Which imaging modality is most sensitive for detecting soft-tissue nerve root compression in suspected radiculopathy?

• A. MRI.
• B. X-ray.
• C. CT without contrast.
• D. Ultrasound.

Answer: (A)

For suspected radiculopathy, the key is visualizing soft tissues around the spine—the discs, nerve roots, thecal sac, and surrounding ligaments. Magnetic resonance imaging provides superior soft-tissue contrast and can show disc herniation or bulging compressing a nerve root, foraminal stenosis from facet joint changes or ligamentum flavum hypertrophy, and any associated nerve root edema or irritation. This level of detail across multiple planes makes MRI the most sensitive method for detecting soft-tissue nerve root compression.

X-ray mainly shows bone and alignment; it misses soft-tissue pathology. CT without contrast better delineates bony structures and acute fractures but has limited sensitivity for soft tissues like nerve roots. Ultrasound isn’t effective for imaging deep spinal structures and nerve roots. So MRI stands out as the best option for identifying soft-tissue nerve root compression in radiculopathy.