Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2025; 17(6): 107164
Published online Jun 28, 2025. doi: 10.4329/wjr.v17.i6.107164
Enhancing back pain and sciatica diagnosis: Coronal short tau inversion recovery’s role in routine lumbar magnetic resonance imaging protocols
Somaya Al Kiswani, Maysoon Nasser, Abdulla Alzibdeh, Elias EQ Lahham
Somaya Al Kiswani, Department of Radiology, King Hussein Cancer Center, Amman 11941, Jordan
Maysoon Nasser, Department of Radiology, Jordan University of Science and Technology, Amman 11941, Jordan
Abdulla Alzibdeh, Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan
Elias EQ Lahham, Department of Radiation Oncology, Augusta Victoria Hospital, Jerusalem 9119101, Palestine
Author contributions: Al Kiswani S contributed to the conceptualization, methodology, data organization, and writing of the original manuscript; Nasser M conducted the survey, data collection, and formal analysis; Alzibdeh A carried out resources, supervision, project management; Lahham EEQ performed validation, visualization, writing; Al Kiswani S and Lahham EEQ contributed to the review and editing of the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Al-Quds University Jerusalem, approval No. 603/REC/2025.
Clinical trial registration statement: Not applicable.
Informed consent statement: This study was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent to participate in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: All data generated or analyzed during this study are available within the article’s supplementary materials. The datasets analyzed during the study are available from the corresponding author upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Elias EQ Lahham, MD, Chief Physician, Lecturer, Researcher, Department of Radiation Oncology, Augusta Victoria Hospital, Martin Buber, Jerusalem 9119101, Palestine. eliaslahham2011@hotmail.com
Received: March 17, 2025
Revised: April 12, 2025
Accepted: May 21, 2025
Published online: June 28, 2025
Processing time: 101 Days and 18.9 Hours
Abstract
BACKGROUND

Back pain and sciatica are common complaints that often require imaging for accurate diagnosis and management. Conventional lumbar magnetic resonance imaging (MRI) protocols typically include sagittal and axial T1 and T2 sequences; however, these may miss certain pathologies. The addition of coronal short tau inversion recovery (STIR) sequences offers the potential to enhance the detection of both spinal and extra-spinal abnormalities, thereby improving clinical decision-making and patient outcomes.

AIM

To evaluate the impact of adding coronal STIR sequences to routine lumbar MRI in diagnosing back pain and sciatica.

METHODS

We prospectively analyzed data from patients aged 6 and older presenting with back pain or sciatica who underwent lumbar spine MRI at our institution. The standardized MRI protocol utilized included sagittal and axial T1 and T2 sequences, complemented by a coronal STIR sequence. Data on structural abnormalities were collected, reviewed, and analyzed using counts, percentages, and Fisher's exact test for categorical variables.

RESULTS

Our cohort comprised 274 patients (115 males, 159 females; mean age 44.91 years). Notably, 39 patients exhibited abnormalities across all sequences, while 72.63% showed normal findings on the coronal STIR sequence. Importantly, 30.29% of cases were diagnosed as normal without the coronal STIR, and 36 patients with normal T1 and T2 sequences presented abnormalities on the coronal STIR. The coronal STIR sequence successfully identified 26 spinal and 10 non-spinal pathologies, including 17 cases of sacroiliitis, with a significant association (P < 0.0001) between sacroiliitis diagnosis and abnormalities visible solely on this sequence.

CONCLUSION

Integrating coronal STIR into routine lumbar MRI enhances detection of hidden spinal and extra-spinal pathologies, improves patient management, and offers a cost-effective, practical upgrade with significant diagnostic and clinical value.

Keywords: Low back pain; Magnetic resonance imaging; Coronal short tau inversion recovery; Sacroiliitis; Diagnostic accuracy

Core Tip: Incorporating a coronal short tau inversion recovery sequence into routine lumbar magnetic resonance imaging protocols significantly enhances diagnostic accuracy for patients with back pain and sciatica. This sequence improves the detection of spinal and extra-spinal pathologies - especially sacroiliitis and pelvic abnormalities - that may be missed on standard axial and sagittal T1 and T2 sequences. Our findings support the integration of coronal short tau inversion recovery as a cost-effective, practical addition that can meaningfully influence diagnosis and clinical management.