Sagittal T2W Research Articles

Deep learning constrained compressed sensing reconstruction improves high-resolution three-dimensional (3D) T2-weighted turbo spin echo magnetic resonance imaging (MRI) of the lumbar spine

We sought to assess the image quality of three-dimensional (3D) T2-weighted (T2w) turbo spin echo (TSE) sequences with deep learning (DL)-constrained compressed sensing (CS) reconstruction relative to a reference two-dimensional (2D) T2w TSE sequence for routine clinical lumbar spine MRI. Fifty-three patients underwent imaging of the lumbar spine with a sagittal 2D T2w TSE sequence and with two CS-accelerated 3D T2w TSE sequences (voxel size of 0.4×0.4×0.5 mm) with CS factors of 7 and 11. The CS-accelerated sequences were reconstructed with iterative reconstruction with wavelet transformation (conventional CS) and secondly with a DL-constrained CS reconstruction (named CS-AI). Two readers graded image quality, based on 8 metrics (overall image quality, presence of image noise, presence of motion artifacts, delineation/conspicuity and clarity of anatomical structures such as the spinal cord, cauda equine nerve roots, cerebrospinal fluid (CSF), intervertebral disc, and bone marrow and intervertebral foramen) using Likert scales. Overall inter-readout agreement was substantial (Krippendorff's α=0.724, 95% confidence interval [CI]: 0.692-0.755). The CS7-AI and CS11-AI sequences were comparable or better than the 2D sequence in all 8 metrics (p < 0.001-p > 0.99). The CS7 and CS11 sequences were comparable or better than the 2D sequence in only 5 and 3 of the 8 metrics, respectively (p < 0.001-p > 0.99). A DL-constrained CS reconstruction significantly improves the quality of accelerated high-resolution 3D T2w TSE imaging of the lumbar spine. Thus, high-quality imaging in a submillimeter resolution in all three imaging planes can be achieved without compromising the image quality as compared with standard 2D T2w TSE imaging.

Implementing a rapid cord compression Magnetic Resonance Imaging protocol in the emergency department: Lessons learned.

(1) Evaluate efficacy of an abbreviated total spine protocol in triaging emergency department (ED) patients through retrospective evaluation. (2) Describe patient outcomes following implementation of a rapid cord compression protocol. (1) All contrast-enhanced total spine magnetic resonance imaging studies (MRIs) performed on ED patients (n = 75) between 10/1-12/31/2022 for evaluation of cord compression were included. Two readers with 6 and 5years of experience blindly reviewed the abbreviated protocol (comprised of sagittal T2w and axial T2w sequences) assessing presence of cord compression or severe spinal canal stenosis. Ground truth was consensus by a neuroradiology fellow and 2 attendings. (2) The implemented rapid protocol included sagittal T1w, sagittal T2w Dixon and axial T2w images. All ED patients (n = 85) who were imaged using the rapid protocol from 5/1-8/31/2023 were included. Patient outcomes and call-back rates were determined through chart review. (1) Sensitivity and specificity for severe spinal canal stenosis and/or cord compression was 1.0 and 0.92, respectively, for reader 1 and 0.78 and 0.85, respectively, for reader 2. Negative predictive value was 1.0 and 0.97 for readers 1 and 2, respectively. (2) The implemented rapid cord compression protocol resulted in 60% reduction in imaging time at 1.5T. The call-back rate for additional sequences was 7%. In patients who underwent surgery, no additional MRI images were acquired in 82% of cases (9/11). Implementing an abbreviated non-contrast total spine protocol in the ED results in a low call-back rate with acquired MRI images proving sufficient for both triage and treatment planning in most patients.

Cervical spinal cord morphometrics in degenerative cervical myelopathy: quantification using semi-automated normalized technique and correlation with neurological dysfunctions

