Magnetic Resonance Imaging Of Lumbar Spine Research Articles

Radiomic nomogram based on lumbar spine magnetic resonance images to diagnose osteoporosis.

We aimed to establish a novel model using a radiomics analysis of magnetic resonance (MR) images for predicting osteoporosis. To investigate the effectiveness of a radiomics approach utilizing magnetic resonance imaging (MRI) of the lumbar spine in identifying osteoporosis. In this retrospective study, a total of 291 patients who underwent MRI were analyzed. Radiomics features were extracted from the MRI scans of all 1455 lumbar vertebrae, and build the radiomics model based on T2-weighted (T2W), T1-weighted (T1W), and T2W + T1W imaging. The performance of the combined model was assessed using metrics such as the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. The AUCs of these models were compared using the DeLong test. Their clinical usefulness was assessed using a decision curve analysis. T2W, T1W, and T1W + T2W imaging retained 27, 27, and 17 non-zero coefficients, respectively. The AUCS about radiomics scores based on T2W, T1W, and T1W + T2W imaging were 0.894, 0.934, and 0.945, respectively, which all performed better than the clinical model significantly. The rad-signatures based on T1W + T2W imaging, which exhibited a stronger predictive power, were included in the creation of the nomogram for osteoporosis diagnosis, and the AUC was 0.965 (95% confidence interval (CI)=0.944-0.986) in the training cohort and 0.917 (95% CI=0.738-1.000) in the test cohort. The calibration curve indicated that the radiomics nomogram had considerable clinical usefulness in prediction, observation, and decision curve analysis. A reliable and powerful tool for identifying osteoporosis can be provided by the nomogram that combines the T1W and T2W imaging radiomics score with clinical risk factors.

Mo-fi-disc scoring system: Towards understanding the radiological tools to better delineate the disease process and enhancing our solutions for low back pain in artificial intelligence era

Background‘Mo-fi-disc’ is a new scoring system that quantifies degeneration of the lumbar spine and predicts the intensity of low back pain (LBP). However, its association with LBP-related disability is unknown. In the present study, we aimed to analyze whether ‘Mo-fi-disc’ scoring system could predict LBP-related disability and distinguish patients with LBP from asymptomatic subjects, while the spine medicine marching towards the era of artificial intelligence (AI). MethodsThis is a cross-sectional analysis of a prospectively collected database. We included age-, gender-, and BMI-matched 132 subjects (patients: 66, asymptomatic subjects: 66). Modic changes (Mo), fatty infiltration in the paraspinal muscles (fi), and intervertebral disc degeneration (disc) were evaluated using ‘Mo-fi-disc’ scoring system on lumbar spine magnetic resonance imaging. Pain and disability were evaluated with visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. ResultsA Mo-fi-disc score of 5.5 was the most appropriate cut-off value. Mo-fi-disc scoring system had an OR of 1.79 in distinguishing patients with LBP from asymptomatic subjects. One point increment in VAS and ODI had ORs of 1.82 and 1.13 for predicting higher Mo-fi-disc scores. Conclusion‘Mo-fi-disc’ scoring system is a useful tool depicting intensity of LBP and LBP-related disability. The cut off value of Mo-fi-disc score is 5.5 to distinguish patients with LBP from asymptomatic subjects. This scoring system, with progressive improvement of its faults, could help clinicians to select appropriate patients for conservative and surgical management in the very near future, in AI-based spine medicine. IRB approval noATADEK 2019-12/4.

Lumbar spine segmentation in MR images: a dataset and a public benchmark

This paper presents a large publicly available multi-center lumbar spine magnetic resonance imaging (MRI) dataset with reference segmentations of vertebrae, intervertebral discs (IVDs), and spinal canal. The dataset includes 447 sagittal T1 and T2 MRI series from 218 patients with a history of low back pain and was collected from four different hospitals. An iterative data annotation approach was used by training a segmentation algorithm on a small part of the dataset, enabling semi-automatic segmentation of the remaining images. The algorithm provided an initial segmentation, which was subsequently reviewed, manually corrected, and added to the training data. We provide reference performance values for this baseline algorithm and nnU-Net, which performed comparably. Performance values were computed on a sequestered set of 39 studies with 97 series, which were additionally used to set up a continuous segmentation challenge that allows for a fair comparison of different segmentation algorithms. This study may encourage wider collaboration in the field of spine segmentation and improve the diagnostic value of lumbar spine MRI.

