Spine Magnetic Resonance Imaging Examinations Research Articles

The dark side of T2: central nervous system lesions with low signal intensity on T2-weighted imaging.

The majority of central nervous system diseases show high signal intensity on T2-weighted magnetic resonance imaging. Diseases of the central nervous system with low signal intensity are less common, which makes it a finding that helps narrow the differential diagnosis. This was a retrospective analysis of brain and spine magnetic resonance imaging examinations in which that finding was helpful in the diagnostic investigation. We selected the cases of patients examined between 2015 and 2022. All diagnoses were confirmed on the basis of the clinical-radiological correlation or the histopathological findings. We obtained images of 14 patients with the following central nervous system diseases: arteriovenous malformation; cavernous malformation; metastasis from lymphoma; medulloblastoma; embryonal tumor; metastasis from melanoma; Rathke's cleft cyst; Erdheim-Chester disease; aspergillosis; paracoccidioidomycosis; tuberculosis; syphilis; immunoglobulin G4-related disease; and metastasis from a pulmonary neuroendocrine tumor. We described lesions of different etiologies in which the T2-weighted imaging profile helped narrow the differential diagnosis and facilitated the definitive diagnosis.

The Evaluation of The Relationship Between Psoas Muscle Atrophy and Intervertebral Disc and Facet Joint Degeneration in Patients With Lumbar Pain Using Lumbar Spine MRI

Objective: The purpose of the present study was to determine the relationship between psoas muscle lipoatrophy and facet and disc degeneration in patients
 with low back pain with lumbar spinal Magnetic Resonance Imaging (MRI).
 Material and Methods: A total of 304 patients who had low back pain were included in this retrospective cross-sectional study. The lumbar MRIs of all patients were evaluated for signs of psoas muscle atrophy. Fat content for each muscle was graded semi-quantitatively (Grade 0-4). The disc and facet joint
 degenerations of each patient were also graded. Psoas muscle thickness was measured in the mediolateral axial plane parallel to the vertebra.
 Results: It was found that the mean right psoas muscle thickness score of the patients was 35.9±7.2 mm on average, and the mean left psoas muscle thickness score was 35.8±7.1 mm. It was also found that 41.8% of the right psoas muscle degeneration was grade 1, 41.1% was grade 2, 33.6% of the left psoas muscle degeneration was grade 1, 45.1% was grade 2, 64.1% of the right facet degeneration was grade 1, 23.4% was grade 2, and 53.9% of the left facet degeneration was grade 1, and 30.3% was grade 2.
 Conclusion: When lumbar spine MRI examinations are evaluated, psoas muscles must also be evaluated in terms of atrophy. Indicating psoas muscle lipoatrophy in patients with low back pain may be useful for better rehabilitation planning.

Pattern of Magnetic Resonance Imaging Findings in Lumbar Spine Pathologies and its Correlation with Demographic Variables in Rivers State

Introduction: Magnetic Resonance Imaging (MRI) currently is an excellent imaging modality of choice for the demonstration of pathologies of the lumbar spine and the intervertebral disc. A sound knowledge of the common pathologies of the lumbar spine in our setting will assist clinicians and radiologists in making accurate diagnosis. Aim: To determine the type and distribution of MRI findings in lumbar spine pathologies and its demographic correlation in Rivers State. Materials and Methods: This was an observational cross-sectional study carried out among all symptomatic and asymptomatic patients who were referred for lumbar spine MRI at some selected Imaging Diagnostics Centres in Rivers State, from May 2020 to November 2020. The lumbar spine MRI examinations were performed using 0.35 Tesla MRI machines with both planar surface and multicoil phased array. The patients were evaluated for disabilities using the Nurick grading classifications. Data obtained were analysed using both descriptive (mean, deviation, frequency and percentage) and inferential (Pearson’s Correlation) statistical tools. The level of statistically significance was set at p <0.05. Results: Out of 151 patients that were included in this study, majority 78 (51.7%) of the patients were within the age group of 40-59 years with an overall mean age of 52.51±14 years. The majority 114 (75.50%) of the patients had single pathology. Among those that had single pathology, a greater proportion had spondylosis 65 (43.05%). A greater proportion 73 (48.34%) of the patients had single level of spinal involvement with lumbar vertebra four (L4) commonly affected in 26 (17.22%). Out of 151 patients, majority 49 (32.45%) had Nurick grade II and the least 7 (4.64%) had Nurick grade V. Conclusion: Lumbar spine pathologies frequently involve the fourth lumbar vertebra and middle-aged males are commonly affected.

