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Tran CV, Yang HR, Ahmad ZY, Utukuri PS, Quarterman P, Fung M, Lignelli A, Wong TT. Utility of Zero-Echo time sequence as an adjunct for MR evaluation of degenerative disease in the cervical spine. Skeletal Radiol 2024; 53:899-908. [PMID: 37945769 DOI: 10.1007/s00256-023-04507-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Determine the utility of ZTE as an adjunct to routine MR for assessing degenerative disease in the cervical spine. METHODS Retrospective study on 42 patients with cervical MR performed with ZTE from 1/1/2022 to 4/30/22. Fellowship trained radiologists evaluated each cervical disc level for neural foraminal (NF) narrowing, canal stenosis (CS), facet arthritis (FA), and presence of ossification of the posterior longitudinal ligament (OPLL). When NF narrowing and CS were present, the relative contributions of bone and soft disc were determined and a confidence level for doing so was assigned. Comparisons were made between assessments on routine MR without and with ZTE. RESULTS With ZTE added, bone contribution as a cause of NF narrowing increased in 47% (n = 110) of neural foramina and decreased in 12% (n = 29) (p = < 0.001). Bone contribution as a cause of CS increased in 25% (n = 33) of disc levels and decreased in 10% (n = 13) (p = 0.013). Confidence increased in identifying the cause of NF narrowing (p = < 0.001)) and CS (p = 0.009) with ZTE. The cause of NF narrowing (p = 0.007) and CS (p = 0.041) changed more frequently after ZTE was added when initial confidence in making the determination was low. There was no change in detection of FA or presence of OPLL with ZTE. CONCLUSION Addition of ZTE to a routine cervical spine MR changes the assessment of the degree of bone involvement in degenerative cervical spine pathology.
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Affiliation(s)
- Clement Vinh Tran
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Hye Ryung Yang
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Zohaib Y Ahmad
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Pallavi S Utukuri
- Department of Radiology, Division of Neuroradiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | | | - Maggie Fung
- New York, NY General Electric (GE) Healthcare, New York, NY, USA
| | - Angela Lignelli
- Department of Radiology, Division of Neuroradiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital - Columbia University Medical Center, New York, NY, USA.
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Hesni S, Baxter D, Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol 2023; 52:2341-2365. [PMID: 37071191 DOI: 10.1007/s00256-023-04329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This review provides a detailed description of the imaging features of cervical spondylotic myelopathy and radiculopathy, with a focus on MRI. Where relevant, we will outline grading systems of vertebral central canal and foraminal stenosis. Whilst post-operative appearances of the cervical spine are outside the scope of this paper, we will touch on imaging features recognised as predictors of clinical outcome and neurological recovery. This paper will serve as a reference for both radiologists and clinicians involved in the care of patients with cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - David Baxter
- Department of Surgery, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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Feuerriegel GC, Kronthaler S, Weiss K, Haller B, Leonhardt Y, Neumann J, Pfeiffer D, Hesse N, Erber B, Schwaiger BJ, Makowski MR, Woertler K, Karampinos DC, Wurm M, Gersing AS. Assessment of glenoid bone loss and other osseous shoulder pathologies comparing MR-based CT-like images with conventional CT. Eur Radiol 2023; 33:8617-8626. [PMID: 37453986 PMCID: PMC10667374 DOI: 10.1007/s00330-023-09939-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To evaluate and compare the diagnostic performance of CT-like images based on a 3D T1-weighted spoiled gradient-echo sequence (T1 GRE), an ultra-short echo time sequence (UTE), and a 3D T1-weighted spoiled multi-echo gradient-echo sequence (FRACTURE) with conventional CT in patients with suspected osseous shoulder pathologies. MATERIALS AND METHODS Patients with suspected traumatic dislocation of the shoulder (n = 46, mean age 40 ± 14.5 years, 19 women) were prospectively recruited and received 3-T MR imaging including 3D T1 GRE, UTE, and 3D FRACTURE sequences. CT was performed in patients with acute fractures and served as standard of reference (n = 25). Agreement of morphological features between the modalities was analyzed including the glenoid bone loss, Hill-Sachs interval, glenoid track, and the anterior straight-line length. Agreement between the modalities was assessed using Bland-Altman plots, Student's t-test, and Pearson's correlation coefficient. Inter- and intrareader assessment was evaluated with weighted Cohen's κ and intraclass correlation coefficient. RESULTS All osseous pathologies were detected accurately on all three CT-like sequences (n = 25, κ = 1.00). No significant difference in the percentage of glenoid bone loss was found between CT (mean ± standard deviation, 20.3% ± 8.0) and CT-like MR images (FRACTURE 20.6% ± 7.9, T1 GRE 20.4% ± 7.6, UTE 20.3% ± 7.7, p > 0.05). When comparing the different measurements on CT-like images, measurements performed using the UTE images correlated best with CT. CONCLUSION Assessment of bony Bankart lesions and other osseous pathologies was feasible and accurate using CT-like images based on 3-T MRI compared with conventional CT. Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT. CLINICAL RELEVANCE STATEMENT In an acute trauma setting, CT-like images based on a T1 GRE, UTE, or FRACTURE sequence might be a useful alternative to conventional CT scan sparing associated costs as well as radiation exposure. KEY POINTS • No significant differences were found for the assessment of the glenoid bone loss when comparing measurements of CT-like MR images with measurements of conventional CT images. • Compared to the T1 GRE and FRACTURE sequence, the UTE measurements correlated best with CT whereas the FRACTURE sequence appeared to be the most robust regarding motion artifacts. • The T1 GRE sequence had the highest resolution with high bone contrast and detailed delineation of even small fractures but was more susceptible to motion artifacts.
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Affiliation(s)
- Georg C Feuerriegel
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Sophia Kronthaler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Yannik Leonhardt
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan Neumann
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Bernd Erber
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Marcus R Makowski
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Musculoskeletal Radiology Section, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital of Munich, LMU Munich, Munich, Germany
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Tsuchiya K, Gomyo M, Katase S, Hiraoka S, Tateishi H. Magnetic resonance bone imaging: applications to vertebral lesions. Jpn J Radiol 2023; 41:1173-1185. [PMID: 37209299 PMCID: PMC10613598 DOI: 10.1007/s11604-023-01449-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
MR bone imaging is a recently introduced technique, that allows visualization of bony structures in good contrast against adjacent structures, like CT. Although CT has long been considered the modality of choice for bone imaging, MR bone imaging allows visualization of the bone without radiation exposure while simultaneously allowing conventional MR images to be obtained. Accordingly, MR bone imaging is expected as a new imaging technique for the diagnosis of miscellaneous spinal diseases. This review presents several sequences used in MR bone imaging including black bone imaging, ultrashort/zero echo time (UTE/ZTE) sequences, and T1-weighted 3D gradient-echo sequence. We also illustrate clinical cases in which spinal lesions could be effectively demonstrated on MR bone imaging, performed in most cases using a 3D gradient-echo sequence at our institution. The lesions presented herein include degenerative diseases, tumors and similar diseases, fractures, infectious diseases, and hemangioma. Finally, we discuss the differences between MR bone imaging and previously reported techniques, and the limitations and future perspectives of MR bone imaging.
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Affiliation(s)
- Kazuhiro Tsuchiya
- Department of Radiology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
| | - Miho Gomyo
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Shichiro Katase
- Department of Radiology, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Sayuki Hiraoka
- Department of Radiology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
| | - Hidekatsu Tateishi
- Department of Radiology, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
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Abstract
ABSTRACT This review summarizes the existing techniques and methods used to generate synthetic contrasts from magnetic resonance imaging data focusing on musculoskeletal magnetic resonance imaging. To that end, the different approaches were categorized into 3 different methodological groups: mathematical image transformation, physics-based, and data-driven approaches. Each group is characterized, followed by examples and a brief overview of their clinical validation, if present. Finally, we will discuss the advantages, disadvantages, and caveats of synthetic contrasts, focusing on the preservation of image information, validation, and aspects of the clinical workflow.
