Lumbar Magnetic Resonance Imaging Scans Research Articles

Improving Osteoporosis Prediction Using Vertebral Bone Quality Score and Paravertebral Muscle Measurements From Lumbar MRI Scans.

Retrospective cohort. This study aims to use a novel method of combining vertebral bone quality score with paravertebral cross-sectional area measurements to improve the accuracy of predicting individuals with total hip T-scores <-2.5. Osteoporosis is a prevalent skeletal condition associated with decreased bone density and increased fracture risk. Dual-energy x-ray absorptiometry (DXA) is the conventional method for diagnosing osteoporosis, but it has limitations. Opportunistic osteoporosis screening techniques using lumbar magnetic resonance imaging (MRI), particularly the vertebral bone quality (VBQ) score, have shown promise. This study aims to improve the accuracy of predicting individuals with low total hip T-scores using a novel method that combines VBQ scores with paravertebral cross-sectional area (CSA) measurements. A retrospective cohort of 98 patients with DXA and lumbar MRI scans was analyzed. VBQ scores were calculated based on lumbar MRI images, and CSA measurements of paravertebral and psoas muscles were obtained. Threshold-based logistic regression was used to identify optimal thresholds for predicting total hip T-scores <-2.5. The combined model incorporating the VBQ score and paravertebral muscle percent achieved an accuracy of 96.9% for predicting total hip T-scores <-2.5, compared to 81.6% when using the VBQ score alone. Incorporating paravertebral muscle measurements significantly improved the accuracy of identifying osteoporotic individuals. The combination of VBQ score and paravertebral muscle measurements enhances the accuracy of predicting individuals with low total hip T-scores. Lumbar MRI scans provide valuable information beyond opportunistic osteoporosis screening, and the inclusion of paravertebral muscle measurements could aid in identifying at-risk individuals more accurately.

The association between vertebral endplate defects, subchondral bone marrow changes, and lumbar intervertebral disc degeneration: a retrospective, 3-year longitudinal study.

To investigate the influence of vertebral endplate defects and subchondral bone marrow changes on the development of lumbar intervertebral disc degeneration (DD). Patients > 18 y/o without any history of lumbar fusion who had repeat lumbar magnetic resonance imaging scans primarily for low back pain (LBP) performed at a minimum of 3years apart at a single institution, and no spinal surgery in between scans were included. Total endplate score (TEPS), Modic changes (MC), and Pfirrmann grading (PFG) per lumbar disc level were assessed. DD was defined as PFG ≥ 4. Three hundred and fifty-three patients (54.4% female) were included in the final analysis, comprising 1765 lumbar intervertebral discs. The patient population was 85.6% Caucasian with a median age of 60.1years and a body mass index (BMI) of 25.8kg/m2. A cutoff score of 5 was identified for the TEPS above which both the prevalence of DD and the odds of developing DD increased. The probability of developing DD did not differ significantly between lumbar disc levels (P = 0.419). In the multivariable analysis with adjustments for age, sex, race, body mass index (BMI), MC, TEPS cutoff > 5, and spinal level, only age (OR = 1.020; P = 0.002) was found to be an independent risk factor for developing intervertebral DD. Our results suggest that TEPS does not unequivocally predict intervertebral DD in patients with LBP, since higher degrees of endplate defects might also develop secondarily to DD, and MC tend to occur late in the cascade of degeneration.

Effects of Competition Level on the Prevalence and Incidence of Lumbar Disk Degeneration in Japanese Collegiate Gymnasts

Lumbar disk degeneration (LDD) occurs frequently in athletes. Researchers have found that LDD occurs mainly in the lower disks (L4/L5 and L5/S1) in the general and athletic populations. However, a retrospective study showed a high prevalence of LDD in the upper lumbar disks (L1/L2), especially in elite gymnasts. To investigate the effect of competition level on the prevalence and incidence of LDD in the upper lumbar disks(L1/L2). Cross-sectional study; Level of evidence, 3; and cohort study; Level of evidence, 2. We conducted 2 studies to evaluate the effect of competition level on the prevalence and incidence of LDD in Japanese collegiate gymnasts. In study 1, a cross-sectional study of 298 collegiate gymnasts was conducted between 2011 and 2015. Competition levels were categorized as regional, national, and international, and T2-weighted magnetic resonance imaging (MRI) was used to evaluate LDD. Chi-square testing was applied to assess differences in the prevalence of LDD and spinal levels among the 3 competition levels. In study 2--a prospective cohort study--LDD progression and its related risk factors were investigated in 51 collegiate gymnasts. Baseline lumbar MRI scans and measurements of physical function (generalized joint laxity and finger-floor distance test) were performed in March 2014. Follow-up lumbar MRI scans were obtained 2 years later, in February 2016. Logistic regression analyses were performed to investigate the relationship between competition level and LDD progression. In study 1, the prevalence of at least 1 degenerated disk in the regional, national, and international groups was 44.2% (19/43), 44.7% (98/219), and 52.8% (19/36), respectively (P = .655). The prevalence of LDD at L1/L2 in the international group was significantly higher than that in the other 2 groups (P = .018). In study 2, the presence of LDD at L1/L2 was associated significantly with international-level competition (adjusted odds ratio, 47.8; 95% CI, 2.75-830.50). In Japanese collegiate gymnasts, competing at the international level was found to be a risk factor for LDD at L1/L2.

