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Axial T2-weighted fat-saturated imaging provides information not readily available from routine lumbar spine magnetic resonance imaging (MRI) protocols and routine inclusion of this sequence in place of axial T1-weighted imaging provides additional diagnostic information that can be obtained without increasing examination time or cost. The purpose of this review is to highlight the value of axial T2-weighted fat-saturated imaging as part of a routine lumbar spine MRI protocol.

Magnetic resonance imaging is established as the technique of choice for assessment of degenerative disorders of the lumbar spine. However, it is routinely performed with the patient supine and the hips and knees flexed. The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion-extension, in the erect position or by using axial loading. This article reviews the literature relating to the above techniques.

The aim of this study is to assess the ability of conventional lumbar spine magnetic resonance imaging (MRI) to demonstrate the pars interarticularis. The right and left L4 and L5 pars in 50 patients undergoing lumbar spine MRI for low back pain, with or without radiculopathy, were assessed and classified into four types. Based on their appearance, 59 (29.5%) were classified as normal (Type 1), 59 (29.5%) as hypointense (Type 2), 53 (26.5%) could not be demonstrated (Type 3) and 29 (14.5%) were thought to have defects (Type 4). The gold standard was set by the consensus opinion of two consultant musculoskeletal radiologists on the available plain radiographs of the lumbar spine. MRI was found to have a sensitivity of 57% to 86%, specificity of 81% to 82%, positive predictive value of 14% to 18% and negative predictive value of 97% to 99% for the diagnosis of a pars defect.