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Lombardi AF, Ma YJ, Jang H, Jerban S, Du J, Chang EY, Chung CB. Synthetic CT in Musculoskeletal Disorders: A Systematic Review. Invest Radiol 2023; 58:43-59. [PMID: 36070535 PMCID: PMC9742139 DOI: 10.1097/rli.0000000000000916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Repeated computed tomography (CT) examinations increase patients' ionizing radiation exposure and health costs, making an alternative method desirable. Cortical and trabecular bone, however, have short T2 relaxation times, causing low signal intensity on conventional magnetic resonance (MR) sequences. Different techniques are available to create a "CT-like" contrast of bone, such as ultrashort echo time, zero echo time, gradient-echo, and susceptibility-weighted image MR sequences, and artificial intelligence. This systematic review summarizes the essential technical background and developments of ultrashort echo time, zero echo time, gradient-echo, susceptibility-weighted image MR imaging sequences and artificial intelligence; presents studies on research and clinical applications of "CT-like" MR imaging; and describes their main advantages and limitations. We also discuss future opportunities in research, which patients would benefit the most, the most appropriate situations for using the technique, and the potential to replace CT in the clinical workflow.
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Affiliation(s)
- Alecio F Lombardi
- From the Department of Radiology, University of California San Diego, La Jolla, and the Research Service, Veterans Affairs San Diego Healthcare System, California
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The diagnostic value of susceptibility-weighted imaging for identifying acute intraarticular hemorrhages. Skeletal Radiol 2022; 51:1777-1785. [PMID: 35212784 DOI: 10.1007/s00256-022-04016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of susceptibility-weighted imaging (SWI) in identifying acute intraarticular hemorrhages and differentiating blood from other types of joint effusions. METHODS Thirty-two patients (21 men, 11 women; mean age 38.7 ± 16.5 SD) clinically suspected of having joint effusion were prospectively included. All the patients underwent both conventional MRI and SWI. Two radiologists independently reviewed the conventional MRI images and scored the likelihood of intraarticular hemorrhage using a 5-level scoring system. Immediately thereafter, SWI images of each patient were also provided for the radiologists, and the scoring was repeated evaluating the conventional MRI and SWI images together. The patients underwent joint aspiration or surgical operation as the reference standard. The area under the curve (AUC) of conventional MRI and conventional MRI + SWI methods were calculated and compared. The weighted kappa analysis was used to evaluate the interobserver agreement. RESULTS Traumatic knee injury comprised the majority of study sample. Eighteen out of 32 of the patients were proven to have intraarticular hemorrhage. Using the conventional MRI, reader 1 and 2 achieved AUCs of 0.67 (p = 0.09) and 0.53 (p = 0.76), respectively. Following the addition of SWI, reader 1 and 2 achieved AUCs of 0.96 (p = 0.0001) and 0.95 (p = 0.0001), respectively, and interobserver agreement improved from Κ = 0.61 to Κ = 0.93. Accordingly, difference between the AUCs was 0.28 (p = 0.003) and 0.42 (p = 0.0001) for reader 1 and 2, respectively. CONCLUSIONS If confirmed by future studies, SWI enables the reliable and accurate diagnosis of acute intraarticular hemorrhages.