AI-Based Measurement of Lumbar Spinal Stenosis on MRI: External Evaluation of a Fully Automated Model.

The aim of this study was to clinically validate a fully automated AI model for magnetic resonance imaging (MRI)-based quantifications of lumbar spinal canal stenosis. This retrospective study included lumbar spine MRI of 100 consecutive clinical patients (56 ± 17 years; 43 females, 57 males) performed on clinical 1.5 (51 examinations) and 3 T MRI scanners (49 examinations) with heterogeneous clinical imaging protocols. The AI model performed segmentations of the thecal sac on axial T2-weighted sequences. Based on these segmentations, the anteroposterior (AP) and mediolateral (ML) distance, and the area of the thecal sac were measured in a fully automated manner. For comparison, 2 fellowship-trained musculoskeletal radiologists performed the same segmentations and measurements independently. Statistics included 1-sample t tests, the intraclass correlation coefficient (ICC), Bland-Altman plots, and Dice coefficients. A P value of <0.05 was considered statistically significant. The average measurements of the AI model, reader 1, and reader 2 were 194 ± 72 mm2, 181 ± 71 mm2, and 179 ± 70 mm2 for thecal sac area, 13 ± 3.3 mm, 12.6 ± 3.3 mm, and 12.6 ± 3.2 mm for AP distance, and 19.5 ± 3.9 mm, 20 ± 4.3 mm, and 19.4 ± 4 mm for ML distance, respectively. Significant differences existed for all pairwise comparisons, besides reader 1 versus AI model for the ML distance and reader 1 versus reader 2 for the AP distance (P = 0.1 and P = 0.21, respectively). The pairwise mean absolute errors among reader 1, reader 2, and the AI model ranged from 0.59 mm and 0.75 mm for the AP distance, from 1.16 mm to 1.37 mm for the ML distance, and from 7.9 mm2 to 15.54 mm2 for the thecal sac area. Pairwise ICCs among reader 1, reader 2, and the AI model ranged from 0.91 and 0.94 for the AP distance and from 0.86 to 0.9 for the ML distance without significant differences. For the thecal sac area, the pairwise ICC between both readers and the AI model of 0.97 each was slightly, but significantly lower than the ICC between reader 1 and reader 2 of 0.99. Similarly, the Dice coefficient and Hausdorff distance between both readers and the AI model were significantly lower than the values between reader 1 and reader 2, overall ranging from 0.93 to 0.95 for the Dice coefficients and 1.1 to 1.44 for the Hausdorff distances. The investigated AI model is reliable for assessing the AP and the ML thecal sac diameters with human level accuracies. The small differences for measurement and segmentation of the thecal sac area between the AI model and the radiologists are likely within a clinically acceptable range.

Acontractile detrusor as an initial presentation of sacral spinal cord lesion: Case series.

This study aims to investigate cases of acontractile bladder as the initial presentation of benign and malignant spinal conditions. The focus is on the challenges in making a diagnosis and the importance of a thorough neurological evaluation. We conducted a retrospective case series involving three patients who exhibited symptoms of acontractile bladder. Detailed clinical histories, urodynamic studies, and imaging techniques such as lumbosacral magnetic resonance imaging (MRI) were analyzed. Histopathological findings from relevant biopsies were also taken into account. Case 1: A 14-year-old female presented with urinary retention, back pain, and an acontractile bladder on urodynamic study. Further examination, including lumbosacral MRI and histopathology, confirmed a diagnosis of metastatic Ewing's Sarcoma. Case 2: A 39-year-old female with urinary incontinence and elevated post-void residual exhibited delayed bladder sensation. Lumbar spine MRI revealed a grade I Schwannoma after surgical resection. Case 3: A 15-year-old male with lower urinary tract symptoms and an acontractile detrusor on urodynamic study was found to have a Tarlov cyst on lumbosacral MRI. Atonic or Underactive bladder syndrome may be the initial presentation of a serious spinal condition. Complete neurological evaluation is mandatory if no obvious clinical cause.

