance of nerve roots.
A Paucity of Publications
Intrathecal radiculitis is frequently not recognized, and there exists a paucity of publications in the literature related to this subject.
Why is this of Interest to Us?
Frequently, lumbar spine studies are performed without contrast. In those cases, one could suggest that intrathecal nerve root edema may actually be present but without contrast, remain undetected.
The ability to detect edematous nerve roots within the thecal sac provides insight into those patients who have acute symptomatology. Those patients may benefit from segmental mobility inherent to chiropractic care.
- Czervionke and Fenton. Imaging Painful Spine Disorders. Elsevier Publication. Copyright © 2011 by Mayo Foundation for Medical Education.
- Jinkins JR. MR of enhancing nerve roots in the unoperated lubosacral spine. ANJR Am J Neuroradiol. 1993;14(1):193-202.
The views and opinions expressed in this presentation are solely those of the author. We offer this only to educate and inform.
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