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Cheng L, Jiang C, Huang J, Jin J, Guan M, Wang Y. Lumbosacral Transitional Vertebra Contributed to Lumbar Spine Degeneration: An MR Study of Clinical Patients. J Clin Med 2022; 11:2339. [PMID: 35566465 PMCID: PMC9104340 DOI: 10.3390/jcm11092339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/26/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to comprehensively characterize degenerative findings associated with various types of lumbosacral transitional vertebra (LSTV) on magnetic resonance images. Three hundred and fifty patients with LSTV (52.3 ± 10.9 years), including 182 Castellvi type I, 107 type II, 43 type III, and 18 type IV, and 179 controls without LSTV (50.6 ± 13.1 years), were studied. Discs, endplates, and posterior vertebral structures were assessed and compared to those of controls for the most caudal three discs on MRIs. There were no differences in degenerative findings between patients with type I LSTV and controls. For types III and IV, the transitional discs had smaller sizes, lower Pfirrmann scores, and lower rates of disc bulging (2.3% and 5.6% vs. 39.1%), osteophytes (2.3% vs. 15.1%), disc herniation (2.3% and 5.6% vs. 31.8%), and Modic changes (2.3% and 5.6% vs. 16.8%) than controls. However, the cranial discs had more severe Pfirrmann scores, disc narrowing and spinal canal narrowing, and greater rates of disc herniation (41.9% and 50.0% vs. 25.7%), endplate defects (27.9% and 33.3% vs. 14.4%) and spondylolisthesis (18.6% vs. 7.3%) than controls. Type II LSTV was associated with degenerative findings in the cranial segments but to a lesser degree, as compared with type III/IV LSTV. Thus, Castellvi type III/IV LSTV predisposed the adjacent spinal components to degeneration and protected the transitional discs. Type II LSTV had significant effects in promoting transitional and adjacent disc degeneration. Type I LSTV was not related to spinal degeneration.
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Affiliation(s)
| | | | | | | | - Ming Guan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.C.); (C.J.); (J.H.); (J.J.)
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (L.C.); (C.J.); (J.H.); (J.J.)
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Ulas ST, Ziegeler K, Richter ST, Ohrndorf S, Poddubnyy D, Makowski MR, Diekhoff T. CT-like images in MRI improve specificity of erosion detection in patients with hand arthritis: a diagnostic accuracy study with CT as standard of reference. RMD Open 2022; 8:rmdopen-2021-002089. [PMID: 35177555 PMCID: PMC8860086 DOI: 10.1136/rmdopen-2021-002089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To compare the diagnostic accuracy of susceptibility-weighted imaging (SWI), standard T1-weighted (T1w) images and high-resolution 3D-gradient echo sequences (volumetric interpolated breath-hold examination (VIBE)) for detection of erosions in patients with peripheral arthritis using CT as standard of reference. MATERIALS AND METHODS A total of 36 patients were included in the study. All patients underwent CT and MRI, including SWI, VIBE and T1w sequences of the clinically more affected hand. Two trained readers scored all imaging datasets separately for erosions in a blinded fashion. Specificity, sensitivity and diagnostic accuracy of MRI sequences were calculated on a per-patient level. RESULTS CT was positive for erosion in 16 patients and 77 bones (Rheumatoid Arthritis MRI Score >0), T1w in 28 patients, VIBE in 25 patients and SWI in 17 patients. All MRI sequences performed with comparably high sensitivities (T1w 100%, VIBE 94% and SWI 94%). SWI had the highest specificity of 90%, followed by VIBE (50%) and T1w (40%). Both T1w and VIBE produced significantly higher sum scores than CT (341 and 331 vs 148, p<0.0001), while the sum score for SWI did not differ from CT (119 vs 148; p=0.411). CONCLUSION Specificity for erosion detection remains a challenge for MRI when conventional and high-resolution sequences are used but can be improved by direct bone depiction with SWI. Both T1w and VIBE tend to overestimate erosions, when CT is used as the standard of reference.
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Affiliation(s)
- Sevtap Tugce Ulas
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Katharina Ziegeler
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Sophia-Theresa Richter
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany.,Department of Radiology, Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
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Morbée L, Chen M, Herregods N, Pullens P, Jans LBO. MRI-based synthetic CT of the lumbar spine: Geometric measurements for surgery planning in comparison with CT. Eur J Radiol 2021; 144:109999. [PMID: 34700094 DOI: 10.1016/j.ejrad.2021.109999] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE MRI is the imaging modality of choice for soft tissue-related spine disease. However, CT is superior to MRI in providing clear visualization of bony morphology. The purpose of this study is to test equivalency of MRI-based synthetic CT to conventional CT in quantitatively assessing bony morphology of the lumbar spine. METHOD A prospective study with an equivalency design was performed. Adult patients who had undergone MRI and CT of the lumbar spine were included. Synthetic CT images were generated from MRI using a deep learning-based image synthesis method. Two readers independently measured pedicle width, spinal canal width, neuroforamen length, anterior and posterior vertebral body height, superior and inferior vertebral body length, superior and inferior vertebral body width, maximal disc height, lumbar curvature and spinous process length on synthetic CT and CT. The agreement among CT and synthetic CT was evaluated using equivalency statistical testing. RESULTS Thirty participants were included (14 men and 16 women, range 20-60 years). The measurements performed on synthetic CT of pedicle width, spinal canal width, vertebral body height, vertebral body width, vertebral body length and spinous process length were statistically equivalent to CT measurements at the considered margins. Excellent inter- and intra-reader reliability was found for both synthetic CT and CT. CONCLUSIONS Equivalency of MRI-based synthetic CT to CT was demonstrated on geometrical measurements in the lumbar spine. In combination with the soft tissue information of the conventional MRI, this provides new possibilities in diagnosis and surgical planning without ionizing radiation.