Preoperative Association Between Quantitative Lumbar Muscle Parameters and Spinal Sagittal Alignment in Lumbar Fusion Patients.

A retrospective cross-sectional study. To assess the association between spinal muscle morphology and spinopelvic parameters in lumbar fusion patients, with a special emphasis on lumbar lordosis (LL). Maintenance of sagittal alignment relies on muscle forces, but the basic association between spinal muscles and spinopelvic parameters is poorly understood. Patients operated between 2014 and 2017 who had both lumbar magnetic resonance imaging scan and standing whole-spine radiographs within six months before surgery were included. Muscle measurements were conducted on axial T2-weighted magnetic resonance images at the superior endplate L3-L5 for the psoas and L3-S1 for combined multifidus and erector spinae (paraspinal) muscles. A pixel intensity threshold method was used to calculate the total cross-sectional area (TCSA) and the functional cross-sectional area (FCSA). Spinopelvic parameters were measured on lateral standing whole-spine radiographs and included LL, pelvic incidence (PI), PI-LL mismatch, pelvic tilt, sacral slope, thoracic kyphosis, and sagittal vertical axis. Analyses were stratified by biological sex. Multivariable linear regression analyses with adjustments for age and body mass index (BMI) were performed. A total of 104 patients (62.5% female) were included in the analysis. The patient population was 90.4% White with a median age at surgery of 69 years and a median BMI of 27.8kg/m 2 . All muscle measurements were significantly smaller in women. PI, pelvic tilt, and thoracic kyphosis were significantly greater in women. PI-LL mismatch was 6.1° (10.6°) in men and 10.2° (13.5°) in women ( P =0.106), and sagittal vertical axis was 45.3 (40.8)mm in men and 35.7 (40.8)mm in women ( P =0.251). After adjusting for age and BMI, paraspinal TCSA at L3-L5, and paraspinal FCSA at L4 showed significant positive associations with LL in women. In men, psoas TCSA at L5 and psoas FCSA at L5 showed significant negative associations with LL, but none of the paraspinal muscle measurements. Our findings indicate that psoas and lumbar spine extensor muscles interact differently on LL among men and women, creating a unique mechanical environment. Level 4.

Activity specific areal bone mineral density is reduced in athletes with stress fracture and requires profound recovery time: A study of lumbar stress fracture in elite cricket fast bowlers

ObjectivesThe aims of this study were to determine whether lumbar areal bone mineral density differed between cricket fast bowlers with and without lumbar stress fracture, and whether bone mineral density trajectories differed between groups during rehabilitation. DesignCross-sectional and cohort. Methods29 elite male fast bowlers received a post-season anteroposterior lumbar dual-energy X-ray absorptiometry scan and a lumbar magnetic resonance imaging scan to determine stress fracture status. Participants were invited for three additional scans across the 59 weeks post baseline or diagnosis of injury. Bone mineral density was measured at L1 – L4 and ipsilateral and contralateral L3 and L4 sites. Independent-sample t-tests determined baseline differences in bone mineral density and multilevel models were used to examine differences in bone mineral density trajectories over time between injured and uninjured participants. Results17 participants with lumbar stress fracture had lower baseline bone mineral density at L1 – L4 (7.6 %, p = 0.034) and contralateral sites (8.8–10.4 %, p = 0.038–0.058) than uninjured participants. Bone mineral density at all sites decreased 1.9–3.0 % by 20–24 weeks before increasing to above baseline levels by 52 weeks post injury. ConclusionsInjured fast bowlers had lower lumbar bone mineral density at diagnosis that decreased following injury and did not return to baseline until up to a year post-diagnosis. Localised maladaptation of bone mineral density may contribute to lumbar stress fracture. Bone mineral density loss following injury may increase risk of recurrence, therefore fast bowlers require careful management when returning to play.