A Retrospective Study of the Effect of Spinopelvic Parameters on Fatty Infiltration in Paraspinal Muscles in Patients With Lumbar Spondylolisthesis.

The effect on fat infiltration (FI) of paraspinal muscles in degenerative lumbar spinal diseases has been demonstrated except for spinopelvic parameters. The present study is to identify the effect of spinopelvic parameters on FI of paraspinal muscle (PSM) and psoas major muscle (PMM) in patients with degenerative lumbar spondylolisthesis. A single-center, retrospective cross-sectional study of 160 patients with degenerative lumbar spondylolisthesis (DLS) and lumbar stenosis (LSS) who had lateral full-spine x-ray and lumbar spine magnetic resonance imaging was conducted. PSM and PMM FIs were defined as the ratio of fat to its muscle cross-sectional area. The FIs were compared among patients with different pelvic tilt (PT) and pelvic incidence (PI), respectively. The PSM FI correlated significantly with pelvic parameters in DLS patients, but not in LSS patients. The PSM FI in pelvic retroversion (PT > 25°) was 0.54 ± 0.13, which was significantly higher in DLS patients than in normal pelvis (0.41 ± 0.14) and pelvic anteversion (PT < 5°) (0.34 ± 0.12). The PSM FI of DLS patients with large PI ( > 60°) was 0.50 ± 0.13, which was higher than those with small ( < 45°) and normal PI (0.37 ± 0.11 and 0.36 ± 0.13). However, the PSM FI of LSS patients didn't change significantly with PT or PI. Moreover, the PMM FI was about 0.10-0.15, which was significantly lower than the PSM FI, and changed with PT and PI in a similar way of PSM FI with much less in magnitude. FI of the PSMs increased with greater pelvic retroversion or larger pelvic incidence in DLS patients, but not in LSS patients.

Evaluation of Fluoroscopically Guided Transforaminal Selective Nerve Root Sleeve Injections for Lumbar Spinal Stenosis With Radiculopathy Utilizing Patient Reported Outcome Measurement Information System as an Outcome Measure

ObjectiveTo evaluate the therapeutic effect of transforaminal selective nerve root sleeve injections (TFSNRIs) in a specific subset of patients with clinical symptoms and presentation consistent with spinal stenosis. DesignRetrospective review. SettingTertiary academic spine center. ParticipantsA total of 176 patients with radicular leg pain with or without low back pain as well as ≥3 clinical features of spinal stenosis and corroborative radiographic features of spinal stenosis on lumbar spine magnetic resonance imaging without confounding spinal pathology (N=176). InterventionsFluoroscopically guided transforaminal selective nerve root sleeve injections. Main Outcome MeasuresPatient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) v1.2/v2.0, Pain Interference (PI) v1.1, and PROMIS (D) v1.0 were collected at baseline and post-procedure short term (<3-months) and long-term (6-12 month) follow-up. Statistical analysis comparing baseline and postprocedural PROMIS scores was performed. Differences were compared with previously established minimal clinically important differences in the spine population. ResultsFor patients with spinal stenosis treated with TFSNRI, no statistically significant improvement was observed short- and long-term follow-up in PROMIS PF (P=.97, .77) and PROMIS Depression (P=.86, .85) scores. At short-term follow-up, PROMIS PI scores did significantly improve (P=.01) but the average difference of pre- and post-procedure scores did not reach clinical significance. No significant difference in PROMIS PI was noted at long-term follow-up (.75). ConclusionsAlthough a statistically significant difference was observed for improvement in pain, in this retrospective study, TFSNRI did not provide clinically significant improvement in patients’ function, pain, or depression for lumbar spinal stenosis at short- and long-term follow-up.

Reporting of Facet Joint Inflammation in Lumbar Spine MRI Studies in Patients With Low Back Pain.

