# Grading cervical neural foraminal stenosis via 3-T MR nerve/bone fusion imaging compared with T2-weighted imaging

## TL;DR

This study shows that 3-T MR nerve/bone fusion imaging is more reliable and accurate than traditional T2-weighted imaging for grading cervical neural foraminal stenosis.

## Contribution

The study introduces 3-T MR nerve/bone fusion imaging as a more reliable and symptom-correlated method for evaluating cervical neural foraminal stenosis.

## Key findings

- 3D-T2-FFE/FRACTURE fusion imaging detected all extraforaminal nerve roots, while T2WI only detected 63.04%.
- CNFS grading on fusion imaging showed substantial to nearly perfect agreement, compared to moderate agreement on T2WI.
- CNFS grades from fusion imaging correlated with clinical symptoms (NDI and NPS), unlike T2WI.

## Abstract

To investigate the value of 3-T MR nerve/bone fusion imaging in grading cervical neural foraminal stenosis (CNFS).

Fifty-eight healthy participants and 23 patients with suspected cervical radiculopathy were prospectively enrolled. MR nerve and bone sequences were 3D-T2-weighted fast field echo (3D-T2-FFE) and fast field echo resembling a CT using restricted echo-spacing (FRACTURE), respectively. The agreements of overall image quality, image artifacts, the width of cervical neural foramen (WCNF), and the width of extraforaminal nerve root (WENR) were assessed on 3D-T2-FFE/FRACTURE fusion images in healthy participants. The detection rate, visibility score of extraforaminal nerve root (ENR), and the CNFS grade were compared for patients between the 3D-T2-FFE/FRACTURE fusion image and the T2-weighted images (T2WI). The correlation between CNFS grade and the neck disability index (NDI) and numerical pain scale (NPS) was assessed.

The agreements were moderate to good for overall image quality and image artifacts (κ = 0.614–0.867), and good to excellent for WCNF and WENR (ICC = 0.755–0.931). The detection rate of ENR on 3D-T2-FFE/FRACTURE fusion (184/184, 100%) was higher than that on T2WI (116/184, 63.04%). The agreements for CNFS grade were substantial to nearly perfect on 3D-T2-FFE/FRACTURE fusion (κ = 0.774–0.837), and moderate on T2WI (κ = 0.436–0.636). The CNFS grade on 3D-T2-FFE/FRACTURE fusion was moderately correlated with NDI (ρ = 0.49)/NPS (ρ = 0.55), while there was no correlation between T2WI and NDI/NPS.

Compared with T2WI, 3D-T2-FFE/FRACTURE fusion provides a more reliable and reproducible evaluation of the severity of CNFS. The CNFS grade based on 3D-T2-FFE/FRACTURE fusion is associated with clinical symptoms.

The use of 3-T MR nerve/bone fusion imaging in clinical practice may facilitate a one-stop-shop, radiation-free, and more precise approach to comprehensively evaluate CNFS.

Grading cervical foraminal stenosis is relatively difficult in clinical practice.MR nerve/bone fusion grading of cervical foraminal stenosis is more reliable.MR nerve/bone fusion grading of cervical foraminal stenosis correlates with symptoms.

Grading cervical foraminal stenosis is relatively difficult in clinical practice.

MR nerve/bone fusion grading of cervical foraminal stenosis is more reliable.

MR nerve/bone fusion grading of cervical foraminal stenosis correlates with symptoms.