Does lumbar MRI predict degree of disability in patients with degenerative disc disease? A prospective cross-sectional study at University of Gondar comprehensive specialized hospital, North West Ethiopia, 2020

BackgroundLow back pain (LBP) is one of the most serious public health problem globally with substantial socioeconomic implications. Degenerative disc disease is an important cause of LBP in the elderly. Magnetic resonance imaging (MRI) is routinely ordered by physicians in evaluation of patients with suspected degenerative disc disease in the lumbar spine. However there is no unanimous agreement in the literatures when it comes to the association of degree of disability to that of severity of lumbar MRI findings.ObjectiveThe aim of this study is to assess the association between degree of disability measured using Oswestry Disability Index (ODI) and findings on lumbar spine MRI in patients with degenerative disc disease at University of Gondar comprehensive Specialized Hospital, North West Ethiopia, 2020.Methods and materialsA prospective cross-sectional study was conducted on 72 consecutively enrolled patients with degenerative disc disease who underwent lumbar MRI scan. Degree of disability was measured using ODI questionnaire translated to local language. Association between lumbar spine MRI parameters and ODI score and category was tested using Spearman’s rank correlation coefficient and Chi square tests.ResultsThe mean age of the study subjects was 43.81 ± 1.88 years (range 22–83 years). Forty-three (59.7%) of the study population were female. In terms of ODI category, most fell under minimal 33 (45.8%) or moderate 25 (34.7%) disability. Disc bulge (81.9%) and foraminal stenosis were the most frequent MRI abnormalities detected. ODI score showed weak correlation with grade of spinal canal stenosis. Grade of foraminal stenosis showed no correlation with ODI score.ConclusionThe clinical relevance of MRI findings in predicting degree of disability in patients with degenerative disc disease is limited and MRI study should be sparingly ordered in evaluation of these patients particularly in resource constrained settings.

Reliability and validity of subjective radiologist reporting of temporal changes in lumbar spine MRI findings.

The importance of lumbar findings on magnetic resonance imaging (MRI) remains controversial. Changes in lumbar MRI findings over time may provide important insights into the causes of low back pain. However, the reliability and validity of temporal changes are unknown. To (1) investigate the interrater reliability of subjective radiologist reporting of temporal changes in lumbar spine MRI findings and (2) determine how commonly temporal changes are reported when two scans are conducted 30 minutes apart (considered false positives). Cross-sectional study. Radiology clinic. Forty volunteers (mean age 40; 53% female) with current (n=31) or previous (n=9) low back pain underwent initial lumbar MRI on a single 3T scanner. Participants then lay on a bed for 30 minutes before undergoing an identical MRI. In addition, we purposely selected five participants from a previous study with repeat lumbar MRI scans where temporal changes were reported in at least one MRI finding (1-12 weeks after initial scan) and another five participants where no temporal change was reported. The 10 participants were included in analyses for aim 1 only. Not applicable. Two blinded radiologists reported on temporal changes between the baseline and repeat scan for 12 different MRI findings (eg, disk herniation, annular fissure) at five levels. The interrater reliability of subjective reporting of temporal changes was poor for all MRI findings based on Kappa values (≤ 0.24), but agreement was relatively high (≥ 90.8%). This is explained by the low prevalence of temporal changes as demonstrated by high values for Prevalence and Bias Adjusted Kappa (≥ 0.82). "False positive" temporal changes were reported by at least one radiologist for most MRI findings, but the rate was generally low. Caution is required when interpreting temporal changes in lumbar MRI findings owing to low reliability and some false positive reporting.

CLRM-10. THE INTER-RELATIONSHIP BETWEEN MULTI-MODAL LONGITUDINAL BIOMARKERS OF NEURAL DAMAGE, INFLAMMATION, AND COGNITION AFTER CAR T CELLULAR THERAPY: A SINGLE-CENTER PROSPECTIVE OBSERVATIONAL TRIAL (NCT04614987)

