Magnetic Resonance Imaging For Low Back Pain Research Articles

Relation of bone mineral density with fat infiltration of paraspinal muscles: The Goutallier classification

ObjectivesMuscle and bone tissue are interrelated throughout their developmental processes via paracrine and endocrine pathways. Osteosarcopenia has emerged with the growing data proving the high rate of simultaneous occurrence of sarcopenia and osteoporosis. We aimed to evaluate the relationship between osteoporosis, and muscle quality by grading the fatty infiltration in paraspinal muscles according to the Goutallier classification in magnetic resonance imaging (MRI). MethodsData of postmenopausal patients who underwent MRI for low back pain were analyzed retrospectively. Lumbar spine and femoral neck bone mineral density (BMD) were measured by using dual energy X-ray absorptiometry (DXA). Grade of paraspinal muscle fatty infiltration for each level of lumbar vertebrae including L1-L2, L2-L3, L3-L4, was evaluated separately according to Goutallier classification system. ResultsA total of 91 postmenopausal women were included in the study. The mean age of the study population was 60.5 ± 11. Lumbar vertebrae L1-L4 total T-scores and BMD g/cm2 were lower in patients with higher grades of Goutallier classification (P = 0.031 and P = 0.023, respectively). The distribution of the severity of fatty degeneration was significantly higher in the osteoporosis/osteopenia group at all 3 disc levels. No significant correlation was observed between femoral neck BMD and paraspinal muscle fat infiltration. ConclusionsThere is a strong relationship between osteoporosis of the lumbar spine and paraspinal muscle quality, which can be considered as a reflection of osteosarcopenia. The Goutailler classification can be an effective and easy method in the evaluation of muscle quality with MRI.

Appropriateness of referrals from primary care for lumbar MRI

BackgroundInternational guidelines do not recommend routine imaging, including magnetic resonance imaging (MRI), and seek to guide clinicians only to refer for imaging based on specific indications. Despite this, several studies show an increase in the use of MRI among patients with low back pain (LBP) and an imbalance between appropriate versus inappropriate use of MRI for LBP. This study aimed to investigate to what extent referrals from general practice for lumbar MRI complied with clinical guideline recommendations in a Danish setting, contributing to the understanding and approaches to lumbar MRI for all clinicians managing LBP in the primary sector.Materials and methodsFrom 2014 to 2018, all referrals for lumbar MRI were included from general practitioners in the Central Denmark Region for diagnostic imaging at a public regional hospital. A modified version of the American College of Radiology Imaging Appropriateness Criteria for LBP was used to classify referrals as appropriate or inappropriate, based on the unstructured text in the GPs’ referrals. Appropriate referrals included fractures, cancer, symptoms persisting for more than 6 weeks of non-surgical treatment, previous surgery, candidate for surgery or suspicion of cauda equina. Inappropriate referrals were sub-classified as lacking information about previous non-surgical treatment and duration.ResultsOf the 3772 retrieved referrals for MRI of the lumbar spine, 55% were selected and a total of 2051 referrals were categorised. Approximately one quarter (24.5%) were categorised as appropriate, and 75.5% were deemed inappropriate. 51% of the inappropriate referrals lacked information about previous non-surgical treatment, and 49% had no information about the duration of non-surgical treatment. Apart from minor yearly fluctuations, there was no change in the distribution of appropriate and inappropriate MRI referrals from 2014 to 2018.ConclusionThe majority of lumbar MRI referrals (75.5%) from general practitioners for lumbar MRI did not fulfil the ACR Imaging Appropriateness Criteria for LBP based on the unstructured text of their referrals. There is a need for referrers to include all guideline-relevant information in referrals for imaging. More research is needed to determine whether this is due to patients not fulfilling guideline recommendations or simply the content of the referrals.

Can T2-weighted Dixon fat-only images replace T1-weighted images in degenerative disc disease with Modic changes on lumbar spine MRI?