Degenerative cervical myelopathy (DCM) is characterized by spinal cord atrophy. Accurate estimation of spinal cord atrophy is key to the understanding of neurological diseases, including DCM. However, its clinical application is hampered by difficulties in its precise and consistent estimation due to significant variability in spinal cord morphometry along the cervical spine, both within and between individuals. To characterize morphometrics of the compressed spinal cord in DCM patients. We employed our semiautomated analysis framework that incorporates the Spinal Cord Toolbox (SCT) and a normalization approach to effectively address the challenges posed by cord compression in these patients. Additionally, we examined the clinical relevance of these morphometric measures to enhance our understanding of DCM pathophysiology. Prospective study. This study investigated 36 DCM patients and 31 healthy controls (HCs). Clinical scores including 9-hole peg test for hand dexterity, hand grip strength, balance, gait speed, modified Japanese Orthopaedic Association (mJOA) score, and imaging-based spinal cord morphometrics. Using the generic spine acquisition protocol and our semiautomated analysis pipeline, spinal cord morphometrics, including cross-sectional area (CSA), anterior-posterior (AP) and transverse (RL) diameters, eccentricity, and solidity, were estimated from sagittal T2w magnetic resonance imaging (MRI) images using the Spinal Cord Toolbox (SCT). Normalized metrics were extracted from the C1 to C7 vertebral levels and compared between DCM patients and HC. Morphometric data at regions of maximum spinal cord compression (MSCC) were correlated with the clinical scores. A subset of participants underwent follow-up scans at 6 months to monitor longitudinal changes in spinal cord atrophy. Spinal cord morphometric data were normalized against the healthy population morphometry (PAM50 database) and extracted for all participants. DCM patients showed a notable reduction in CSA, AP, and RL diameter across all vertebral levels compared to HC. MSCC metrics correlated significantly with clinical scores like dexterity, grip strength, and mJOA scores. Longitudinal analysis indicated a decrease in CSA and worsening clinical scores in DCM patients. Our processing pipeline offers a reliable method for assessing spinal cord compression in DCM patients. Normalized spinal cord morphometrics, particularly the CSA could have potential for monitoring DCM disease severity and progression, guiding treatment decisions. Furthermore, to our knowledge our study is the first to apply the generic spinal cord acquisition protocol, ensuring consistent imaging across different MRI scanners and settings. Coupled with our semiautomated analysis pipeline, this protocol is key for the detailed morphometric characterization of compressed spinal cords in patients with DCM, a disease that is both complex and heterogenous. This study was funded by the National Institute of Neurological Disorders and Stroke (NINDS) (K23:NS091430) and (R01: NS129852-01A1).

Infant head and brain segmentation from magnetic resonance images using fusion-based deep learning strategies

Magnetic resonance (MR) imaging is widely used for assessing infant head and brain development and for diagnosing pathologies. The main goal of this work is the development of a segmentation framework to create patient-specific head and brain anatomical models from MR images for clinical evaluation. The proposed strategy consists of a fusion-based Deep Learning (DL) approach that combines the information of different image sequences within the MR acquisition protocol, including the axial T1w, sagittal T1w, and coronal T1w after contrast. These image sequences are used as input for different fusion encoder–decoder network architectures based on the well-established U-Net framework. Specifically, three different fusion strategies are proposed and evaluated, namely early, intermediate, and late fusion. In the early fusion approach, the images are integrated at the beginning of the encoder–decoder architecture. In the intermediate fusion strategy, each image sequence is processed by an independent encoder, and the resulting feature maps are then jointly processed by a single decoder. In the late fusion method, each image is individually processed by an encoder–decoder, and the resulting feature maps are then combined to generate the final segmentations. A clinical in-house dataset consisting of 19 MR scans was used and divided into training, validation, and testing sets, with 3 MR scans defined as a fixed validation set. For the remaining 16 MR scans, a cross-validation approach was adopted to assess the performance of the methods. The training and testing processes were carried out with a split ratio of 75% for the training set and 25% for the testing set. The results show that the early and intermediate fusion methodologies presented the better performance (Dice coefficient of 97.6 ± 1.5% and 97.3 ± 1.8% for the head and Dice of 94.5 ± 1.7% and 94.8 ± 1.8% for the brain, respectively), whereas the late fusion method generated slightly worst results (Dice of 95.5 ± 4.4% and 93.8 ± 3.1% for the head and brain, respectively). Nevertheless, the volumetric analysis showed that no statistically significant differences were found between the volumes of the models generated by all the segmentation strategies and the ground truths. Overall, the proposed frameworks demonstrate accurate segmentation results and prove to be feasible for anatomical model analysis in clinical practice.

Diagnostic Contribution of Additional Sequences to the Evaluation of Cord Lesions in Patients with Cervical Spinal Multiple Sclerosis in Turkey: A Retrospective Study.