Retrospective. We aimed to assess the frequency of facet joint inflammatory features noted in routine radiology reports of lumbar spine magnetic resonance imaging (MRI) studies among patients with chronic low back pain. Facet joint arthropathy is one of the most common causes of chronic low back pain. It may encompass various inflammatory imaging characteristics, such as facet joint effusion, bone marrow edema, and soft tissue edema. The extent to which radiology reports mention inflammatory features of the lumbar facet joints and the accuracy of these reports have not been investigated. The authors performed a chart review on 49 subjects with previous facet-related interventions ( i.e . medial branch blocks or intra-articular facet joint injection) and MRI available in the medical record. One senior musculoskeletal radiologist and a musculoskeletal radiology fellow graded the inflammatory features using a published facet joint inflammation grading system [Gold Standard (GS)]. The authors identified the inflammatory markers mentioned in the radiology reports and calculated the sensitivity and positive predictive value of the radiology reports compared with GS readings. Compared with the GS, the sensitivity of radiology reports for facet joint effusion, bone marrow, and soft tissue edema ranged from 6% to 22%, and the positive predictive value ranged from 25% to 100%. L4/5 had the highest number of cases with inflammatory features noted on the reports. Inflammatory findings, such as facet joint effusion, bone marrow edema, and soft tissue edema, are not commonly identified in radiology reports. Further investigations are needed to determine the clinical importance of MRI-detected lumbar facet joint inflammatory features as a potential mechanism of nociception and as a predictor of outcomes following injections or other therapies.

Are clinically unimportant findings qualified as benign in lumbar spine imaging reports? A content analysis of plain X-ray, CT and MRI reports.

Lumbar spine diagnostic imaging reports may cause patient and clinician concern when clinically unimportant findings are not explicitly described as benign. Our primary aim was to determine the frequency that common, benign findings are reported in lumbar spine plain X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) reports as either normal for age or likely clinically unimportant. We obtained 600 random de-identified adult lumbar spine imaging reports (200 X-ray, 200 CT and 200 MRI) from a large radiology provider. Only reports requested for low back pain were included. From the report text, one author extracted each finding (e.g., 'broad-based posterior disc bulge') and whether it was present or absent (e.g., no disc bulge) until data saturation was reached, pre-defined as a minimum of 50 reports and no new/similar findings in the last ten reports within each imaging modality. Two authors independently judged whether each finding was likely clinically unimportant or important. For each likely clinicially unimportant finding they also determined if it had been explicitly reported to be benign (expressed as normal, normal for age, benign, clinically unimportant or non-significant). Data saturation was reached after coding 262 reports (80 X-ray, 82 CT, 100 MRI). Across all reports we extracted 3,598 findings. Nearly all reports included at least one clinically unimportant finding (76/80 (95%) X-ray, 80/82 (98%) CT, 99/100 (99%) MRI). Over half of the findings (n = 2,062, 57%; 272 X-Ray, 667 CT, 1123 MRI) were judged likely clinically unimportant. Most likely clinically unimportant findings (90%, n = 1,854) were reported to be present on imaging (rather than absent) and of those only 18% (n = 331) (89 (35%) X-ray, 93 (16%) CT and 149 (15%) MRI) were explicitly reported as benign. Lumbar spine imaging reports frequently include findings unlikely to be clinically important without explicitly qualifying that they are benign.

Comparison of T2-Weighted 3D-Space and T2-Weighted 2D-TSE Sequences in Lumbar Spine Magnetic Resonance Imaging (MRI)

Background: Spine-related issues like low back pain have substantially increased in the past few decades across all age categories having various reasons. Objectives: To compare the image quality and diagnostic value of 3D space MRI sequence with 2D TSE MRI sequence in lumbar spine imaging. Methods: Fifty patients, irrespective of gender having age between 30-70 years, who presented with lower back pain were enrolled for the study. Lumbar spine imaging was done using 2D TSE and 3D space sequences and the subsequent images were evaluated by two senior consultant radiologists for qualitative analysis of visibility and pathologic indices of both sequences. Data was analyzed on SPSS 25.0. Statistical analysis was done using Cohen's kappa (k). Results: Female participants were 56% of total study population. Mean age of study participants found to be 53.62±10.76 years. Statistically significant difference (p-value =0.000) was noted for visibility score of all the lumbar spine components, when the 3D SPACE and 2D TSE images were compared with 3D-SPACE images found being superior in visibility. Inter- observer agreement for visibility of various regions of lumber spine was nearly perfect (k&gt; 0.8) and substantial (0.6 to 0.8) for 3D-SPACE, while substantial (0.8&lt;k&gt; 0.6) for 2D-TSE. Pathologic indexes had a significant level of inter-observer agreement (k &gt; 0.6). Inter-observer agreement for 3D sequence (k = 0.72) was greater than that for 2D-TSE sequence (k = 0.64). Conclusion: Images from 3D-SPACE sequences provide superior visibility over 2D-TSE and could be recommended as alternative imaging method for lumbar spine pathologies. Higher inter observer agreement illustrate that it may be included in routine sequences to make the better diagnosis for lumbar spine pathologies correctly.