BACKGROUNDImmune effector cell associated neurotoxicity syndrome (ICANS) remains a devastating, frequent complication of chimeric antigen receptor (CAR) T cell therapy for advanced-stage hematologic malignancies. Symptoms range from encephalopathy and headaches to aphasia, strokes, and diffuse cerebral edema. Persistent mild cognitive symptoms have also been reported. Unfortunately, the underlying pathophysiology driving ICANS is poorly understood. Current proposed models center on systemic inflammatory changes leading to endothelial dysfunction, blood-brain barrier (BBB) breakdown, and systemic cytokine and/or monocytes infiltration into the central nervous system (CNS). However, these models do not integrate predisposing risk factors for the development of ICANS. We previously demonstrated that pre-infusion plasma neurofilament light chain (NfL), a marker of neurodegeneration, may predict development of ICANS. Early elevations in NfL suggest development of ICANS is also related to pre-existing neuroaxonal injury. The longitudinal relationship between latent neuroaxonal injury, blood brain barrier (BBB) integrity, neuroinflammation, and cognition remains unknown.METHODSThis prospective, observational trial examines the relationship between multi-modal (blood, cerebrospinal fluid (CSF), neuroimaging) biomarkers and cognition in a cohort of twenty patients undergoing standard-of-care CAR T cellular therapy. Biomarkers for neural injury include blood and CSF NfL and volumetric measures derived from structural magnetic resonance imaging (MRI). Biomarkers for neuroinflammation include blood and CSF glial fibrillary acidic protein (GFAP) and qualification of white matter hyper-intensity burden on MRI. BBB integrity will be quantified using the serum/CSF albumin ratio. Finally, neuropsychological performance testing will assay cognitive performance across multiple cortical domains including attention, memory, and executive function. Participants will undergo a baseline (pre-infusion) examination, followed by evaluation (blood draw, voluntary lumbar puncture, MRI scan, and cognitive testing) on post-infusion day 3 (D3), D30, D90, and D180. The primary outcome is percent change in a given biomarker level.RESULTS/CONCLUSIONSThis ongoing trial has 2 of 20 planned participants enrolled.

The Association Between Different Trajectories of Low Back Pain and Degenerative Imaging Findings in Young Adult Participants Within The Raine Study.

Case-control study. Investigate the association between lumbar spine magnetic resonance imaging (MRI) findings and 5-year trajectories of low back pain (LBP) in young Australian adults. The association between lumbar spine imaging findings and LBP remains unclear due to important limitations of previous research, such as a lack of clearly defined LBP phenotypes and inadequate controlling for age, which may substantially affect the association. Seventy-eight "case" participants with a previously identified "consistent high disabling LBP" trajectory from age 17 to 22 years and 78 "control" participants from a trajectory with consistently low LBP over the same time period, matched for sex, body mass index, physical activity levels, and work physical demands, were identified from Gen2 Raine Study participants. At age 27, participants underwent a standardized lumbar MRI scan, from which 14 specific MRI phenotypes were identified. Primary analyses used unconditional logistic regression, adjusting for covariates used in the matching process, to investigate the relationship between presence of each imaging finding and being a case or control. Secondary analyses explored those relationships based on the number of spinal levels with each MRI finding. The odds for being a case compared with a control were higher in those with disc degeneration (Pfirrmann grade ≥ 3; OR = 3.21, 95% CI: 1.60-6.44; P = 0.001) or those with a herniation (OR = 1.90, 95% CI: 0.96-3.74; P - 0.065). We also found that the association became substantially stronger when either disc degeneration or herniation was present at two or more spinal levels (OR = 5.56, 95% CI: 1.97-15.70; P = 0.001, and OR = 5.85, 95% CI: 1.54-22.25; P = 0.009, respectively). The other investigated MRI findings were not associated with greater odds of being a case. Lumbar disc degeneration and herniation may be important contributors to disabling LBP in young adults. Further investigation of their potential prognostic and causal roles is indicated.Level of Evidence: 4.

Predicting Spinal Surgery Candidacy From Imaging Data Using Machine Learning.

The referral process for consultation with a spine surgeon remains inefficient, given a substantial proportion of referrals to spine surgeons are nonoperative. To develop a machine-learning-based algorithm which accurately identifies patients as candidates for consultation with a spine surgeon, using only magnetic resonance imaging (MRI). We trained a deep U-Net machine learning model to delineate spinal canals on axial slices of 100 normal lumbar MRI scans which were previously delineated by expert radiologists and neurosurgeons. We then tested the model against lumbar MRI scans for 140 patients who had undergone lumbar spine MRI at our institution (60 of whom ultimately underwent surgery, and 80 of whom did not). The model generated automated segmentations of the lumbar spinal canals and calculated a maximum degree of spinal stenosis for each patient, which served as our biomarker for surgical pathology warranting expert consultation. The machine learning model correctly predicted surgical candidacy (ie, whether patients ultimately underwent lumbar spinal decompression) with high accuracy (area under the curve=0.88), using only imaging data from lumbar MRI scans. Automated interpretation of lumbar MRI scans was sufficient to correctly determine surgical candidacy in nearly 90% of cases. Given that a significant proportion of referrals placed for spine surgery evaluation fail to meet criteria for surgical intervention, our model could serve as a valuable tool for patient triage and thereby address some of the inefficiencies within the outpatient surgical referral process.