Trans-Ethnic Polygenic Analysis Supports Genetic Overlaps of Lumbar Disc Degeneration With Height, Body Mass Index, and Bone Mineral Density.

Lumbar disc degeneration (LDD) is age-related break-down in the fibrocartilaginous joints between lumbar vertebrae. It is a major cause of low back pain and is conventionally assessed by magnetic resonance imaging (MRI). Like most other complex traits, LDD is likely polygenic and influenced by both genetic and environmental factors. However, genome-wide association studies (GWASs) of LDD have uncovered few susceptibility loci due to the limited sample size. Previous epidemiology studies of LDD also reported multiple heritable risk factors, including height, body mass index (BMI), bone mineral density (BMD), lipid levels, etc. Genetics can help elucidate causality between traits and suggest loci with pleiotropic effects. One such approach is polygenic score (PGS) which summarizes the effect of multiple variants by the summation of alleles weighted by estimated effects from GWAS. To investigate genetic overlaps of LDD and related heritable risk factors, we calculated the PGS of height, BMI, BMD and lipid levels in a Chinese population-based cohort with spine MRI examination and a Japanese case-control cohort of lumbar disc herniation (LDH) requiring surgery. Because most large-scale GWASs were done in European populations, PGS of corresponding traits were created using weights from European GWASs. We calibrated their prediction performance in independent Chinese samples, then tested associations with MRI-derived LDD scores and LDH affection status. The PGS of height, BMI, BMD and lipid levels were strongly associated with respective phenotypes in Chinese, but phenotype variances explained were lower than in Europeans which would reduce the power to detect genetic overlaps. Despite of this, the PGS of BMI and lumbar spine BMD were significantly associated with LDD scores; and the PGS of height was associated with the increased the liability of LDH. Furthermore, linkage disequilibrium score regression suggested that, osteoarthritis, another degenerative disorder that shares common features with LDD, also showed genetic correlations with height, BMI and BMD. The findings suggest a common key contribution of biomechanical stress to the pathogenesis of LDD and will direct the future search for pleiotropic genes.

Image interpretation by radiographers in brain, spine and knee MRI examinations: Findings from an accredited postgraduate module

IntroductionThe aim of the study was to evaluate the performance of radiographers in image interpretation of magnetic resonance imaging (MRI) brain, spine and knee examinations following a nine-month work based postgraduate MRI module. MethodsTwenty-seven participants each submitted 60 image commentaries taken from prospective clinical workloads. The image interpretations (n = 1620) comprised brain, spine, and knee MRI examinations. Prevalence of abnormal examinations approximated 53% (brain), 74% (spine), and 73% (knee), and included acute and chronic pathology, normal variants and incidental findings. Each image interpretation was graded against reference standard consultant radiologist definitive report. ResultsThe radiographer's performance on brain image interpretations demonstrated mean accuracy at 86.7% (95% CI 83.4–89.3) with sensitivity and specificity of 84% (95% CI 80.9–86.4) and 89.7% (95% CI 86.2–92.6) respectively. For spinal interpretations the mean accuracy was 86.4% (95% CI 83.4–89.0), sensitivity was 90.2% (95% CI 88.2–92), mean specificity was 75.3% (95% CI 69.4–80.4). The mean results for knee interpretation accuracy were 80.9% (95% CI 77.3–84.1), sensitivity was 83.3% (95% CI 80.8–85.5), with 74.3% specificity (95% CI 67.4–80.4). ConclusionsThe radiographer's demonstrated skills in brain, spine and knee MRI examination image interpretation. These skills are not to replace radiologist reporting but to meet regulating body standards of proficiency, and to assist decision making in communicating unexpected serious findings, and/or extend scan range and sequences. Further research is required to investigate the impact of these skills on adjusting scan protocols or flagging urgent findings in clinical practice.

Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period

Background ContextIn today's health-care climate, magnetic resonance imaging (MRI) is often perceived as a commodity—a service where there are no meaningful differences in quality and thus an area in which patients can be advised to select a provider based on price and convenience alone. If this prevailing view is correct, then a patient should expect to receive the same radiological diagnosis regardless of which imaging center he or she visits, or which radiologist reviews the examination. Based on their extensive clinical experience, the authors believe that this assumption is not correct and that it can negatively impact patient care, outcomes, and costs. PurposeThis study is designed to test the authors' hypothesis that radiologists' reports from multiple imaging centers performing a lumbar MRI examination on the same patient over a short period of time will have (1) marked variability in interpretive findings and (2) a broad range of interpretive errors. Study DesignThis is a prospective observational study comparing the interpretive findings reported for one patient scanned at 10 different MRI centers over a period of 3 weeks to each other and to reference MRI examinations performed immediately preceding and following the 10 MRI examinations. Patient SampleThe sample is a 63-year-old woman with a history of low back pain and right L5 radicular symptoms. Outcome MeasuresVariability was quantified using percent agreement rates and Fleiss kappa statistic. Interpretive errors were quantified using true-positive counts, false-positive counts, false-negative counts, true-positive rate (sensitivity), and false-negative rate (miss rate). MethodsInterpretive findings from 10 study MRI examinations were tabulated and compared for variability and errors. Two of the authors, both subspecialist spine radiologists from different institutions, independently reviewed the reference examinations and then came to a final diagnosis by consensus. Errors of interpretation in the study examinations were considered present if a finding present or not present in the study examination's report was not present in the reference examinations. ResultsAcross all 10 study examinations, there were 49 distinct findings reported related to the presence of a distinct pathology at a specific motion segment. Zero interpretive findings were reported in all 10 study examinations and only one finding was reported in nine out of 10 study examinations. Of the interpretive findings, 32.7% appeared only once across all 10 of the study examinations' reports. A global Fleiss kappa statistic, computed across all reported findings, was 0.20±0.06, indicating poor overall agreement on interpretive findings. The average interpretive error count in the study examinations was 12.5±3.2 (both false-positives and false-negatives). The average false-negative count per examination was 10.9±2.9 out of 25 and the average false-positive count was 1.6±0.9, which correspond to an average true-positive rate (sensitivity) of 56.4%±11.7 and miss rate of 43.6%±11.7. ConclusionsThis study found marked variability in the reported interpretive findings and a high prevalence of interpretive errors in radiologists' reports of an MRI examination of the lumbar spine performed on the same patient at 10 different MRI centers over a short time period. As a result, the authors conclude that where a patient obtains his or her MRI examination and which radiologist interprets the examination may have a direct impact on radiological diagnosis, subsequent choice of treatment, and clinical outcome.

Usefulness of magnetic resonance imaging as a prognostic variable in myelodysplastic syndromes.

BackgroundMyelodysplastic syndromes are clonal disorders of stem cells, characterized by heterogeneous clinical presentation. Hematopoiesis is ineffective, characterized by abnormal differentiation, maturation and survival of hematopoietic cells.Material/MethodsThe examinations were conducted in the Hematology Ward and the Internal Medicine Ward of the Specialist Hospital No. 1 in Bytom in the years 2006–2011. The study group included 53 patients with diagnosed myelodysplastic syndrome. The results of magnetic resonance imaging (MRI) of the spine were obtained from the medical documentation of patients.ResultsIn the group of patients diagnosed with RT (refractory thrombocytopenia) and in the group diagnosed with RA (refractory anemia), 100% of lumbar spine images in T1- and T2-weighted sequences assessed together showed increased signal intensity. In patients diagnosed with RAEB (refractory anemia with excess blasts), MRI showed decreased signal intensity in 76.5% of subjects in the sequences analyzed together. In the group of patients with increased LDH (lactate dehydrogenase), 22 patients (55%) showed decreased signal intensity in the combined analysis of T1- and T2-weighted sequences. Among transfusion-dependent patients, 20 scans (60.6%) showed decreased signal intensity.ConclusionsAs the risk category of MDS increases towards high – bad risk, decreased signal intensity is observed in lumbar spine MRI in T1- and T2-weighted images in all studied stratification scales. There is a positive correlation between decreased signal intensity in lumbar spine MRI examinations and increased LDH level in blood serum, as well as dependence on blood product transfusions, especially packed red blood cells.