Metastatic spinal lymphoma: A case report

Background. Metastatic spinal lymphoma is a rare case, especially with the initial clinical manifestation of back pain, which only occurs in less than 5% of patients. We report a case of an adult male with low back pain that was found to be metastatic spinal lymphoma, and this study is the first to report a case of metastatic spinal lymphoma with initial complaints of back pain. Case presentation. A 66-year-old male presented with progressive lower extremity weakness since 2 weeks. The initial complaint was back pain since 2 months before admission. The patient had no history of previous trauma, history of hypertension, diabetes, or heart disease was also denied. The patient admitted that there was a weight loss in the last 2-3 months Radiologic examination of the lumbar spinal MRI (magnetic resonance imaging) without contrast was performed and showed an impression of bone metastasis at the corpus VL (lumbar vertebrae) 1-5, and paraspinal musculospasm Conclusion. We report rare case of metastatic spinal lymphoma, spinal lymphoma should be considered and monitored for non-specific clinical findings that resemble other possible causes.

Assessing bone density on MRI: comparison between routine MRI sequences and DEXA scans.

Magnetic Resonance Imaging (MRI) is frequently utilised to aid in the comprehensive assessment of back pain, while dual-energy x-ray absorptiometry (DEXA) is the gold standard test for the assessment of bone density. Assessing bone density on MRI could reduce costs and avoid exposing patients to ionising radiation. The aim of this paper is to investigate whether the relative signal intensity of vertebral bodies compared to other structures can detect osteoporosis on MRI. 100 patients that had undergone both a lumbar spine MRI and a DEXA scan were identified. The T1 and T2 signal intensity of L1-L4 vertebral bodies (VB), cerebro-spinal fluid (CSF), and psoas muscle were measured within a 1-cm2 region of interest (ROI), and the signal intensity ratios were calculated. The ratios were stratified as normal, osteopenic, or osteoporotic based on DEXA T-scores. The T1 VB /T1 CSF ratio was significantly higher in the osteoporotic group than the normal and osteopenic groups (p < 0.001). The T1 VB /T1 CSF ratio had excellent discrimination (AUC = 0.841) for the presence of osteoporosis. The Pearson correlation coefficient between the DEXA T-score and the T1VB/T1CSF ratio was -0.474 (p < 0.001). The intra-observer (ICC = 0.910, 95% CI = 0.757-0.966) and inter-observer reliability (ICC = 0.927, 95% CI = 0.824-0.970) were excellent. In our cohort, a T1 VB / T1 CSF ratio of greater than 4 is 66.7% sensitive but 90.0% specific for the presence of osteoporosis. A high T1VB/T1CSF ratio suggests osteoporosis on MRI. Prospective validation is needed to confirm these findings.

Abdominal Fat is a Reliable Indicator of Lumbar Intervertebral Disc Degeneration than Body Mass Index

