Demystifying MR Neurography of the Lumbosacral Plexus: From Protocols to Pathologies

Figure 10

73-year-old female with pain for 4 months in sciatic territory, with history of Hodgkin lymphoma undergoing chemotherapy. MRN images in axial T1-weighted contrast-enhanced (a), coronal VIBE subtraction (b), and coronal T1 postcontrast VIBE 3D SPACE ((c) and (d)) show a large, lobular, contrasting, infiltrative mass (solid arrows) suggestive of a lymphoproliferative process, disseminated inferiorly through the left paravertebral region near the psoas and presacral region. The mass also infiltrates the left neural foramina and emergent nerve roots of L4-L5 and L5-S1 and, bilaterally, in S1-S2 to S4-S5. It determines diffuse involvement of the left sacral plexus, proximal segments of the obturator, pudendal and sciatic nerve, close to the piriformis and internal obturator muscles (arrowhead). There is also signs of bone infiltration (wavy arrow).

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