Spinal magnetic resonance imaging with reduced specific absorption rate in patients harbouring a spinal cord stimulation device - A single-centre prospective study analysing safety, tolerability and image quality

Spinal cord stimulation (SCS) is an accepted treatment in patients with failed back surgery (FBS), complex regional pain syndrome (CRPS) and persistent radicular pain following surgery. In order to avoid patient hazards or device malfunction manufacturers advise to abstain from magnetic resonance imaging (MRI) in patients with implanted electrodes or pulse generators. In a prospective study, 13 patients harbouring an implanted Medtronic Spinal Cord Stimulation (SCS) device underwent MRI (1.5 T) of the lumbar (n=13), the cervical (n=2) or the thoracic spine (n=1) following the development of new spinal symptoms. An adapted MRI protocol was used limiting the transmitted energy and specific absorption rate. Tolerability and safety were assessed by means of a standardized patient evaluation form documenting pain on a visual analogue scale (0-10), neurologic deficit, and discomfort during the scan. In addition, overall satisfaction with the examination procedure was rated on a Likert scale (1-5). Image quality was rated independently and blinded to the presence of a SCS device by the radiologist and the surgeon as equivalent, superior or inferior compared to the standard spine MRI examination. None of the 13 patients investigated by the modified spinal MRI protocol experienced new neurological deficits, worsening of symptoms or a defect/malfunction of the implant device. Three patients (23.1 %) reported transient warm sensation in the location of the electrode and in one case intermittent slight tingling in the lower extremities. Overall satisfaction with the examination was 1.13 ± 0.34 according to Likert scale (1-5). The image quality was rated - not statistically significant - slightly inferior to standard lumbar spine imaging (0.82 ± 0.54) with a kappa value of 0.68 between the two investigators. MRI examinations detected relevant and new lesions in 9 (69.2 %) patients which affected treatment in 8 (61.5 %) individuals. Using a protocol with a reduced specific energy absorption rate, spinal MRI examinations in patients with SCS can be considered safe. The current view that neurostimulators are a general contraindication to MR examinations has to be reconsidered in patients with new or progressive spinal symptoms.

Fiber Bragg grating-based sensor for monitoring respiration and heart activity during magnetic resonance imaging examinations

We present a fiber-optic sensor for monitoring respiration and heart activity designed to operate in the magnetic resonance imaging (MRI) environment. The sensor employs a Plexiglas springboard, which converts movements of the patient's body lying on the board (i.e., lung- and heart-induced vibrations) to strain, where a fiber Bragg grating attached to the board is used to measure this strain. Experimental studies are carried out during thoracic spine MRI examinations. The presence of the metal-free sensor construction in the MRI environment does not pose a threat to the patient and has no influence over the quality of imaging, and the signal is identical to that obtained without any electromagnetic interference. The results show that the sensor is able to accurately reflect the ballistocardiographic signal, enabling determinations of the respiration rate (RR) and heart rate (HR). The data delivered by the sensor are normally distributed on the Bland-Altman plot for the characteristic point determination and exhibit clear dependence on the RR and HR values for the RR and HR determinations, respectively. Measurement accuracies are better than 7% of the average values, and thus, with further development, the sensor will be implemented in routine MRI examinations.