An Objective Assessment of Lumbar Spine Degeneration/Ageing Seen on MRI Using An Ensemble Method-A Novel Approach to Lumbar MRI Reporting.

Retrospective, randomized, radiographic study assessing age-related changes (ARCs) on lumbar magnetic resonance imaging (MRI) using an ensemble method. This study proposed to develop a novel reporting method to calculate a predicted "age estimate" for the ARC seen on lumbar MRI. Lumbar MRI reports include pathological findings but usually not the prevalence data of common findings which has been shown to decrease the need for narcotics in the management of non-specific lower back pain (NSLBP). Comparing the normal age estimation for lumbar spine degenerative changes/ARC on MRI and comparing this to the patient's real age may improve patient outcome in the management of NSLBP. A total of 60 lumbar MRI were taken from patients aged between 0 and 100 years. Lumbar MRI features reported as associated with age on review of the literature were measured on each MRI and statistically evaluated for correlation with age. Factors found to be associated were then entered into an ensemble model consisting of several machine learning techniques. The resulting ensemble model was then tested to predict age for a further 10 random lumbar MRI scans. One further lumbar MRI was then assessed for observer variability. Features that correlated with age were disc signal intensity, the appearance of paravertebral and psoas muscle, disc height, facet joint size, ligamentum flavum thickness, Schmorl nodes, Modic changes, vertebral osteophytes, and high-intensity zones. With the ensemble model, 80% of estimated spinal age were within 11 years of the subjects' physical age. It would appear that the intervertebral discs, and many other structures that are subjected to loading in and around the lumbar spine change their lumbar MRI appearance in a predictable way with increasing age. ARC on lumbar MRI can be assessed to predict an "expected age" for the subject.Level of Evidence: 2.

Open-source image analysis software yields reproducible MRI measures of lumbar intervertebral disc degeneration in sheep models.

Sheep are established models for intervertebral disc degeneration (IVDD) translational research. Objectives of this retrospective, secondary analysis, observational study were to evaluate reproducibility of two magnetic resonance imaging (MRI) measures of IVDD in sheep using open-source image analysis software. Sagittal planar, T2-weighted, lumbar MRI scans from a previous, prospective study were evaluated (4 sheep @ 3 treatment periods/sheep @ 7 lumbar discs /treatment period=84 discs). A standardized protocol was developed for measuring MRI index (nucleus pulposus signal intensity × nucleus pulposus sagittal area), and nucleus pulposus signal intensity standard deviation (NPSISD). Scans were randomized and four observers with varying experience levels applied the protocol to independently perform triplicate measures. Mean coefficient of variation values for both the MRI index and NPSISD were within an acceptable range (<10). Mean values for the three readers with at least 2 months of image analysis experience did not differ (P>.05).

Predictive Classification System for Low Back Pain Based on Unsupervised Clustering.

Retrospective study. Lumbar magnetic resonance imaging (MRI) findings are believed to be associated with low back pain (LBP). This study sought to develop a new predictive classification system for low back pain. Normal subjects with repeated lumbar MRI scans were retrospectively enrolled. A new classification system, based on the radiological features on MRI, was developed using an unsupervised clustering method. One hundred and fifty-nine subjects were included. Three distinguishable clusters were identified with unsupervised clustering that were significantly correlated with LBP (P = .017). The incidence of LBP was highest in cluster 3 (57.14%), nearly twice the incidence in cluster 1 (30.11%). There were obvious differences in the sagittal parameters among the 3 clusters. Cluster 3 had the smallest intervertebral height. Based on follow-up findings, 27% of subjects changed clusters. More subjects changed from cluster 1 to clusters 2 or 3 (14.5%) than changed from cluster 2 or cluster 3 to cluster 1 (5%). Participation in sport was more frequent in subjects who changed from cluster 3 to cluster 1. Using an unsupervised clustering method, we developed a new classification system comprising 3 clusters, which were significantly correlated with LBP. The prediction of LBP is independent of age and better than that based on individual sagittal parameters derived from MRI. A change in cluster during follow-up may partially predict lumbar degeneration. This study provides a new system for the prediction of LBP that should be useful for its diagnosis and treatment.