Multiple Sclerosis (MS) is the most common cause of non-traumatic disability in young adults. Spinal cord involvement is observed in 55-75% of patients with MS. To identify the strengths and shortcomings of sagittal phase-sensitive inversion recovery (PSIR), sagittal proton density/T2-weighted (PD/T2W), and axial turbo inversion recovery magnitude (TIRM) sequences in the detection of cervical MS plaques by comparing with routine sequences (axial and sagittal T2W, sagittal T1W, sagittal TIRM, fat-suppressed contrast T1W) and therefore determine their diagnostic contributions. A total of 48 patients in whom additional magnetic resonance imaging (MRI) sequences were obtained for the diagnosis of cervical MS were retrospectively identified and included in the study. A total of 111 MS plaques were analyzed in terms of visibility, number, size, border sharpness, and intensity ratio based on the routine and additional MRI sequences. The evaluation of the images was independently undertaken by two radiologists. The highest visibility was provided by sagittal PSIR, sagittal TIRM, and axial TIRM sequences (P < 0.05 for all additional sequences). Seven lesions in PD/T2W and four lesions in axial T2W sequences were unable to be detected. Lesions seen in sagittal and axial TIRM sequences were larger than the others. The sharpest borders were determined in the axial TIRM sequence, and the most diffuse borders in the PD/T2W sequence. In intensity ratio, the sagittal PSIR sequence revealed the most significant contrast difference. The sagittal PSIR sequence may improve the detection of cervical MS plaques due to the improved visibility and intensity ratios. The axial TIRM sequence may be more useful than routine axial T2W in the evaluation of visibility, border sharpness, and size measurement of MS plaques.

The impact of novel inflammation-preserving treatment towards lumbar disc herniation resorption in symptomatic patients: a prospective, multi-imaging and clinical outcomes study.

We performed a prospective one-year multi-imaging study to assess the clinical outcomes and rate of disc resorption in acute lumbar disc herniation (LDH) patients undergoing inflammation-preserving treatment (i.e. no NSAIDS, steroids). All patients received gabapentin to relieve leg pain, 12 sessions of acupuncture. Repeat MRI was performed, every 3months, after 12 sessions of treatment continued for those without 40% reduction in herniated disc sagittal area. Disc herniations sizes were measured on sagittal T2W MRI sequences, pre-treatment and at post-treatment intervals. Patients were stratified to fast, medium, slow, and prolonged recovery groups in relation to symptom resolution and disc resorption. Ninety patients (51% females; mean age: 48.6years) were assessed. Mean size of disc herniation was 119.54 ± 54.34mm2, and the mean VAS-Leg score was 6.12 ± 1.13 at initial presentation. A total of 19 patients (21.1%) improved at the time of the repeat MRI (i.e. within first 3months post-treatment). 100% of all patient had LDH resorption within one year (mean: 4.4. months). There was no significant difference at baseline LDH between fast, medium, slow, and prolonged resorption groups. Initial LDH size was weakly associated with degree of leg pain at baseline and initial gabapentin levels. Surgery was avoided in all cases. This is the first study to note inflammation-preserving treatment, without conventional anti-inflammatory and steroid medications, as safe and effective for patients with an acute LDH. Rate of disc resorption (100%) was higher than comparative recent meta-analysis findings (66.7%) and no patient underwent surgery.

Quality assessment of routine brain imaging at 0.55 T: initial experience in a clinical workflow.

The purpose of this study was to assess the quality of clinical brain imaging in healthy subjects and patients on an FDA-approved commercial 0.55 T MRI scanner, and to provide information about the feasibility of using this scanner in a clinical workflow. In this IRB-approved study, brain examinations on the scanner were prospectively performed in 10 healthy subjects (February-April 2022) and retrospectively derived from 44 patients (February-July 2022). Images collected using the following pulse sequences were available for assessment: axial DWI (diffusion-weighted imaging), apparent diffusion coefficient maps, 2D axial fluid-attenuated inversion recovery images, axial susceptibility-weighted images (both magnitude and phase), sagittal T1 -weighted (T1w) Sampling Perfection with Application Optimized Contrast images, sagittal T1w MPRAGE (magnetization prepared rapid gradient echo) with contrast enhancement, axial T1w turbo spin echo (TSE) with and without contrast enhancement, and axial T2 -weighted TSE. Two readers retrospectively and independently evaluated image quality and specific anatomical features in a blinded fashion on a four-point Likert scale, with a score of 1 being unacceptable and 4 being excellent, and determined the ability to answer the clinical question in patients. For each category of image sequences, the mean, standard deviation, and percentage of unacceptable quality images (<2) were calculated. Acceptable (rating ≥ 2) image quality was achieved at 0.55 T in all sequences for patients and 85% of the sequences for healthy subjects. Radiologists were able to answer the clinical question in all patients scanned. In total, 50% of the sequences used in patients and about 60% of the sequences used in healthy subjects exhibited good (rating ≥ 3) image quality. Based on these findings, we conclude that diagnostic quality clinical brain images can be successfully collected on this commercial 0.55 T scanner, indicating that the routine brain imaging protocol may be deployed on this system in the clinical workflow.