To determine whether abdominal fat status correlates with low back pain (LBP) and lumbar intervertebral disc degeneration (IVDD), and to identify a new anthropometric index to predict the likelihood of developing LBP. Patients with chronic low back pain admitted to the Affiliated Hospital of Southwest Medical University from June 2022 to May 2023 were collected as the experimental group. Volunteers without LBP from June 2022 to May 2023 were also recruited as the control group. They underwent lumbar spine magnetic resonance imaging (MRI) and had their body mass index (BM) measured. Abdominal parameters were measured on T2-weighted median sagittal MRI at the L3/4 level: abdominal diameter (AD), sagittal abdominal diameter (SAD), and subcutaneous abdominal fat thickness (SAFT). Each lumbar IVDD was assessed using the Pfirrmann grading system. The differences in abdominal parameters and BMI between the experimental and control groups were compared, and the correlations between abdominal parameters, BMI, LBP, and IVDD were analyzed. AD, SAD, and SAFT had moderate-to-strong correlations with BMI. SAD was significantly associated with severe IVDD at L4-L5 and L5-S1 levels with ORs of 3.201 (95% CI: 1.850-5.539, p < 0.001) and 1.596 (95% CI: 1.072-2.378, p = 0.021), respectively. BMI had no significant association with severe IVDD. In females, SAFT and BMI were significantly correlated with LBP; in males, only SAFT was significantly correlated with LBP. Appropriate cutoff values for males and females were 1.52cm (AUC=0.702, 95% CI: 0.615-0.789,p<0.001) and 1.97cm (AUC=0.740, 95% CI: 0.662-0.818,p<0.001), respectively. Males and females with SAFT of >1.52cm and >1.97cm, respectively, had significantly higher rates of LBP. SAD could predict severe IVDD better than BMI. SAFT is a better predictor of LBP than BMI, especially in males, and reliably distinguished patients with LBP from asymptomatic subjects with reliable cutoff values for males and females.

Vertebral changes in the lumbar spine of adults presenting with chronic low back pain at a Referral Hospital in western Kenya

Background: Chronic low back pain is a common musculoskeletal symptom affecting the lower part of the spine. It is described as pain and discomfort around the lumbar region lasting for more than twelve weeks. The symptoms of chronic low back pain might range from a dull ache to a stubbing or shooting sensation. This nature of pain may be localized around the axial region or radiate to the lower limbs affecting the patients’ daily activities. The aim of this study, therefore, was to evaluate vertebral changes in the lumbar spine of adults presenting with chronic low back pain at Kakamega County General and Referral Hospital.&#x0D; Methods: This was a cross-sectional quantitative descriptive study whereby; patients’ data was collected during patients’ presentation at orthopedic outpatient clinic and MRI department. Purposive sampling of lumbar spine Magnetic resonance imaging scans was used to obtain data. A total of 144 patients were selected using the Yamane Taro formula. Anatomical vertebral changes of the lumbar spine were assessed from the selected MRIs to evaluate the structural causes of chronic low back pain. Descriptive statistics such as frequency and percentage were used in analyzing the data.&#x0D; Results: It was noted that osteophytes were the most pathological changes causing chronic low back pain while fractures were the least common. Osteophytic changes in the vertebra and desiccation of the intervertebral discs can predispose one to chronic lower back pain.&#x0D; Conclusion: The study recommends early screening and treatment of lower back pain to avert its sequelae.

Optimal cutoff point of vertebral body cross-sectional area as a morphological parameter for predicting lumbar spondylolysis.

The relationship between vertebral body cross-sectional area (VBCSA) and spinal conditions associated with increased lumbar lordosis, such as lumbar spondylolysis (LSL), is not known. We investigated the morphological parameter, VBCSA, to predict LSL. The VBCSA on MRI has not been studied for its association with LSL. We hypothesized that VBCSA is an important morphological parameter for LSL prediction. We collected VBCSA data from 90 patients (43 males and 47 females) with LSL and 91 control subjects (44 males and 47 females) who underwent lumbar spine magnetic resonance imaging (LS-MRI). Axial T2-weighted LS-MRI images were obtained from all participants. Using our picture archiving and communications system, we analyzed the VBCSA at the level of the L5 vertebral body by utilizing MRI. The average VBCSA was 2263.51 ± 306.02 mm2 in the male control group and 1820.92 ± 224.89 mm2 in the male LSL group. LSL patients had significantly lower VBCSAs (P < .001) than did the male controls. The average VBCSA was 1985.21 ± 258.05 mm2 in the female control group and 1553.73 ± 250.02 mm2 in the female LSL group, and the LSL patients also had significantly lower VBCSAs (P < .001) than did the female controls. The optimal VBCSA cutoff value in the male group was 2014.69 mm2 with 76.7% sensitivity, 75.0% specificity, and an area under the receiver operating curve (AUC) of 0.89 (95% CI: 0.82-0.95). In the female group, the optimal cutoff score was 1814.11 mm2 with 76.6% sensitivity, 76.6% specificity, and an AUC of 0.88 (95% CI: 0.82-0.95). VBCSA is a sensitive objective morphological parameter for assessing LSL, and a lower VBCSA is associated with a higher possibility of LSL. We believe that these results will be useful in diagnostic radiology for evaluating patients with LSL.