The association between physical activity and vertebral dimension change in early adulthood – The Northern Finland Birth Cohort 1986 study

Small vertebral size is a well-known risk factor for vertebral fractures. To help understanding the factors behind vertebral size, we aimed to investigate whether physical activity and participation in high-impact exercise are associated with the growth rate of the vertebral cross-sectional area (CSA) among young adults. To conduct our study, we utilized the Northern Finland Birth Cohort 1986 as our study population (n = 375). Questionnaire data about physical activity was obtained at 16, 18 and 19 years of age and lumbar magnetic resonance imaging scans at two timepoints, 20 and 30 years of age. We used generalized estimating equation (GEE) models to conduct the analyses. We did not find any statistically significant associations between vertebral CSA, physical activity, and high-impact exercise in our study sample. We conclude that neither physical activity nor high-impact sports seem to influence the change in vertebral CSA among young adults.

Artificial Intelligence Comparison of the Radiologist Report With Endoscopic Predictors of Successful Transforaminal Decompression for Painful Conditions of the Lumber Spine: Application of Deep Learning Algorithm Interpretation of Routine Lumbar Magnetic Resonance Imaging Scan.

Identifying pain generators in multilevel lumbar degenerative disc disease is not trivial but is crucial for lasting symptom relief with the targeted endoscopic spinal decompression surgery. Artificial intelligence (AI) applications of deep learning neural networks to the analysis of routine lumbar MRI scans could help the primary care and endoscopic specialist physician to compare the radiologist's report with a review of endoscopic clinical outcomes. To analyze and compare the probability of predicting successful outcome with lumbar spinal endoscopy by using the radiologist's MRI grading and interpretation of the radiologic image with a novel AI deep learning neural network (Multus Radbot™) as independent prognosticators. The location and severity of foraminal stenosis were analyzed using comparative ordinal grading by the radiologist, and a contiguous grading by the AI network in patients suffering from lateral recess and foraminal stenosis due to lumbar herniated disc. The compressive pathology definitions were extracted from the radiologist lumbar MRI reports from 65 patients with a total of 383 levels for the central canal - (0) no disc bulge/protrusion/canal stenosis, (1) disc bulge without canal stenosis, (2) disc bulge resulting in canal stenosis, and (3) disc herniation/protrusion/extrusion resulting in canal stenosis. Both neural foramina were assessed with either - (0) neural foraminal stenosis absent, or (1) neural foramina are stenosis present. Reporting criteria for the pathologies at each disc level and, when available, the grading of severity were extracted and assigned into two categories: "Normal," and "Stenosis." Clinical outcomes were graded using dichotomized modified Macnab criteria considering Excellent and Good results as "Improved," and Fair and Poor outcomes as "Not Improved." Binary logistic regression analysis was used to predict the probability of the AI- and radiologist grading of stenosis at the 88 foraminal decompression sites to result in "Improved" outcomes. The average age of the 65 patients was 62.7 +/- 12.7 years. They consisted of 51 (54.3%) males and 43 (45.7%) females. At an average final follow-up of 57.4 +/- 12.57, Macnab outcome analysis showed that 86.4% of the 88 foraminal decompressions resulted in Excellent and Good (Improved) clinical outcomes. The stenosis grading by the radiologist showed an average severity score of 4.71 +/- 2.626, and the average AI severity grading was 5.65 +/- 3.73. Logit regression probability analysis of the two independent prognosticators showed that both the grading by the radiologist (86.2%; odds ratio 1.264) and the AI grading (86.4%; odds ratio 1.267) were nearly equally predictive of a successful outcome with the endoscopic decompression. Deep learning algorithms are capable of identifying lumbar foraminal compression due to herniated disc. The treatment outcome was correlated to the decompression of the directly visualized corresponding pathology during the lumbar endoscopy. This research should be extended to other validated pain generators in the lumbar spine. 3. Validity, clinical teaching, evaluation study.

Reliability Analysis of Deep Learning Algorithms for Reporting of Routine Lumbar MRI Scans.