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Affiliation(s)
- Lieve Morbée
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Min Chen
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Pim Pullens
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Ghent Institute for Functional and Metabolic Imaging, Ghent University, Ghent, Belgium
| | - Lennart B O Jans
- Department of Radiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Chong LR, Lee K, Sim FY. 3D MRI with CT-like bone contrast - An overview of current approaches and practical clinical implementation. Eur J Radiol 2021; 143:109915. [PMID: 34461599 DOI: 10.1016/j.ejrad.2021.109915] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022]
Abstract
CT is the imaging modality of choice for assessment of 3D bony morphology but incurs the penalty of ionizing radiation. Improving the ability of 3D MRI to provide high-resolution images of cortical bone with CT-like bone contrast has been a focus of recent research. The ability of 3D MRI to deliver cortical bone information with similar diagnostic performance to CT would complement assessment of soft tissues and medullary bone from a single MRI examination, simplifying evaluation and obviating radiation exposure from additional CT. This article presents an overview of current 3D MRI approaches for imaging cortical bone with CT-like bone contrast including ultrashort echo time, zero echo time, T1-weighted gradient recalled echo, susceptibility-weighted imaging and deep learning techniques. We also discuss clinical implementation of an optimized stack-of-stars 3D gradient recalled echo pulse sequence (3D-Bone) on commercially available MRI scanners for rendering 3D MRI with CT-like bone contrast in our institutional practice.
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Affiliation(s)
- Le Roy Chong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Kathy Lee
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Fang Yang Sim
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
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12
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Deppe D, Hermann KG, Proft F, Poddubnyy D, Radny F, Protopopov M, Makowski MR, Diekhoff T. CT-like images of the sacroiliac joint generated from MRI using susceptibility-weighted imaging (SWI) in patients with axial spondyloarthritis. RMD Open 2021; 7:rmdopen-2021-001656. [PMID: 34049998 PMCID: PMC8166621 DOI: 10.1136/rmdopen-2021-001656] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Background To analyse the added value of susceptibility-weighted imaging (SWI) compared with standard T1-weighted (T1) MRI for detecting structural lesions of the sacroiliac joint (SIJ) in patients with axial spondyloarthritis (axSpA) using CT as reference standard. Material and methods Sixty-eight patients with suspected or proven axSpA underwent both MRI and CT of the SIJ on the same day. Two readers separately scored CT, T1 and SWI for the presence of erosions, sclerosis and joint space changes using an established 24-region SIJ model. Disagreement was resolved by a third reader. Diagnostic accuracy (McNemar test), Cohen’s kappa (k), sensitivity (SE) and specificity were calculated on the joint level using CT as reference. Results In CT, 38 joints showed erosions, 67 sclerosis and 37 joint space changes. Agreement with CT for erosions was 92.6% (k=0.811 (0.7–0.92)) in SWI and 87.5% (k=0.682 (0.54–0.82)) in T1 (p=0.143) and agreement for sclerosis 84.6% (k=0.69 (0.57–0.81)) and 62.5% (k=0.241 (0.13–0.35)) (p<0.001), respectively. This resulted in superior SE of SWI (81.6% vs 73.7%) for erosions and sclerosis (74.6% vs 23.9%) at a minor expense of SP. No differences were detected for joint space changes. Conclusion In patients with axSpA, SWI depicts erosions and sclerosis more accurately than T1 spin echo MRI at 1.5 T.