The Effect of Sagittal STIR and FLAIR Sequences Compared to Sagittal T2-W for Characterizing MS Lesions in Cervical Spine MRI

Purpose: Multiple Sclerosis (MS) is an acute, autoimmune, and inflammatory disease in the central nervous system. This study investigated the effect of sagittal Short Tau Inversion Recovery (STIR) and T2-W Fluid Attenuated Inversion Recovery (FLAIR) sequences rather than sagittal T2-W as complementary sequences in patients with cervical spinal cord lesions and suspected MS.&#x0D; Materials and Methods: This cross-sectional study was performed on all individuals referred to the Shahid Ghazi MRI center in Sanandaj for six months. Sixty patients with a cervical spine MRI request that were suspected of having MS were examined. The number of MS plaques in the sagittal T2-W FSE, sagittal STIR, and sagittal T2-W FLAIR were recorded separately. A comparison between routine sequences and sequence supplementation has been made for characterizing MS plaque in the spine.&#x0D; Results: Results showed that the greatest agreement was related to sagittal STIR, and sagittal FLAIR (Cohen’s kappa = 0.56). Whereas the least agreement values were from sagittal T2-W and sagittal FLAIR, STIR and FLAIR, T2-W and FLAIR, T2-W and STIR (Cohen’s kappa = 0.20, 0.33, 0.48, 0.55), respectively. Sagittal STIR and sagittal FLAIR were excellent predictors for MS plaques diagnosis due to the area under the ROC curve = 0.56; sensitivity (95% CI) = [0.85 (0.73426 to 0.929044)] and specificity (95% CI) = [0.46 (0.336699 to 0.600035)].&#x0D; Conclusion: Results show that FLAIR T2-W images in sagittal sequence are appropriate for detecting lesions around spinal cord lesions. Furthermore, using thresholds obtained via statistical analysis, plaques in the cervical spinal cord can be identified in sagittal STIR images.

Comparison of diagnostic accuracy of magnetic resonance spectroscopy with conventional magnetic resonance imaging for brain tumors and correlation with histopathology as gold standard

Background; Despite a large number of revolutionized advancements in Imaging technology clinicians are unable to get hundred percent accurate results. Multiple limitations have been observed in Imaging modalities. Multiple published trials are available online on the evaluations of these imaging modalities individually and in combinations to find out the level of accuracy of these technologies. Objective; This study was design to compare the diagnostic accuracy of MR Spectroscopy with MRI which is a conventional diagnostic tool for brain tumor diagnosis while keeping the Histopathology evaluation as Gold Standard. Methodology; The patients who fulfilled the inclusion criteria were included in study. All scans were carried out on GE 1.5 Tesla MR Scanner using head coil. Axial T1W, T2W, Fluid Attenuated Inversion Recovery (FLAIR), Sagittal T2W, Coronal Fluid Attenuation. Inversion Recovery (FLAIR) and T1W post- contrast Axial, Coronal and Sagittal images were acquired. MR spectroscopy was performed through single voxel technique. Final diagnosis was made on histopathology results. The reports of biopsy were co related with radiological diagnosis of MRI and MRS. Results; The study was conducted with 150 suspected cases. There were 85(56.7%) males and 65(43.3%) females. Histopathology 100(66.7%) cases were confirmed positive and 50(33.3%) negative.

Saturday, June 18, 20229:30 AM - 10:30 AM GPP06 Presentation Time: 9:30 AM: Image-Guided Cervical Cancer Brachytherapy: Summary of Consensus Recommendations from the Society for Abdominal Radiology and American Brachytherapy Society

<h3>Purpose</h3> To summarize recommendations regarding imaging guidance for cervical cancer brachytherapy implant placement from the Society of Abdominal Radiology (SAR) and American Brachytherapy Society (ABS). <h3>Materials and Methods</h3> A comprehensive literature search was conducted on PubMed for image-guided cervical cancer brachytherapy (BT) using radiography, ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Original research studies were included for evaluation if they included sensitivity and specificity of tumor detection, complication rates, or additional quantitative imaging results directly related to brachytherapy, such as geometric distortion measurements. The literature review was evaluated by an expert panel of members from the Society for Abdominal Radiology (SAR) and American Brachytherapy Society (ABS). These data were analyzed to determine an overall level of evidence for each recommendation and the subsequent strength of each claim. <h3>Results</h3> Three-dimensional (3D) imaging is recommended for treatment planning whenever feasible due to the rate of toxicities ≥ Grade 3 decreasing from between 0-13.5% with 2D planning to 0-5.8% with 3D planning. US guidance is highly recommended for tandem selection and insertion to reduce uterine perforation rates from 2.3-34%/insertion without US-guidance to 0-1.4%/insertion with US. US-guided interstitial needle placement is feasible when post-implant 3D imaging is available for treatment planning. Post-implant CT is recommended over orthogonal radiography to reduce genitourinary and gastrointestinal complications and evaluate proper applicator positioning. Tumor visualization is optimal on T2-weighted (T2w) MRI, which also provides improved specificity for assessment of parametrial invasion. CT-based treatment planning should refer to prior MRI for high risk-clinical target volume (HR-CTV) contouring, when available. Treatment planning on MRI is highly recommended for HR-CTV delineation, and post-applicator imaging should include at minimum both a 2D sagittal T2w and 3D axial T2w fast spin echo-based sequence. <h3>Conclusions</h3> Imaging-guidance for cervical brachytherapy implant placement is now standard-of-care. 3D imaging with MRI is highly recommended for treatment planning purposes, although CT-based planning also results in fewer complications as compared to 2D planning techniques. Ultrasound is useful for applicator placement, but application to treatment planning is limited.

