Diagnosis of herniated intervertebral disc assisted by 3-dimensional, multiaxial, magnetic resonance imaging

Magnetic resonance (MR) imaging with multiaxal cross sections has been used to improve the resolution of small, fine, and slender spinal roots to more precisely diagnose herniated intervertebral disc (HIVD), especially in cases of far lateral disc (FLD) herniation. However, false-negative results remain a problem because of the unsatisfactory resolution of these methods. We report the use of a volume visualization technique to generate three- dimensional (3D) images from multiaxial sections. In our study, 10 patients with FLD herniation each underwent MR imaging (method 1), 3D MR image reconstruction with single-axis cross-sections (method 2), and 3D MR image reconstruction with multiaxial cross sections (method 3). Final diagnoses were confirmed at surgery. The preoperative diagnosis matched the operative findings in five patients using method 1, six patients using method 2, and nine patients using method 3. In addition, the software developed for this application includes functions which simulate decompression of the spinal cord and roots. Therefore, this computer-aided diagnosis system using multiaxial cross sections is a useful tool for diagnosing HIVD and for training medical residents and students. This technique has three main advantages over conventional imaging modalities: 1) resolution of small, fine, or slender anatomic structures, which reduces the possibility of false- positive and false-negative image findings; 2) segmentation (disarticulation) of images; and 3) simulation of surgery.