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Affiliation(s)
- Dominik Deppe
- Department of Radiology, Freie Universität Berlin, Berlin, Germany
| | | | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Denis Poddubnyy
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Radny
- Department of Radiology, Freie Universität Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectiology and Rheumatology, Charite Universitatsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Freie Universität Berlin, Berlin, Germany
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Conger A, Kendall RW, Sperry BP, Petersen R, Salazar F, Cunningham S, Henrie AM, Bisson EF, Teramoto M, McCormick ZL. One-year results from a randomized comparative trial of targeted steroid injection via epidural catheter versus standard transforaminal epidural injection for the treatment of unilateral cervical radicular pain. Reg Anesth Pain Med 2021; 46:813-819. [PMID: 33990435 DOI: 10.1136/rapm-2021-102514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the long-term effectiveness of catheter-directed cervical interlaminar epidural steroid injection with triamcinolone compared with cervical transforaminal steroid injection with dexamethasone for the treatment of refractory unilateral radicular pain. DESIGN Prospective, randomized, comparative trial. METHODS The primary outcome was the proportion of participants with ≥50% Numeric Rating Scale 'dominant pain' (the greater of arm vs neck) reduction from baseline. Secondary outcomes included ≥30% Neck Disability Index reduction and Patient Global Impression of Change response indicating 'much improved' or 'very much improved'. RESULTS Data from 117 participants (55.6% women; 52.3±12.5 years of age; body mass index, 28.2±6.5 kg/m2) were analyzed. The proportion of participants who experienced ≥50% pain reduction at 1 month, 3 months, and 6 months has been previously reported. At 1 year, 61.2% (95% CI, 46.9% to 73.9%) of the catheter group compared with 51.9% (95% CI, 38.4% to 65.2%) of the transforaminal group reported ≥50% 'dominant' pain reduction (p=0.35). The proportion of participants who experienced ≥30% improvement in Neck Disability Index score was 60.4% (95% CI, 45.9% to 73.3%) and 47.1% (95% CI, 33.7% to 60.8%) in the catheter and transforaminal groups (p=0.18). Patient Global Impression of Change improvement was similar in both groups: 60.5% (95% CI, 44.2% to 74.8%) and 57.5% (95% CI, 41.7% to 71.9%) of the catheter and transforaminal groups reported being 'much improved' or 'very much improved', respectively (p=0.79). CONCLUSION Both cervical catheter-directed interlaminar epidural injection and cervical transforaminal steroid injection were effective in reducing pain and disability in the majority of participants with refractory unilateral cervical radiculopathy for up to 1 year.
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Affiliation(s)
- Aaron Conger
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Richard W Kendall
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Beau P Sperry
- Los Angeles David Geffen School of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Fabio Salazar
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Shellie Cunningham
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - A Michael Henrie
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurosurgery, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Masaru Teramoto
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
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14
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Susceptibility Weighted Imaging for evaluation of musculoskeletal lesions. Eur J Radiol 2021; 138:109611. [PMID: 33677418 DOI: 10.1016/j.ejrad.2021.109611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
The presence of blood or calcium in the musculoskeletal (MSK) system may be linked to specific pathological conditions. The ability of MRI for calcium detection is usually limited compared with other techniques such as CT. In a similar manner, the accuracy of MRI for detection and evaluation of hemorrhage in soft tissues is closely linked to the degree of degradation of blood products. Blood and calcium are substances that cause local inhomogeneity of the magnetic field resulting in susceptibility artifacts. To try to evaluate these substances, specific MRI sequences which are highly sensitive to these local magnetic field inhomogeneities such as Susceptibility Weighted Imaging (SWI) have been developed and successfully applied in the Central Nervous System, but scarcely used in MSK. SWI may increase the overall sensitivity of MRI to detect blood and calcium in several clinical scenarios such as degenerative joint disease or bone and soft tissue lesion assessment and discriminate between both compounds, something which is not always possible with conventional MRI approaches. In this paper, physical basis and technical adjustment for SWI acquisition at MSK are detailed reviewing the potential application of SWI in different MSK clinical scenarios.