Extra-spinal incidental findings at lumbar spine MRI in the general population: a large cohort study

ObjectiveTo determine the prevalence of clinically and non-clinically relevant extra-spinal incidental findings (IF) in patients undergoing magnetic resonance imaging (MRI) of the lumbar spine and to evaluate the rate of undetected findings in archived radiological reports.MethodsA retrospective search of patients undergoing lumbar spine MRI from January 2006 to December 2010 was conducted. By means of randomisation, we retrospectively reviewed 3,000 lumbar spine MRI examinations. Extra-spinal abnormalities were classified according to a modified CT Colonography Reporting and Data System (C-RADS). We retrospectively compared our structured approach with the archived MRI reports as it regarded the detection of extra-spinal IF to estimate non-detection rates.ResultsBy means of the structured approach used, extra-spinal findings were detected in 2,060 (68.6 %) of the 3,000 lumbar spine MRI examinations; 362 (17.6 %) patients had indeterminate or clinically important findings (E3 and E4) requiring clinical correlation or further evaluation. After review of the original archived radiological reports, potentially important C-RADS E3 and E4 extra-spinal IF were respectively reported in 47 of the 265 (17.7 %) and in 8 of 74 (10.8 %) patients.ConclusionsOur study shows that incidental extra-spinal findings at conventional lumbar spine MRI are common but underestimated in radiological reports.

Metastatic non-Hodgkin lymphoma presenting as low back pain and radiculopathy: a case report

ObjectiveThe purpose of this case report is to describe a case of metastatic non-Hodgkin lymphoma in the lumbar spine presenting as lumbar radiculopathy. Clinical FeaturesA 46-year-old man sought care from his doctor of chiropractic for low back pain and right leg radiculopathy. The patient was referred for a magnetic resonance imaging (MRI) scan to evaluate for a suspected disk herniation. The MRI scan revealed 2 lumbar pathologic compression fractures with cauda equina compression, and MRI short tau inversion recovery (STIR) sagittal image of the lumbar spine showed high signal in T12 and S2. Intervention and OutcomeThe patient was referred for an immediate consultation with his medical physician with the preliminary diagnosis of metastatic bone lesions or primary bone lesions of unknown etiology. The patient underwent bone biopsy, computed tomography, and positron emission tomography scanning and was diagnosed with small cell non-Hodgkin lymphoma with osseous metastasis. The patient underwent chemo- and radiation therapy, and the lymphoma is now in remission 18 months later. ConclusionThis case describes the presentation of metastatic non-Hodgkin lymphoma as a possible contributing cause in a patient presenting with lumbar radiculopathy, a common musculoskeletal condition. As well, this case highlights the importance of STIR sequences as part of a routine lumbar spine MRI examination. Without the STIR sequences, the additional deposits in T12 and S1 would not have been readily appreciated. Although metastatic non-Hodgkin lymphoma of the spine is rare, it should be remembered in the differential diagnoses.

Modic changes and associated features in Southern European chronic low back pain patients

Background context Conflicting reports exist regarding the prevalence of Modic changes among low back pain (LBP) patients and factors associated with their existence. Purpose To assess the prevalence of Modic changes and other findings on lumbar magnetic resonance imaging (MRI) among Spanish adult chronic LBP patients and the patient characteristics and radiological findings associated with Modic changes. Study design A cross-sectional imaging study among chronic LBP patients. Patient sample Four hundred eighty-seven patients (263 women and 224 men) undergoing lumbar spine MRI examination for chronic LBP. Outcome measures Gender, age, body mass index (BMI), lifetime smoking exposure, degree of physical activity, and image features (disc degeneration, type and extension of Modic changes, disc contour, annular tears, spinal stenosis, and spondylolisthesis). Methods Ten radiologists from six hospitals across six cities in Spain consecutively recruited adult patients in whom lumbar MRI had been prescribed for LBP lasting ≥3 months. Patients' characteristics and imaging findings were assessed through previously validated instruments. A multivariate logistic regression model was developed to assess the features associated with Modic changes. Results Modic changes were found in 81% of the patients. The most common was Type II (51.3%), affecting only the end plate. Variables associated with Type I changes were disc contour abnormalities, spondylolisthesis, and disc degeneration. The same variables were associated with a higher risk of Type II or any type of Modic changes, as well as being male, and having a higher BMI. Conclusions Modic changes are found in 81% (95% confidence interval, 77–85) of adult Spanish patients in whom an MRI is prescribed for chronic LBP. Modic changes are more likely to be found in males with a high BMI, who also show disc contour abnormalities, spondylolisthesis, or disc degeneration.