Exploring non-invasive diagnostic tools for deep gluteal syndrome: a multimodal approach integrating clinical and imaging techniques

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F25%3A00085822" target="_blank" >RIV/00023001:_____/25:00085822 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11130/25:10501067 RIV/00064203:_____/25:10501067

Výsledek na webu

<a href="https://qims.amegroups.org/article/view/141349/pdf" target="_blank" >https://qims.amegroups.org/article/view/141349/pdf</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.21037/qims-2025-241" target="_blank" >10.21037/qims-2025-241</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Exploring non-invasive diagnostic tools for deep gluteal syndrome: a multimodal approach integrating clinical and imaging techniques

Popis výsledku v původním jazyce

Background: Deep gluteal syndrome (DGS) involves extrapelvic entrapment or irritation of the sciatic nerve (SN) within the deep gluteal space, often mimicking S1 radicular syndrome. Accurate differentiation between DGS and true nerve root pathology is essential for effective treatment. This study aimed to distinguish DGS from nerve root affections and identify the causes of symptoms in individuals with suspected DGS using a comprehensive multi-modal evaluation, including advanced diagnostic techniques. Methods: Nineteen subjects (13 females, 6 males, mean age of 36.8 +/- 10.9 years, range 23-65 years) with unilateral gluteal pain radiating to the S1 dermatome for at least three months and symptoms exacerbated by prolonged sitting were evaluated. All underwent 3T magnetic resonance imaging (MRI) (Siemens MAGNETOM VIDA) for standard spine and pelvis imaging, diffusion tensor imaging (DTI) of the lumbosacral plexus (LSP) and SN, electromyography (EMG) of the H-reflex circuit with positional maneuvers, and clinical tests targeting DGS. Results: Nerve root contact was demonstrated in only two subjects on the pathology side. Morphological findings on standard MRI with the potential to cause DGS symptoms were inconsistent. Surprisingly, narrowing between the ischium and lesser trochanter of the femur was found in 42% on the symptomatic side. Statistically significant higher mean diffusivity (MD) (P=0.023), radial diffusivity (RD) (P=0.038), and axial diffusivity (AD) (P=0.026) values were observed on the symptomatic side of the SN, indicating edema and microstructural changes. No significant differences were noted in fractional anisotropy (FA) (P=0.913) and normalized quantitative anisotropy (NQA) values (P=0.778). No changes in diffusivity were observed at the LSP level. Twelve subjects (63%) showed increased latency (&gt;1.2 ms) or complete disappearance of the H-reflex when using modified muscle position/activation on the symptomatic side. Clinical tests showed inconclusive results. Conclusions: Advanced diagnostic tools such as DTI and EMG combined with positional maneuvers can help identify DGS when standard imaging and clinical tests are inconclusive. Elevated diffusivity values in the symptomatic SN suggest possible edema and structural changes, supporting the utility of a multimodal approach for accurate diagnosis and treatment of DGS.

Název v anglickém jazyce

Exploring non-invasive diagnostic tools for deep gluteal syndrome: a multimodal approach integrating clinical and imaging techniques

Popis výsledku anglicky

Background: Deep gluteal syndrome (DGS) involves extrapelvic entrapment or irritation of the sciatic nerve (SN) within the deep gluteal space, often mimicking S1 radicular syndrome. Accurate differentiation between DGS and true nerve root pathology is essential for effective treatment. This study aimed to distinguish DGS from nerve root affections and identify the causes of symptoms in individuals with suspected DGS using a comprehensive multi-modal evaluation, including advanced diagnostic techniques. Methods: Nineteen subjects (13 females, 6 males, mean age of 36.8 +/- 10.9 years, range 23-65 years) with unilateral gluteal pain radiating to the S1 dermatome for at least three months and symptoms exacerbated by prolonged sitting were evaluated. All underwent 3T magnetic resonance imaging (MRI) (Siemens MAGNETOM VIDA) for standard spine and pelvis imaging, diffusion tensor imaging (DTI) of the lumbosacral plexus (LSP) and SN, electromyography (EMG) of the H-reflex circuit with positional maneuvers, and clinical tests targeting DGS. Results: Nerve root contact was demonstrated in only two subjects on the pathology side. Morphological findings on standard MRI with the potential to cause DGS symptoms were inconsistent. Surprisingly, narrowing between the ischium and lesser trochanter of the femur was found in 42% on the symptomatic side. Statistically significant higher mean diffusivity (MD) (P=0.023), radial diffusivity (RD) (P=0.038), and axial diffusivity (AD) (P=0.026) values were observed on the symptomatic side of the SN, indicating edema and microstructural changes. No significant differences were noted in fractional anisotropy (FA) (P=0.913) and normalized quantitative anisotropy (NQA) values (P=0.778). No changes in diffusivity were observed at the LSP level. Twelve subjects (63%) showed increased latency (&gt;1.2 ms) or complete disappearance of the H-reflex when using modified muscle position/activation on the symptomatic side. Clinical tests showed inconclusive results. Conclusions: Advanced diagnostic tools such as DTI and EMG combined with positional maneuvers can help identify DGS when standard imaging and clinical tests are inconclusive. Elevated diffusivity values in the symptomatic SN suggest possible edema and structural changes, supporting the utility of a multimodal approach for accurate diagnosis and treatment of DGS.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30224 - Radiology, nuclear medicine and medical imaging

Projekt

—

Návaznosti

V - Vyzkumna aktivita podporovana z jinych verejnych zdroju

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Quantitative imaging in medicine and surgery

ISSN

2223-4292

e-ISSN

2223-4306

Svazek periodika

15

Číslo periodika v rámci svazku

9

Stát vydavatele periodika

CN - Čínská lidová republika

Počet stran výsledku

15

Strana od-do

8409-8422

Kód UT WoS článku

001567978800003

EID výsledku v databázi Scopus

2-s2.0-105013770422