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MRI FINDINGS IN GUILLIAN BARRE SYNDROME

WHAT ARE THE MRI FINDINGS IN GUILLIAN- BARRE SYNDROME

Guillain-Barré Syndrome (GBS) has distinct MRI findings in the spine. In this post we look at the characteristic MRI findings of GBS in the spine.

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WHAT ARE KEY MRI FINDINGS TO LOOK FOR IN GUILLAIN-BARRÉ SYNDROME?

NERVE ROOT ENHANCEMENT

This is the most significant MRI finding in Guillain-Barré Syndrome.
Look for enhancement of the nerve roots in the cauda equina region on post-contrast T1-weighted images (Blue arrows axial and sagittal images).
Always fat saturate the post contrast T1 scans to make it easier to see the enhancement.

NERVE ROOT SWELLING

The enhancement signifies inflammation of the nerve roots, which is a characteristic feature of Guillain-Barré Syndrome.
This inflammation may cause the nerve roots to appear thicker than normal. However, this can be subjective and is not that common to see. In this case there is no appreciable swelling (Pink arrows).

SYMMETRY

Typically, the enhancement of the nerve roots is symmetric (Blue arrows axial image), affecting nerve roots on both sides of the thecal sac.

ABSENCE OF OTHER SPINAL ABNORMALITIES

GBS typically does not cause any other structural abnormalities in the spine.
If there are other abnormal findings in the spine, consider other diagnoses.

NORMAL BRAIN MRI

Typically, the brain MRI is normal in Guillain-Barré Syndrome patients.
If there are other abnormal findings in the Brain, consider other diagnoses.

DO YOU NEED TO DO A FOLLOW-UP MRI?

This is really up to the clinician and would only be done if the patient is not responding to treatment as expected.
In follow up scans look for a decrease in nerve root enhancement +/- reduction in nerve size if it was initially enlarged, indicating response to treatment.

ARE THE NERVE ROOT FINDINGS SPECIFIC FOR GUILLAIN-BARRÉ SYNDROME?

No. Nerve root enhancement and thickening are non-specific and can be seen in infection or malignancy amongst other causes. The clinical context of the scan is important in differentiating these.

TEST YOURSELF ON SOME COMMON & FREQUENTLY ASKED QUESTIONS

WHAT IS THE MOST SIGNIFICANT MRI FINDING IN GUILLAIN-BARRÉ SYNDROME?

The most significant MRI finding in Guillain-Barré Syndrome is the enhancement of the nerve roots in the cauda equina region on post-contrast T1-weighted images.

HOW CAN THE ENHANCEMENT OF THE NERVE ROOTS IN GBS BE VISUALIZED MORE EASILY?

The enhancement of the nerve roots can be visualized more easily by fat saturating the post-contrast T1 scans.

ARE THE NERVE ROOTS AFFECTED SYMMETRICALLY IN GUILLAIN-BARRÉ SYNDROME?

Yes, typically the enhancement of the nerve roots is symmetric, affecting nerve roots on both sides of the thecal sac.

IS A NORMAL BRAIN MRI COMMON IN GUILLAIN-BARRÉ SYNDROME PATIENTS?

Yes, typically the brain MRI is normal in Guillain-Barré Syndrome patients.

WHAT SHOULD BE LOOKED FOR IN FOLLOW-UP MRI SCANS FOR GBS?

In follow-up MRI scans, a decrease in nerve root enhancement (and size if the nerve roots were initially thickened) should be looked for, indicating response to treatment.