Prognostic factors for surgical outcomes among patients with multilevel cervical spondylotic myelopathy.

Many clinical and imaging characteristics can influence the prognosis of multilevel cervical spondylotic myelopathy (M-CSM). This study investigated the factors that influence surgical outcomes among patients with M-CSM. This prospective study included 30 patients who underwent surgical treatment for M-CSM from June 2019 to June 2021. The average age was 62.29 years, and the average follow-up time was 13.13 months. Preoperative, postoperative, and follow-up Modified Japanese Orthopaedic Association (mJOA) scores were 10.17, 13.53, and 16.17, respectively. The average postoperative and follow-up recovery rates were 45.46% and 76.69%, respectively. Patients older than 60 years (p = 0.04), male patients (p = 0.023), and smokers (p = 0.027) had lower preoperative mJOA scores than other groups. Patients with symptoms duration longer than 6 months had lower recovery rates (p = 0.021) than those with shorter symptom duration. Patients with intramedullary hyperintensity in ≤ 2 vertebra (p = 0.041) or anterior surgery (p = 0.022) had better postoperative recovery rates than their counterparts. A shorter period of hyperintensity in the intramedullary region on sagittal T2-weighted magnetic resonance imaging (T2W MRI) was significantly associated with faster discharge (p = 0.044). Patients with type 3 (discrete focal) hyperintensity in the intramedullary region on axial T2W MRI had a 6.75-fold increase in experiencing less than 50% postoperative recovery compared with other groups (odds ratio: 6.75, 95% confidence interval: 2.73-16.67). Good prognostic factors for a shorter recovery included hyperintensity in the intramedullary region for ≤ 2 levels, shorter period of hyperintensity in the intramedullary region on sagittal T2W MRI, and an anterior surgical approach. A duration of symptoms longer than 6 months and discrete hyperintensity in the intramedullary region on axial T2W MRI were poor prognostic indicators associated with a longer recovery period.

Demonstration of the inferior intercavernous sinus is closely linked to the extent of pneumatization of the sphenoid sinus: useful information for the pituitary surgeon.

To study the utility of T2-weighted MRI sequences in the identification of the inferior intercavernous sinus (IICS), a potential source of bleeding during transsphenoidal surgery of pituitary adenomas. Pituitary sagittal T1W and coronal T2W MRI sequences were analyzed in 237 consecutive patients, after the exclusion of postoperative MRIs and those revealing an empty sella or a pituitary macroadenoma. Sphenoid sinus pneumatization was defined as incomplete (group 1) if it did not reach the nadir of the sella turcica, as complete (group 2) if it extended beyond the nadir of the sella or asymmetric (group 3), when only one side of the sinus was completely pneumatized. In Group 2 (70% of the patients), the IICS was rarely visualized on coronal T2W MRI (6/167 patients-3.6%), whereas in Group 1 it was identified in nearly all patients (55/57 patients - 96.5%, p < 0.001). In Group 3, the IICS was only visible above the non-pneumatized part of the sphenoid sinus. The IICS can be identified on coronal T2W images in patients with an incompletely pneumatized sphenoid sinus, but very rarely in patients with a totally pneumatized sinus. This information can help to increase awareness among pituitary surgeons of the need to potentially manage IICS bleeding during transsphenoidal surgery in patients with an incompletely pneumatized sphenoid sinus.

Change in Morphological Features of Enlarged Subarachnoid Spaces Following Treatment in Idiopathic Normal Pressure Hydrocephalus.