Artificial intelligence could provide more accurate magnetic resonance imaging (MRI) predictors of successful clinical outcomes in targeted spine care. To analyze the level of agreement between lumbar MRI reports created by a deep learning neural network (RadBot) and the radiologists' MRI reading. The compressive pathology definitions were extracted from the radiologist lumbar MRI reports from 65 patients with a total of 383 levels for the central canal: (0) no disc bulge/protrusion/canal stenosis, (1) disc bulge without canal stenosis, (2) disc bulge resulting in canal stenosis, and (3) disc herniation/protrusion/extrusion resulting in canal stenosis. For both, neural foramina were assessed with either (0) neural foraminal stenosis absent or (1) neural foramina stenosis present. Reporting criteria for the pathologies at each disc level and, when available, the grading of severity were extracted, and the Natural Language Processing model was used to generate a verbal and written report. The RadBot report was analyzed similarly as the MRI report by the radiologist. MRI reports were investigated by dichotomizing the data into 2 categories: normal and stenosis. The quality of the RadBot test was assessed by determining its sensitivity, specificity, and positive and negative predictive value as well as its reliability with the calculation of the Cronbach alpha and Cohen kappa using the radiologist MRI report as a gold standard. The authors found a RadBot sensitivity of 73.3%, a specificity of 88.4%, a positive predictive value of 80.3%, and a negative predictive value of 83.7%. The reliability analysis revealed the Cronbach alpha as 0.772. The highest individual values of the Cronbach alpha were 0.629 and 0.681 when compared to the MRI report by the radiologist, rending values of 0.566 and 0.688, respectively. Analysis of interobserver reliability rendered an overall kappa for the RadBot of 0.627. Analysis of receiver operating characteristics (ROC) showed a value of 0.808 for the area under the ROC curve. Deep learning algorithms, when used for routine reporting in lumbar spine MRI, showed excellent quality as a diagnostic test that can distinguish the presence of neural element compression (stenosis) at a statistically significant level (P < .0001) from a random event distribution. This research should be extended to validated and directly visualized pain generators to improve the accuracy and prognostic value of the routine lumbar MRI scan for favorable clinical outcomes with intervention and surgery. 3. Validity, clinical teaching, and evaluation study.

PROSPECTIVE STUDY OF CORREALTION OF MRI FINDINGS AND CLINCAL SYMPTOMS IN LUMBAR SPINE DEGENERATIVE DISEASE

Introduction: Degenerative disease of the lumbar spine is a broad terminology which includes disc degeneration, Modic changes, disc displacement, facet joint arthropathy and associated complications. The modality of choice for imaging degenerative disease of lumbar spine is Magnetic Resonance Imaging (MRI) due to excellent soft tissue spatial resolution and better tissue segregation.The aim of this study was to establish correlation of MRI Findings and Clinical symptoms in lumbar spine degenerative disease.&#x0D; Material and Methods: This descriptive cross-sectional study involved 100 patients; lumbar MRI scans were performed through L1 to S1 Intervertebral disc spaces. Clinical presenting symptoms of the patients were noted , followed by MRI in which mainly six degenerative findings were looked at which were disc degeneration, Modic changes, disc bulge, disc herniation, central canal stenosis and nerve root compression.&#x0D; Results: Most frequent degenerative finding on MRI, in markedly symptomatic patients was disc degeneration seen in 100% of patients, followed by diffuse disc bulge (92.5%) and nerve root compression (82.5%). The least common finding was Facet Joint Hypertrophy seen in 22.9% of patients. In Degenerative imaging findings there was no significant sex difference. Degenerative findings were more common at lower lumbar levels (L4/L5&amp;L5/S1). Disc degeneration, disc herniations, central canal stenosis and nerve root compression were common in patients with radiculopathy than in patients with low back pain only. In Minimally symptomatic patients disc herniation was not seen in any patient.&#x0D; Conclusion:. The most frequent degenerative finding in markedly symptomatic patients was disc degeneration followed by diffuse disc bulge and nerve root compression. Posterolateral was the most common location for disc herniation. Disc herniation, disc degeneration, canal stenosis and nerve root compression were significantly seen in patients with radiculopathy. There were no sequestered discs found in the studied patients. All degenerative findings excluding disc herniation were also seen in lesser prevalence in minimally symptomatic patients.&#x0D; Keywords: Degenerative Disease, Lumbar Spine, MRI, Disc Degeneration, Disc Herniation, Modic Changes, Clinical Symptoms, Back pain

Clinical safety of ProMRI implantable cardioverter-defibrillator systems during head and lower lumbar magnetic resonance imaging at 1.5 Tesla