To evaluate the diagnostic performance and interobserver agreement of a magnetic resonance imaging (MRI) protocol that only includes sagittal T2-weighted Dixon fat and water images as an alternative to a standard protocol that includes both sagittal T1-weighted sequence and T2-weighted Dixon water images as reference standard in lumbar degenerative disc disease with Modic changes. From February 2017 to March 2019, 114 patients who underwent lumbar spine MRI for low back pain were included in this retrospective study. All MRI showed Modic changes at least at one vertebral level. Two radiologists read the standard protocol and 1 month later the alternative protocol. All MRI were assessed for Modic changes (types, location, extension) as well as structural changes (endplate defects, facet arthropathy, spinal stenosis, foraminal stenosis, Schmorl nodes, spondylolisthesis, disc bulges, and degeneration). Interobserver agreement was assessed, as well as diagnostic performance using the standard protocol as reference standard. Interobserver agreement was moderate to excellent (kappa ranging from 0.51 to 0.92). Diagnostic performance of the alternative protocol was good for detection of any Modic change (sensitivity = 100.00% [95% CI, 99.03-100.00]; specificity = 98.89% [95% CI, 98.02-99.44]), as well as for detection of each Modic subtype and structural variables (sensitivity respectively 100% and ranging from 88.43 to 99.75% ; specificity ranging respectively from 97.62 to 100% and 99.58 to 99.91% ). Combined with T2-weighted Dixon water images, T2-weighted Dixon fat images provide good diagnostic performance compared to T1-weighted images in lumbar degenerative disc disease with Modic changes, and could therefore allow for a shortened protocol. • Combined with T2-weighted Dixon water images, T2-weighted Dixon fat images (in comparison to T1-weighted sequence) can provide good diagnostic performance in lumbar degenerative disc disease with Modic changes. • Interobserver agreement of the alternative protocol including sagittal T2-weighted Dixon fat and water images was substantial to excellent for every studied variable exceptfor facet arthropathy. • A shortened MRI protocol including T2-weighted Dixon sequence without T1-weighted sequence could be proposed in this clinical setting.

Downstream Consequences of Inappropriate Early MRI for Low Back Pain

Although guidelines do not recommend magnetic resonance imaging (MRI) for most patients who present with uncomplicated low back pain, clinicians often

Association between Severity of Low Back Pain (LBP) and Magnetic Resonance Imaging Pathologies in Patients with Acute LBP

Background and Objectives: Low Back Pain (LBP) is a common health problem that affects people worldwide, and about 15% of Iranians. It imposes high costs to societies and requires great attention. Magnetic Resonance Imaging (MRI) is considered a reliable and accurate diagnostic tool, however some studies have questioned the appropriateness of MRI in LBP. Thus, this study aimed to evaluate the relationship between the intensity of LBP and positive findings in MRI, in patients with acute LBP.
 
 Materials and Methods: A cross-sectional study was performed on all patients, who reported less than four weeks of LBP and were referred to the radiology center of Shafa-e-Yahyaeian hospital, ranged from March to July, 2014, to perform MRI. Data collected included demographics and pain characteristics, in addition to an Oswestry Disability Index questionnaire. MRI pathologies were distinguished by two spinal surgeons and one radiologist. Data was analyzed using the SPSS software.
 
 Results: A total of 200 patients were enrolled in this study with a mean age of 41.78 years. Nearly half (48%) of the studied patients had positive MRI findings on L4-L5, and NFS and disc bulging (42.5%, and 38%, respectively) were the most common pathologies, while 11.5% of patients had normal MRIs. The mean ODI was highest in patients with vertebral body fracture, and disc herniation and lowest in hemangioma.
 
 Conclusion: A noticeable percentage of patients demonstrated a high ODI score, but MRI findings were in significant association with age of patients, indicating that patients with acute LBP do not require MRI immediately. Using the ODI questionnaire can help us towards a better diagnostic approach.

