ObjectiveStudies showed that T2-weighted turbo spin-echo SPACE (T2-SPACE) could be superior to conventional two-dimensional magnetic resonance imaging (2D MRI) to detect the locations of nerve root compression. However, there is a lack of evidence in patients with cervical spondylotic radiculopathy (CSR). This study aims to evaluate the diagnostic value of contrast-enhanced 3D T2-SPACE sequence in patients with CSR.MethodsThis cohort study enrolled 80 adult CSR patients from October 2021 to May 2023. Patients were allocated into 2D MRI positive and negative groups based on the findings of accurate location of nerve root compression. The nerve root compression diagnostic value was evaluated on 2D MRI, contrast-enhanced 3D T2-SPACE MRI, and surgical findings. Cervical lordosis, the height of the foramina, and the proximal tilting angle of the nerve root (PTA) were measured.ResultsOf the 80 patients, 69 patients were diagnosed correctly by 2D MRI, and 11 patients were correctly diagnosed by contrast-enhanced 3D T2-SPACE MRI. Of those, 0 were false-positive and 9 patients were false-negative compression. Seven out of eleven patients from 2D MRI- group located nerve root compression at foraminal area and the other 4 located nerve root compression at lateral zone. All the negative cases in 2D MRI were correctly diagnosed by contrast-enhanced 3D T2-SPACE MRI. Larger PTAs could be indicators for the diagnosis of foraminal nerve root compression.ConclusionOur results showed that contrast-enhanced 3D T2-SPACE MRI was more accurate than 2D MRI for detecting nerve root compression in patients with CSR. The contrast-enhanced 3D T2-SPACE could better visualize the nerve root compression intra- and extra-foramina than conventional 2D MRI.