Magnetic resonance imaging (MRI) has long been contraindicated in patients with implanted pacemakers, defibrillators, and cardiac resynchronisation therapy (CRT) devices due to the risk of adverse effects through electromagnetic interference. Since many recipients of these devices will have a lifetime indication for an MRI scan, the implantable systems should be developed as ‘MRI-conditional’ (be safe for the MRI environment under predefined conditions). We evaluated the clinical safety of several Biotronik ProMRI (‘MRI-conditional’) defibrillator and CRT systems during head and lower lumbar MRI scans at 1.5 Tesla. The study enrolled 194 patients at 22 sites in Australia, Canada, and Europe. At ≥9 weeks after device implantation, predefined, non-diagnostic, specific absorption rate (SAR)-intensive head and lower lumbar MRI scans (total ≈30 minutes per patient) were performed in 146 patients that fulfilled pre-procedure criteria. Three primary endpoints were evaluated: freedom from serious adverse device effects (SADEs) related to MRI and defibrillator/CRT (leading to death, hospitalisation, life-threatening condition, or potentially requiring implanted system revision or replacement), pacing threshold increase, and sensing amplitude decrease, all at the 1-month post-MRI clinical visit. No MRI-related SADE occurred. Lead values remained stable, measured in clinic and monitored daily by the manufacturer home monitoring technology.

Clinical prevalence and population incidence of serious pathologies among patients undergoing magnetic resonance imaging for low back pain

BACKGROUNDIn rare cases low back pain may be caused by underlying serious pathology such as fracture, malignancy, cauda equina syndrome, or spinal infection. The lack of evidence regarding either the clinical prevalence or population incidence of serious pathologies in the lumbar spine makes it difficult for clinicians to adequately assess a patient's risk of serious pathology. PURPOSETo determine the prevalence of serious pathologies in patients with low back pain who have been referred for a lumbar magnetic resonance imaging (MRI) by a specialist in a private secondary care or public tertiary care setting. The incidence of these serious pathologies in the geographic region of South Auckland, New Zealand was also investigated. STUDY DESIGNRetrospective, observational cohort study. PATIENT SAMPLEConsecutive patients referred for lumbar MRI over a 10-month period (1st of October 2013–31st of July 2014). METHODData from all eligible MRI reports was analyzed and any serious pathologies were identified and recorded. Prevalence (along with 95% confidence intervals) was calculated as a percentage of the study population. Prevalence specific to private secondary care and public tertiary care settings was also calculated and prevalence rate ratios were determined to allow comparison between settings. Incidence in the geographic region of South Auckland, New Zealand, was determined using data collected from participants recruited from the regional public hospital. Population incidence with respect to age, gender, and ethnicity for each target condition was calculated and incidence rate ratios were computed to compare groups. RESULTSA total of 2,383 participants referred for lumbar MRI scans were included in this study. Prevalence was significantly higher in the public tertiary care setting than in the private secondary care setting for all pathologies investigated in this study. Pathology specific prevalence in secondary care vs tertiary care settings was: malignancy, 0.3%, 4.4% (p<.001); fracture 2.2%, 6.7% (p<.001); cauda equina compression 0.6%, 2.3% (p=.001); infection 0.1%, 3.4% (p<.001). The combined prevalence in secondary care was 3.2% and in tertiary care 14.8% (p<.001). Pathology specific total incidence was: fracture, 13 per 100,000 person-years (p-y); malignancy 8.5 per 100,000 p-y; cauda equina compression 4.4 per 100,000 p-y; spinal infection 6.6 per 100,000 p-y. CONCLUSIONSThe prevalence of serious pathologies was significantly higher in tertiary care (public health) than in private secondary care settings. One in every 6.5 patients referred for MRI in tertiary care demonstrated structural abnormalities associated with serious pathology, which raises the question of whether access to MRI should be re-evaluated.

Objectively Measured Physical Activity Is Associated with Vertebral Size in Midlife.

Vertebral fractures reduce the quality of life and are a major burden to the health care sector. Small vertebral size is associated with increased vertebral fracture risk. Previous studies have investigated the relationship between physical activity (PA) and vertebral size, but their results seem somewhat contradictory. In this population-based birth cohort study, we aimed to evaluate the relationship between objectively measured PA and vertebral size. The study population consisted of 1202 cohort participants who underwent PA and vertebral size measurements at the age of 46 to 48 yr. Moderate-to-vigorous PA (MVPA, ≥3.5 METs) was measured by a wrist-worn accelerometer (Polar Active; Polar Electro, Finland) for 14 d. The vertebral axial cross-sectional area (CSA) of the L4 vertebra was measured and calculated from lumbar magnetic resonance imaging scans at 46 to 48 yr. We analyzed the association between the daily amount of MVPA (min·d) and vertebral CSA using multivariable linear regression analysis. The daily amount of MVPA was significantly and positively associated with CSA in both sexes. For every minute per day of MVPA, men had 0.71 mm (95% confidence interval, 0.36-1.06) and women 0.90 mm (95% confidence interval, 0.58-1.21) larger CSA. Physical activity of at least moderate intensity is positively associated with vertebral size and may thus prevent future vertebral fractures.