Automated Detection and Measurement of Dural Sack Cross-Sectional Area in Lumbar Spine MRI Using Deep Learning.

Lumbar spine magnetic resonance imaging (MRI) is a critical diagnostic tool for the assessment of various spinal pathologies, including degenerative disc disease, spinal stenosis, and spondylolisthesis. The accurate identification and quantification of the dural sack cross-sectional area are essential for the evaluation of these conditions. Current manual measurement methods are time-consuming and prone to inter-observer variability. Our study developed and validated deep learning models, specifically U-Net, Attention U-Net, and MultiResUNet, for the automated detection and measurement of the dural sack area in lumbar spine MRI, using a dataset of 515 patients with symptomatic back pain and externally validating the results based on 50 patient scans. The U-Net model achieved an accuracy of 0.9990 and 0.9987 on the initial and external validation datasets, respectively. The Attention U-Net model reported an accuracy of 0.9992 and 0.9989, while the MultiResUNet model displayed a remarkable accuracy of 0.9996 and 0.9995, respectively. All models showed promising precision, recall, and F1-score metrics, along with reduced mean absolute errors compared to the ground truth manual method. In conclusion, our study demonstrates the potential of these deep learning models for the automated detection and measurement of the dural sack cross-sectional area in lumbar spine MRI. The proposed models achieve high-performance metrics in both the initial and external validation datasets, indicating their potential utility as valuable clinical tools for the evaluation of lumbar spine pathologies. Future studies with larger sample sizes and multicenter data are warranted to validate the generalizability of the model further and to explore the potential integration of this approach into routine clinical practice.

Magnetic Resonance Imaging Spectrum of Cauda Equina and Conus Lymphoma: Keys to Unravel the Differential Diagnosis with a Review of the Literature

Central nervous system lymphoma is not an uncommon condition, but spinal lymphoma with isolated involvement of the conus medullaris and cauda equina is a rare entity. Our study aims to evaluate the various magnetic resonance imaging (MRI) features of cauda equina and conus lymphoma. This retrospective study was carried out on nine patients with histopathologically proven cauda equina and conus lymphoma, who were presented at a tertiary care hospital between January 2018 and June 2020. All patients underwent lumbar spine MRI scans using a 1.5 Tesla MR scanner. The clinical data and different MRI findings were analyzed with an independent sample t-test and paired-samples t-test. Among the nine patients with cauda equina and conus lymphoma, three had primary lymphoma and six had secondary lymphoma. Six patients (66.7%) showed a diffuse pattern of involvement of cauda equina and conus medullaris, while three patients (33.3%) showed a focal pattern. T2-weighted imaging (T2WI) hypo to isointense signal intensity lesions were observed in six patients (66.7%) and T2WI iso to slight hyperintensities in three patients (33.3%). Diffuse sheet-like thickening and postcontrast enhancement of the thickened cauda equina nerve roots were observed in two patients of primary and one patient with secondary lymphoma. The diagnosis of cauda equina and conus lymphoma especially primary lymphoma is challenging and requires a high index of clinical suspicion as distinguishing this entity from similar conditions is difficult solely on MRI. Early diagnosis of this entity is important for early institution of treatment for increasing the chances of survival and improvement of symptoms.

Investigation of the relationship between lumbar spine MRI findings and pain in patients who received and did not receive Parkinson's treatment

