Background The articular hydropsy of knee is very popular clinical conditions. And, lumbar facet joint effusion is also very frequency disorders of spine, particularly those involved in RA, thoracic or lumbar kyphosis and degenerative or inflammatory spondyloarthropathy. However, general rheumatologists can not evaluate these pathology due to poor MRI results of the spine. Why is it so difficult to obtain clear MR images of the facet effusion? We have reported numerous reasons for the poor results of MRI to date^1,2. There are a few reports referring the relationship RA and facet effusion, but the etiology of its pathology is still not clear^3,4,5. In this report we show the simple 3-D MRI examination of the lumbar spine to detect facet effusion. We have investigated how to operate the 3-D MRI to obtain clear mages of the facet effusion.

Objectives The aim of this study was to evaluate lumbar facet joint effusion three-dimensionally by using 3-D MR myelography. We show the best sequences to obtain clear MR images.

Methods [Machines]

We used an Echelon Vega® 1.5-T MRI unit (HITACHI, Tokyo, Japan). We use two MRI sequences: 3-D myelography of 1.3 mm slice thickness (Balanced SG® by HITACHI) and 3-D myelography of 1.5 mm slice thickness (RSSG® by HITACHI). The MRI sequences are following. Two MRI sequences (BASG/RSSG) indicate that Mode: 3D coronal/3D coronal, FOV: 250 mm/384 mm, TR: 10.4 ms/18.0 ms, TE: 5.2 ms/9.2 ms, Flip angle: 45°/10°, Slice thickness: 1.3 mm/1.5 mm, Recon-pitch: 0.65 mm/0.75 mm, Recon-slice: 100/90, Scan time: 6’40”/6’45”. We can produce the lumbar facet joint effusion with MIP processing (15 ° x 24 slice) of BASG as 3-D visualization.

[Case]

We chose the patients suffering from back pain with RA (2 cases), lumbar disc herniation (LDH; 2 cases), degenerative lumbar spondylolisthesis (2 cases) or scoliosis (2 cases), lumbar spinal canal stenosis (LSCS; 2 cases), and kyphosis back (2 cases).

Results

1. There were multiple facet effusion at the bilateral multiple levels (L1/2, L2/3, L3/4, L4/5, L5/S1) in the patients of lumbar kyphosis or RA.

2. For a few months there were arising facet effusion at the hernia level of LDH under treatment.

3. In RA, degenerative lumbar spondylolisthesisor and LSCS, we found the facet effusion bilaterally at a single level.

Conclusions It is very difficult for rheumatologists to diagnose the back pain because MR images are often poor and presented in two dimensions. So we propose to use the 3-D MR myelography to find facet effusion as routine daily imaging test. Moreover, for one case in this research we have found multiple disc effusion. It was extremely rare.

Such images will be useful in elucidating the clinical condition of complex painful inflammatory disorders such as RA or degenerative spondyloarthropathy at a glance. We are quite aware of degenerative or inflammatory facet effusion of lumbar spine. It may be a cause of “rheumatoid back pain”.

1. Yamanaka Y, Skeletal Radiol 2010

2. Kamogawa J, In the book “Scoliosis”, InTech, 2012, in press.

3. Schellinger D, RadioGraphics 1987

4. Lakadamyali H, AJR 2008

5. Oishi Y, J Neurosurg Spine 2010

Disclosure of Interest None Declared