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15
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Fritz J. Automated and Radiation-Free Generation of Synthetic CT from MRI Data: Does AI Help to Cross the Finish Line? Radiology 2020; 298:350-352. [PMID: 33355510 DOI: 10.1148/radiol.2020204045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jan Fritz
- From the Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, 3rd Floor, Room 313, New York, NY 10016
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16
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Finkenstaedt T, Siriwanarangsun P, Achar S, Carl M, Finkenstaedt S, Abeydeera N, Chung CB, Bae WC. Ultrashort Time-to-Echo Magnetic Resonance Imaging at 3 T for the Detection of Spondylolysis in Cadaveric Spines: Comparison With CT. Invest Radiol 2019; 54:32-38. [PMID: 30157099 DOI: 10.1097/rli.0000000000000506] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to compare the diagnostic performance and confidence of conventional, optimized, and ultrashort time to echo (UTE) magnetic resonance (MR) protocols for detection of simulated lumbar spondylolysis in human cadavers. In addition, we sought to demonstrate the feasibility of the UTE technique in subjects with and without spondylolysis. MATERIALS AND METHODS Four human lumbar spine specimens with 46 individual pars interarticularis were randomly left intact (n = 26) or received experimental osteotomy (n = 20) using a microsurgical saw to simulate spondylolysis. The specimens were imaged using a computed tomography (CT) scan along with 3 "Tiers" of MR protocols at 3 T: Tier 1, conventional lumbar MR protocol; Tier 2, optimized conventional protocol consisting of a sagittal oblique spoiled gradient recall echo and axial oblique T1 and short tau inversion recovery sequences; and Tier 3, a sagittal UTE MR sequence. Two blinded readers evaluated the images using a 4-point scale (1 = spondylolysis certainly absent, 2 = probably absent, 3 = probably present, 4 = certainly present) at each individual pars. For each imaging protocol, diagnostic performance (sensitivity, specificity, and area under the receiver operating characteristic curve, using the surgical osteotomy as the reference) and confidence were assessed and compared using the McNemar test. Furthermore, 2 human subjects were imaged with the conventional and UTE MR protocols to demonstrate feasibility in vivo. RESULTS Diagnostic performance was moderate for Tiers 1 and 2, with a moderate sensitivity (0.70 to 0.75) and high (1.00) specificity. In contrast, CT and Tier 3 UTE MR imaging had both high sensitivity (1.00) and specificity (1.00). The sensitivities of CT or Tier 3 were statistically greater than Tier 1 sensitivity (P = 0.041) and neared statistical significance when compared with Tier 2 sensitivity (P = 0.074). Area under the receiver operating characteristic curve was also significantly greater for CT and Tier 3 (each area = 1.00), compared with the areas for Tier 1 (0.89, P = 0.037) or Tier 2 (0.873, P = 0.024). Diagnostic confidences of CT or Tier 3 were much greater than other Tiers: Both Tiers 1 and 2 had a large percentage of uncertain (>60%, P < 0.001) or wrong interpretations (>10%, P < 0.001), unlike CT or Tier 3 (0% uncertain or wrong interpretations). Preliminary in vivo UTE images clearly depicted intact and fractured pars. CONCLUSIONS Our study demonstrated that the detection of pars fractures using a single sagittal UTE MR sequence is superior in performance and confidence to conventional and optimized MR protocols at 3 T, whereas matching those from CT evaluation. Furthermore, we demonstrated the feasibility of in vivo application of the UTE sequence in subjects with and without spondylolysis.
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Affiliation(s)
- Tim Finkenstaedt
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Suraj Achar
- Department of Family Medicine, University of California, San Diego, La Jolla
| | | | - Sina Finkenstaedt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Switzerland
| | - Nirusha Abeydeera
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA
| | - Christine B Chung
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA
| | - Won C Bae
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA
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