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Avneesh Chhabra, MD Assistant Professor of Radiology and Orthopedic Surgery MSK Radiology Section

High Resolution MR Neurography. Evaluation O f Radiculopathy. Avneesh Chhabra, MD Assistant Professor of Radiology and Orthopedic Surgery MSK Radiology Section The Russell H. Morgan Department of Radiology and Radiological Science Johns Hopkins Medical Institutions. Background.

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Avneesh Chhabra, MD Assistant Professor of Radiology and Orthopedic Surgery MSK Radiology Section

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  1. High Resolution MR Neurography Evaluation Of Radiculopathy Avneesh Chhabra, MD Assistant Professor of Radiology and Orthopedic Surgery MSK Radiology Section The Russell H. Morgan Department of Radiology and Radiological Science Johns Hopkins Medical Institutions

  2. Background • Radiculopathy (backpain radiating to arms and / or legs) is a major health problem and burden to the society at large. • Approximately 15% of all US adults have recurrent low back pain in their lifetime, with at least 5% becoming disabled. Low back injuries lead to an estimated health cares costs totaling more than $ 55 billion/year.

  3. Radiculopathy MRI + - Nerve Block 6-8 weeks of Physiotherapy Don’t Respond Respond Respond Nerve Block Surgery Don’t Respond Respond

  4. Radiculopathy MRI - 6-8 weeks of Physiotherapy Don’t Respond Respond Nerve Block

  5. MRN- New technique

  6. Radiculopathy HypothesisIn clinically suspected radiculopathy and MRI equivocal subjects, MRN can predict those who will respond to nerve block. Nerve Block

  7. Aims • To test whether MRI predicts subjects who respond to nerve block • To test whether MRI predicts subjects who fail to respond to physiotherapy

  8. STUDY DESIGN • A pilot study of 20 subjects with no history of previous surgery, suspected of radiculopathy by history and clinical examination and with non-contributory or indeterminate conventional MRI • All subjects receive MRN exam as a research tool. The results of MRN will not be made available to the subjects or the referring physician.

  9. STUDY DESIGN • Outcome measures, such as • LBP intensity (visual analogue scale) • Unidimentional QOL thermometer scale • Oswestry Disability Index • Administered at the time of MRN, after completion of physical therapy and 6-12 weeks following nerve block in patients undergoing such procedure.

  10. STUDY DESIGN • Reading Procedure- • Two readers, blinded to clinical information will be given structured training sessions on evaluation of MRN images demonstrating imaging features of nerve impingement 2 weeks before the formal review of all the images. • Each patient’s examination will be read for the assessment of presence or absence of nerve impingement.

  11. STUDY DESIGN • Statistics- • Sensitivity and specificity of MRN interpretation will be calculated with respect to response to physiotherapy and nerve block. • Kappa values for interobserver variability in reading MRN exams between the readers will be assessed. • Linear and logistic regression models will be used to assess the outcomes adjust for age, sex and race as predicted by MRN.

  12. Significance • Since, early detection of cervical and lumbosacral nerve impingement is essential for diagnosis, therapeutic intervention, and for planning of follow-up strategies; MRN could make a major impact in radiculopathy diagnosis by improving the diagnostic accuracy and reader confidence in pin pointing the exact site of nerve impingement. • These results may translate into overall decreased cost of care by reducing the number of spine interventions and subsequent surgeries.

  13. Acknowledgements • My team (Sonye, John, Francisco, Zeshaan & Kelly • Experts- Steve Sozio and Timothy Pavlik • Course directors and teachers

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