• Aaron M Lewis, Robert Layzer, J W Engstrom, Nicholas M Barbaro, and Cynthia T Chin.
• Department of Neurology, University of California, San Francisco, USA. aaron.m.lewis@kaiser.org
• Arch Neurol Chicago. 2006 Oct 1;63(10):1469-72.

BackgroundSciatica without evidence of lumbosacral root compression is often attributed to piriformis syndrome. However, specific diagnostic tools have not been available to demonstrate sciatic nerve entrapment by the piriformis muscle.ObjectiveTo evaluate the use of magnetic resonance (MR) neurography in identifying abnormalities of the sciatic nerve in patients with unexplained sciatica.DesignCase series from a retrospective medical record review.PatientsFourteen patients with sciatic distribution pain and normal results on MR imaging for lumbosacral radiculopathy were referred for MR neurography of the lumbosacral plexus and sciatic nerves.ResultsIn 12 patients, MR neurography demonstrated increased fluid-attenuated inversion recovery signal in the ipsilateral sciatic nerve. In most patients, this abnormal signal was seen at the sciatic notch, at or just inferior to the level of the piriformis muscle. To date, 4 patients have undergone surgical decompression, with excellent relief of symptoms in 3 of them.ConclusionMagnetic resonance neurography often identifies an abnormal increased signal in the proximal sciatic nerve in patients with extraspinal sciatica and allows more accurate diagnosis of sciatic nerve entrapment in suspected cases.

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