Which imaging studies are used in the workup of diabetic lumbosacral plexopathy?

Updated: Jan 04, 2021
  • Author: Divakara Kedlaya, MBBS; Chief Editor: Milton J Klein, DO, MBA  more...
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Answer

Lumbar spine and pelvic radiographs should be performed to evaluate for other causes of the plexopathy. Computed tomography (CT) scanning or magnetic resonance imaging (MRI) of the lumbosacral spine and pelvis may be indicated in some cases to rule out mass lesions. [14]

A study by Matsuda et al of a patient with diabetic lumbosacral radiculoplexus neuropathy found that on T2-weighted MRI scans of the skeletal muscles, high signal intensities could be seen in the bilateral hamstrings and the adductor magnus and right tensor fasciae latae, as well as in the extensor muscles of the lower legs. [31] Another study, which used short tau inversion recovery (STIR) MRI sequences to examine 17 patients with lower limb neuropathies, found that MRI-assessed amyotrophy was significantly greater in patients with severe, chronic, or proximal neuropathy. [32]

A case study by McCormack et al of a patient with diabetes and lumbar disc disease reported on the use of magnetic resonance neurography (MRN) to help distinguish diabetic lumbosacral radiculoplexus neuropathy from radiculopathy. MRI showed that structural changes in the lumbar spine were insufficient to cause the patient’s presenting symptom, ie, acute pain onset in the lower left extremity’s L5-S1 distribution. MRN of the lumbosacral plexus, however, demonstrated that the bilateral sciatic and femoral nerves were inflamed, indicating the presence of radiculoplexus neuropathy. [33]


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