Focally enlarged sulci (FES) are areas of proposed extraventricular fluid entrapment that may occur within idiopathic normal pressure hydrocephalus (iNPH) with radiographic evidence of disproportionately enlarged subarachnoid-space hydrocephalus (DESH), and should be differentiated from atrophy. To evaluate for change in FES size and pituitary height after shunt placement in iNPH. Retrospective. A total of 125 iNPH patients who underwent shunt surgery and 40 age-matched controls. 1.5 T and 3T. Axial T2w FLAIR, 3D T1w MPRAGE, 2D sagittal T1w. FES were measured in three dimensions and volume was estimated by assuming an ellipsoid shape. Pituitary gland height was measured in the mid third of the gland in iNPH patients and controls. Wilcoxon signed-rank test for comparisons between MRI measurements; Wilcoxon rank sum test for comparison ofcases/controls. Significance level was P < 0.05. Fifty percent of the patients had FES. FES volume significantly decreased between the pre and first postshunt MRI by a median of 303 mm3 or 30.0%. Pituitary gland size significantly increased by 0.48 mm or 14.4%. FES decreased significantly by 190 mm3 or 23.1% and pituitary gland size increased significantly by 0.25 mm or 6% between the first and last postshunt MRI. Decrease in size of FES after shunt placement provides further evidence that these regions are due to disordered cerebrospinal fluid (CSF) dynamics and should not be misinterpreted as atrophy. A relatively smaller pituitary gland in iNPH patients that normalizes after shunt is a less-well recognized feature of altered CSF dynamics. 3 TECHNICAL EFFICACY: Stage 2.

Spinal cord grey matter atrophy in Multiple Sclerosis clinical practice

PurposeSeveral studies have indicated the relevance of spinal cord grey matter atrophy for Multiple Sclerosis (MS) related disability. This work aimed at evaluating feasibility and clinical relevance of MRI-derived estimations of spinal cord grey matter atrophy in clinical practice. MethodsA convenience sample of MS patients (n=48) and healthy controls (HC, n=11) was scanned using brain sagittal 3D T1w (MPRAGE) and transverse T2w-FLAIR, and transverse single-slice spinal cord 2D heavily T1w (PSIR: phase-sensitive inversion recovery) sequences. An experienced technician with neuroradiological supervision used a semiautomated thresholding method implemented in JIM software on PSIR sequences to obtain cross-sectional area (CSA) of the spinal canal (CSAcanal), whole cord (CSAcord), grey (CSAgm) and white matter (CSAwm) at C2-C3. MPRAGE and T2w-FLAIR sequences were used to obtain brain parenchymal, grey and white matter fractions (BPF, GMF and WMF) using the Statistical Parametric Mapping software. Appropriate statistical tests were used before and after age and sex adjustment. ResultsCSAgm and CSAwm could be obtained in all HC, but only 18 patients (37.5%) due to presence of lesions at C2-C3. Significant univariate associations between EDSS and BPF (rho =−0.376, p=0.015), GMF (rho =−0.287, p=0.069), CSAcanal (rho =−0.310, p=0.049), CSAcord (rho =−0.533 p<0.001) and CSAgm (rho =−0.511, p=0.062) were detected. After age/sex adjustment trends were observed for CSAcanal and CSAcord. ConclusionIn a clinical practice setting, relevance of spinal cord grey matter is confirmed, but cervical cord lesions could greatly hamper its application. Clinical associations with disability have been observed and seem stronger for spinal cord than for brain atrophy measures.

Magnetic resonance imaging in the evaluation of cervical foraminal stenosis: comparison of 3D T2 SPACE with sagittal oblique 2D T2 TSE

ObjectiveThe oblique orientation of the cervical neural foramina challenges the implementation of a short MRI protocol with concurrent excellent visualization of the spine. While sagittal oblique T2-weighted sequences permit good evaluation of the cervical neuroforamina, all segments may not be equally well depicted on a single sequence and conspicuity of foraminal stenosis may be limited. 3D T2-weighted sequences can be reformatted in arbitrary planes, including the sagittal oblique. We set out to compare 3D T2w SPACE sequences with sagittal oblique reformations and sagittal oblique 2D T2w TSE sequences for the evaluation of cervical foraminal visibility and stenosis.Materials and methodsSixty consecutive patients who underwent MRI of the cervical spine with sagittal oblique 2D T2w TSE and 3D T2w SPACE sequences were included. Image homogeneity of the sequences was evaluated. Imaging sets were assessed for structure visibility and foraminal stenosis by two independent readers. Results of the sequences were compared by Wilcoxon matched-pairs tests. Interreader agreement was evaluated by weighted κ.ResultsVisibility of most structures was rated good to excellent on both sequences (mean visibility scores ≥ 4.5 of 5), though neuroforaminal contents were better seen on sagittal oblique T2w TSE (mean scores 4.1–4.6 vs. 3.1–4.1 on 3D T2w SPACE, p < 0.01). Stenosis grades were comparable between sequences (mean 1.1–2.6 of 4), with slightly higher values for 3D T2w SPACE at some levels (difference ≤ 0.3 points).Conclusion3D T2w SPACE is comparable with sagittal oblique 2D T2w TSE in the evaluation of cervical neural foramina.