Objectives: Parkinson's disease is a chronic, progressive neurodegenerative disorder. Pain is a common symptom in Parkinson's disease, but the prevalence, characteristics, and documentation of its relationship with Parkinson's disease are insufficient. In this study, it was aimed to evaluate the relationship between lumbar spine magnetic resonance imaging (MRI) findings in patients who received and did not receive Parkinson's treatment. Methods: The demographic characteristics of patients with diagnosed Parkinson's disease were retrospectively obtained from the records. Their pain was grouped and the Hoehn Yahr stage at the first examination, and the interventional treatments performed were recorded. MRI measurements were made in the axial plane and sagittal plane of the spinal canal, whereas Ligamentum flavum measurements were made on both the right and left sides. Results: Twenty-six patients were included in the study. The average age was 73.5. Notably, 57.7% of patients were not diagnosed with Parkinson's disease prior to admission, while the Hoehn Yahr stage mostly comprised Stage 2 with 53.8%. Additionally, low back, waist, and hip pain was observed in 84.6% (n = 22), whereas 61.5% (n = 16) of patients experienced radicular pain. Epidural injections accounted for 33.2%. On lumbar MRI, the most narrow spinal segment on axial measurement was shown to be L4-L5. The axial spinal canal measurement of the Hoehn Yahr 1 group was observed to be significantly lower than the Hoehn Yahr 2 group. Conclusions: Optimal management for lumbar pain that increases with age is currently inadequate. There is a need to conduct larger studies on pain complaints, which is one of the frequently experienced non-motor symptoms in Parkinson's disease, as well as the interventional methods applied.

Increased levels of circulating granulocytic myeloid‑derived suppressor cells in lumbar disc herniation.

Myeloid-derived suppressor cells (MDSCs) expand when the body undergoes inflammatory diseases and chronic diseases. However, its role in intervertebral disc degeneration remains unclear. The present study aimed to characterize specific subsets of MDSCs as potential indicators of disease progression in patients with lumbar disc herniation (LDH). The Gene Expression Omnibus (GEO) database was used to analyze the changes in granulocyte MDSCs (G-MDSCs). Peripheral blood samples were collected from 40 patients with LDH and 15 healthy controls, and flow cytometry was used to characterize different subsets of MDSCs. All subjects underwent lumbar spine magnetic resonance imaging. Then, t-distributed stochastic neighborhood embedding and FlowSOM were used to analyze the data obtained by CytoFlex. The correlation between circulating MDSCs and the clinicopathological stage of LDH was then further analyzed. The GEO database predicted that G-MDSCs were highly expressed in patients with LDH. The frequency of circulating G-MDSCs increased with Pfirrmann stage III and IV, while the percentage of mononuclear MDSCs (M-MDSCs) only increased. Patient age and sex did not correlate with the frequency of circulating G-MDSCs and M-MDSCs. The results of the computer algorithm analysis were consistent with those of our manual gating. The present study showed that the occurrence of LDH led to changes in the MDSC subpopulation in the circulating peripheral blood of patients, and the frequency of circulating G-MDSCs in patients with clinical stage III and IV LDH increased with the degree of degeneration. The determination of G-MDSCs can be used as an auxiliary examination item for LDH.

Lumbar Discal Cyst: Is it a Rare Consequence in Lumbar Disc Disease Spectrum? Short Case Series with Review of Literature and Hypothesis Regarding Etiopathogenesis

Abstract Background Lumbar discal cysts are rare intraspinal extradural lesions presenting as lumbar radiculopathy. The rarity of the lesion is sufficient to evoke interest in its diagnosis. The hitherto unsolved etiopathogenesis prompted us to look into these areas in this study. Objectives 1) To review the literature and summarize the clinicoradiological and histopathological features of the discal cyst. 2) To investigate possible mechanisms in the etiopathogenesis of discal cysts. Materials and Methods Three patients presented with features suggestive of lumbar disc prolapse and were diagnosed with discal cyst over 1.5 years and were included in this study. All patients underwent lumbar spine magnetic resonance imaging (MRI) and were subsequently treated by cyst excision. The final diagnosis of the discal cyst was based on histopathological features. Results Out of three patients, two had a discal cyst with disc prolapse, and one had a discal cyst alone. Discal cyst patient underwent excision of cyst alone. Discal cyst patients with disc prolapse underwent discectomy in addition to excision of the discal cyst. One patient had an L2–L3 level discal cyst with disc prolapse, which is uncommon. Conclusions Lumbar discal cysts, although rare, form an important differential diagnosis in patients with lumbar radiculopathy. They have a distinctive MRI appearance, and because discal cyst and disc prolapse shared similar etiopathological features, we hypothesize that discal cyst is a part of the degenerative disc disease spectrum. We also conclude that discal cyst excision should be coupled with discectomy when LDC is associated with disc prolapse.