Characteristics of spondylotic myelopathy on 3D driven-equilibrium fast spin echo and 2D fast spin echo magnetic resonance imaging: a retrospective cross-sectional study.

Mike A. Abdulhadi,Paolo G. P. Nucifora,Joseph R. Perno,Elias R. Melhem,Jonathan A. Coles

doi:10.1371/journal.pone.0100964

Abstract

In patients with spinal stenosis, magnetic resonance imaging of the cervical spine can be improved by using 3D driven-equilibrium fast spin echo sequences to provide a high-resolution assessment of osseous and ligamentous structures. However, it is not yet clear whether 3D driven-equilibrium fast spin echo sequences adequately evaluate the spinal cord itself. As a result, they are generally supplemented by additional 2D fast spin echo sequences, adding time to the examination and potential discomfort to the patient. Here we investigate the hypothesis that in patients with spinal stenosis and spondylotic myelopathy, 3D driven-equilibrium fast spin echo sequences can characterize cord lesions equally well as 2D fast spin echo sequences. We performed a retrospective analysis of 30 adult patients with spondylotic myelopathy who had been examined with both 3D driven-equilibrium fast spin echo sequences and 2D fast spin echo sequences at the same scanning session. The two sequences were inspected separately for each patient, and visible cord lesions were manually traced. We found no significant differences between 3D driven-equilibrium fast spin echo and 2D fast spin echo sequences in the mean number, mean area, or mean transverse dimensions of spondylotic cord lesions. Nevertheless, the mean contrast-to-noise ratio of cord lesions was decreased on 3D driven-equilibrium fast spin echo sequences compared to 2D fast spin echo sequences. These findings suggest that 3D driven-equilibrium fast spin echo sequences do not need supplemental 2D fast spin echo sequences for the diagnosis of spondylotic myelopathy, but they may be less well suited for quantitative signal measurements in the spinal cord.

Highlights

Magnetic resonance imaging (MRI) is commonly used to assess chronic neck pain because of its relative safety as well as the excellent contrast it provides for osseous structures, neural tissue, and cerebrospinal fluid [1]
We address the hypothesis that the appearance of spondylotic cord lesions in the cervical spine is equivalent on 2DFSE and 3D drivenequilibrium fast spin echo (3D-FSE) sequences
We found no significant differences in the number of lesions detected using 2D fast spin echo (2D-FSE) and 3D-FSE sequences

Summary

Introduction

Magnetic resonance imaging (MRI) is commonly used to assess chronic neck pain because of its relative safety as well as the excellent contrast it provides for osseous structures, neural tissue, and cerebrospinal fluid [1]. In the evaluation of cervical spondylosis, an MRI examination often includes multiple T2-weighted sequences that can assess the degree of degenerative spinal stenosis as well as detect the presence of cord pathology such as spondylotic myelopathy [2,3]. These sequences generally use T2*-weighted gradient-recalled echo techniques or T2-weighted fast spin echo techniques. Gradient-recalled echo techniques typically have a short repetition time (TR) due to their lack of a refocusing pulse This results in faster acquisition time that can be leveraged to perform 3D imaging and improve resolution [4,5,6,7]. Gradientrecalled echo techniques are prone to artifact from magnetic susceptibility that may cause image degradation near osseous structures such as the spine, aliasing in the slice select direction, and limited signal-to-noise ratios in comparison to spin echo sequences [4,5,6,7,8,9,10]

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