Synthetic T2-weighted images of the lumbar spine derived from an accelerated T2 mapping sequence: Comparison to conventional T2w turbo spin echo

ObjectivesTo evaluate the diagnostic usefulness of synthetic T2-weighted images of the lumbar spine derived from ten-fold undersampled k-space data using GRAPPATINI, a combination of a model-based approach for rapid T2 and M0 quantification (MARTINI) extended by generalized autocalibrating partial parallel acquistion (GRAPPA). Materials and methodsOverall, 58 individuals (26 female, mean age 23.3 ± 8.1 years) were examined at 3 Tesla with sagittal and axial T2w turbo spin echo (TSE) sequences compared to synthetic T2−weighted contrasts derived at identical effective echo times and spatial resolutions. Two blinded readers graded disk degeneration and evaluated the lumbar intervertebral disks for present herniation or annular tear. One reader reassessed all studies after four weeks. Weighted kappa statistics were calculated to assess inter-rater and intra-rater agreement. Also, all studies were segmented manually by one reader to compute contrast ratios (CR) and contrast-to-noise ratios (CNR) of the nucleus pulposus and the annulus fibrosus. ResultsOverall, the CRT2w was 4.45 ± 1.80 and CRT2synth was 4.71 ± 2.14. Both correlated (rsp = 0.768;p < 0.001) and differed (0.26 ± 1.38;p = 0.002) significantly. The CNRT2w was 1.73 ± 0.52 and CNRT2synth was 1.63 ± 0.50. Both correlated (rsp = 0.875;p < 0.001) and differed (−0.10 ± 0.25;p < 0.001) significantly. The inter-rater agreement was substantial to almost perfect (κ = 0.808–0.925) with the intra-rater agreement also substantial to almost perfect (κ = 0.862–0.963). The area under the curve of the receiver operating characteristics assessing disk herniation or annular tear ranged from 0.787 to 0.892. ConclusionsThis study concludes that synthetic images derived by GRAPPATINI can be used for clinical routine assessment with inter-rater and intra-rater agreements comparable to conventional T2w TSE.

An Infundibular Unidentified Object (IUO): a new pituitary stalk marker?

Measurement of the pituitary stalk (PS) diameter does not always solve the issue of minimal PS thickening. A previously undescribed image is found at the infundibular level on high resolution thin section T2W MRI in a large number of normal individuals. We speculate that this image-whose exact origin is still unknown-may serve as a marker of the normal infundibulum. In the last 6months, 350 consecutive adult patients suspected of sellar pathology or controlled after medical or surgical treatment prospectively underwent a pituitary MRI including a sagittal T2W high resolution sequence. One hundred twelwe patients presenting a pituitary mass with suprasellar extension or those whose PS was not entirely visible were excluded. A short focal annular T2 hypointense thickening of the wall of the infundibular recess of the third ventricle, more pronounced anteriorly was found in 151/238 patients. Additionally, a more or less tiny ventral extension was demonstrated on sagittal T2W sequence in 105/151 patients. These images were not identified on T1W or on T1W gadolinium enhanced sequences. The ring-like infundibular thickening and/or its ventral extension were not identified in 87/238 patients; in 43/87 of these patients the PS was found severely stretched mainly in case of primary or secondary empty sella. If patients with empty sella were excluded, our finding was observed in 194/238 cases, i.e. in 82%. A detailed appearance of the PS on T2W MRI is described for the first time. A previously unreported T2W hypointense annular focal image prolonged by a tiny spicular or nodular ventral bud is found at the lower part of the infundibulum in a majority of normal patients, but not if the PS is stretched such as in empty sella. This image has to be recognized as a normal anatomical landmark. The possible origin of this image is discussed but not totally elucidated. An ongoing research will demonstrate or not if this image may serve as a marker to improve the early diagnosis of PS lesions.

Natural history of the cervical high-intensity intramedullary lesion in achondroplasia.