Factors associated with physiotherapists' preference for MRI in primary care patients with low back and leg pain

BackgroundCriticisms about overuse of MRI in low back pain are well documented. Yet, with the exception of suspicion of serious pathology, little is known about factors that influence clinicians' preference for magnetic resonance imaging (MRI) at first consultation. ObjectiveTo explore factors associated with physiotherapists' preference for MRI for patients consulting with benign low back and leg pain (LBLP) including sciatica. DesignCross-sectional cohort study. MethodsData were collected from 607 primary care LBLP patients participating in the ATLAS cohort study. Following clinical assessment, physiotherapists documented whether he/she wanted the patient to have an MRI. Factors potentially associated with physiotherapists' preference for imaging were selected a priori from patient characteristics and clinical assessment findings. A mixed-effects logistic regression model examined the associations between these factors and physiotherapists' preference for MRI. ResultsPhysiotherapists expressed a preference for MRI in 32% (196/607) of patients, of whom 22 did not have a clinical diagnosis of sciatica (radiculopathy). Factors associated with preference for MRI included; clinical diagnosis of sciatica (OR 4.23: 95% CI 2.29, 7.81), greater than 3 months pain duration (2.61: 1.58, 4.30), high pain intensity (1.24: 1.11, 1.37), patient's low expectation of improvement (2.40: 1.50, 3.83), physiotherapist's confidence in their diagnosis (1.19: 1.07, 1.33), with greater confidence associated with higher probability for MRI preference. ConclusionA clinical diagnosis of sciatica and longer symptom duration were most strongly associated with physiotherapists' preference for MRI. Given current best practice guidelines, these appear to be justifiable reasons for MRI preference at first consultation.

Magnetic resonance imaging of lumbosacral intervertebral discs in nigerians with low back pain

Background: Magnetic resonance imaging (MRI) is the modality of choice in diagnostic imaging of the neurological structures related to low back pain (LBP). Particularly, in evaluation of the vertebral discs, its relationship to the nerve roots and related structures with precise diagnosis that guides the patient's management. This study evaluated the spectrum of intervertebral disc findings in LBP patients at two imaging centers in the South-West and North-Central Nigeria. Association between the clinical diagnosis and MRI disc findings was tested. Materials and Methods: This is a retrospective descriptive study. The request cards, reports, and available recorded images of patients referred for MRI for LBP from 2013 till 2015 were retrieved. The extracted patients' information, radiological findings were documented in a data form, with due compliance to confidentiality of the cohort and analyzed by Statistical Package for Social Sciences (SPSS) software (Version 20.0., IBM Corp. Released 2011, IBM SPSS Statistics for Windows, IBM Corp. Armonk, NY, USA) Results were presented as tables and test of association between variables carried out using Pearson t-test. Results: A total number of 205 patients were enrolled. Age range of the subjects was 10-83 years and mean age = 52.5 ± 15.4 years. There were more females with a male to female ratio of 1:1.04. LBP was more common in the fifth decade and least in ≤20 years (3%). MRI disc abnormalities increased with advancing age with statistically significant association between disc abnormalities and the patient's age, lumbar spondylosis, disc prolapse, and spinal canal stenosis. Conclusion: Disc abnormalities increased significantly with advancing age. Lumbar spondylosis, disc prolapse, and spinal canal stenosis are most commonly associated with florid disc abnormalities on MRI.

The value of lumbar spine MRI in the assessment of the pars interarticularis

The aim of this study is to assess the ability of conventional lumbar spine magnetic resonance imaging (MRI) to demonstrate the pars interarticularis. The right and left L4 and L5 pars in 50 patients undergoing lumbar spine MRI for low back pain, with or without radiculopathy, were assessed and classified into four types. Based on their appearance, 59 (29.5%) were classified as normal (Type 1), 59 (29.5%) as hypointense (Type 2), 53 (26.5%) could not be demonstrated (Type 3) and 29 (14.5%) were thought to have defects (Type 4). The gold standard was set by the consensus opinion of two consultant musculoskeletal radiologists on the available plain radiographs of the lumbar spine. MRI was found to have a sensitivity of 57% to 86%, specificity of 81% to 82%, positive predictive value of 14% to 18% and negative predictive value of 97% to 99% for the diagnosis of a pars defect.