Retrospective cohort study. The cervical high-intensity intramedullary (CHII) lesion is a recognised finding in achondroplasia, manifesting as a focal area of increased T2W signal intensity in the upper cervical cord in the absence of cervical cord compression. The aim of this study is to determine the natural history of this abnormality. Tertiary referral spinal and orthopaedic hospital, UK. A retrospective review was undertaken of all patients with achondroplasia who had undergone at least one MRI study which included the cervical spine. Patient age at presentation was recorded and presence of the CHII lesion was determined on the sagittal T2W FSE sequence. For patients who had follow-up studies, presence of the CHII lesion was assessed for any change in morphology (resolution, partial resolution or enlargement). The development of new CHII lesions and presence of associated cord atrophy was also recorded. The study group consisted of 40 patients (20 males, 20 females: mean age at first MRI of 32.6 years (range 7-66 years). The CHII lesion was identified in 19 (47.5%) cases and was associated with focal cord atrophy in 17 (85%) cases. There was no change or resolution of these lesions nor any associated cord compression. No new CHII lesions developed but progressive cord atrophy was evident. The CHII lesion is seen in 47.5% of cases of achondroplasia. It appears to be a stable abnormality which does not progress or change its morphology. However, it does appear to be associated with progressive cord atrophy.

Comparison of lumbar degenerative disc disease using conventional fast spin echo T 2W MRI and T 2 fast spin echo dixon sequences

To compare the grading of lumbar degenerative disc disease (DDD), Modic end-plate changes (MEPC) and identification of high intensity zones (HIZ) on a combination of sagittal T1weighted turbo spin echo (T1W TSE), T2weighted fast spin echo (T2W FSE) and short tau inversion recovery (STIR) sequences (routine protocol) with a single sagittal T2W FSE Dixon MRI sequence which provides in-phase, opposed-phase, water only and fat only images in a single acquisition (Dixon protocol). 50 patients underwent lumbar spine MRI using the routine protocol with the addition of a T2W FSE Dixon sequence. DDD grade, MEPC and HIZ for each disc level were assessed on the routine and Dixon protocols. Each protocol was reviewed independently by three readers (consultant musculoskeletal radiologists with 26-, 8- and 4 years' experience), allowing assessment of inter-reader agreement and inter protocol agreement for each assessed variable. The study included 17 males and 33 females (mean age 51 years; range 8-82 years). Inter-reader agreement for DDD grade on the routine protocol was 0.57 and for the Dixon protocol was 0.63 (p = 0.08). Inter-reader agreement for MEPC on the routine protocol was 0.45 and for the Dixon protocol was 0.53 (p = 0.02), and inter-reader agreement for identification of the HIZ on the routine protocol was 0.52 and for the Dixon protocol was 0.46 (p = 0.27). Intersequence agreement for DDD grade ranged from 0.61 to 0.97, for MEPC 0.46-0.62 and for HIZ 0.39-0.5. A single sagittal T2W FSE Dixon MRI sequence could potentially replace the routine three sagittal sequence protocol for assessment of lumbar DDD, MEPC and HIZ resulting in ~60% time saving. Grading of lumbar DDD, presence of Modic changes and high intensity zones were compared on sagittal T1W TSE, T2W FSE and STIR sequences with a T2W FSE Dixon sequence, with fair-to-good correlation suggesting that three conventional sequences could be replaced by a single Dixon sequence.

Diagnostic Accuracy of Limited Protocol MRI for Diagnosis of Lumbar Disc Degeneration

Objective: To determine the accuracy of limited protocol Magnetic resonance imaging of lumbar spine in determination of lumbar disc herniation, nerve root compression and annular tear taking findings of routine MRI as a reference standard. Methodology: A descriptive cross-sectional study was conducted from August 2016 to February 2017 at Dow Institute of Radiology (DIR), Dow University of Health Sciences (DUHS). All patients of either gender aged 20 years or more presenting for MRI with low back pain were included. Routine complete protocol included T1W spin echo (SE) images on the sagittal plane, fat suppression sequence on the sagittal plane and T2W fast spin echo (FSE) images on the sagittal and axial planes, while limited protocol included T2W fast spin echo images on the sagittal and axial planes. Statistical analysis for social sciences (SPSS version 24), Inc, USA was used for the purpose of statistical analysis.Results: The sensitivity and specificity of limited protocol of disc herniation, nerve root compression, and AT were found to be 100% taking full protocol for disc herniation, nerve root compression, and AT as a gold standard. A significant difference of disc herniation was observed with age (p-value: <0.001), gender (p-value: 0.011), NRC (p-value: <0.001), and AT (p-value: <0.001).Conclusion: Limited protocol MRI of lumbar spine can lead to a definite diagnosis of LDH, NRC and AT without causing any loss of information.Keywords: Low back pain, diagnostic accuracy, limited protocol MRI, disc herniation, nerve root compression