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Wesselink EO, Pool-Goudzwaard A, De Leener B, Law CSW, Fenyo MB, Ello GM, Coppieters MW, Elliott JM, Mackey S, Weber KA. Investigating the associations between lumbar paraspinal muscle health and age, BMI, sex, physical activity, and back pain using an automated computer-vision model: a UK Biobank study. Spine J 2024; 24:1253-1266. [PMID: 38417587 DOI: 10.1016/j.spinee.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/06/2024] [Accepted: 02/18/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND CONTEXT The role of lumbar paraspinal muscle health in back pain (BP) is not straightforward. Challenges in this field have included the lack of tools and large, heterogenous datasets to interrogate the association between muscle health and BP. Computer-vision models have been transformative in this space, enabling the automated quantification of muscle health and the processing of large datasets. PURPOSE To investigate the associations between lumbar paraspinal muscle health and age, sex, BMI, physical activity, and BP in a large, heterogenous dataset using an automated computer-vision model. DESIGN Cross-sectional study. PATIENT SAMPLE Participants from the UK Biobank with abdominal Dixon fat-water MRI (N=9,564) were included (41.8% women, mean [SD] age: 63.5 [7.6] years, BMI: 26.4 [4.1] kg/m2) of whom 6,953 reported no pain, 930 acute BP, and 1,681 chronic BP. OUTCOME MEASURES Intramuscular fat (IMF) and average cross-sectional area (aCSA) were automatically derived using a computer-vision model for the left and right lumbar multifidus (LM), erector spinae (ES), and psoas major (PM) from the L1 to L5 vertebral levels. METHODS Two-tailed partial Pearson correlations were generated for each muscle to assess the relationships between the muscle measures (IMF and aCSA) and age (controlling for BMI, sex, and physical activity), BMI (controlling for age, sex, and physical activity), and physical activity (controlling for age, sex, and BMI). One-way ANCOVA was used to identify sex differences in IMF and aCSA for each muscle while controlling for age, BMI, and physical activity. Similarly, one-way ANCOVA was used to identify between-group differences (no pain, acute BP, and chronic BP) for each muscle and along the superior-inferior expanse of the lumbar spine while controlling for age, BMI, sex, and physical activity (α=0.05). RESULTS Females had higher IMF (LM mean difference [MD]=11.1%, ES MD=10.2%, PM MD=0.3%, p<.001) and lower aCSA (LM MD=47.6 mm2, ES MD=350.0 mm2, PM MD=321.5 mm2, p<.001) for all muscles. Higher age was associated with higher IMF and lower aCSA for all muscles (r≥0.232, p<.001) except for LM and aCSA (r≤0.013, p≥.267). Higher BMI was associated with higher IMF and aCSA for all muscles (r≥0.174, p<.001). Higher physical activity was associated with lower IMF and higher aCSA for all muscles (r≥0.036, p≤.002) except for LM and aCSA (r≤0.010, p≥.405). People with chronic BP had higher IMF and lower aCSA than people with no pain (IMF MD≤1.6%, aCSA MD≤27.4 mm2, p<.001) and higher IMF compared to acute BP (IMF MD≤1.1%, p≤.044). The differences between people with BP and people with no pain were not spatially localized to the inferior lumbar levels but broadly distributed across the lumbar spine. CONCLUSIONS Paraspinal muscle health is associated with age, BMI, sex, and physical activity with the exception of the association between LM aCSA and age and physical activity. People with BP (chronic>acute) have higher IMF and lower aCSA than people reporting no pain. The differences were not localized but broadly distributed across the lumbar spine. When interpreting measures of paraspinal muscle health in the research or clinical setting, the associations with age, BMI, sex, and physical activity should be considered.
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Affiliation(s)
- Evert Onno Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Annelies Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; SOMT University of Physiotherapy, Softwareweg 5, 3821 BN Amersfoort, the Netherlands
| | - Benjamin De Leener
- Department of Computer Engineering and Software Engineering, Polytechnique Montreal, 2900 Edouard Montpetit Blvd, Quebec H3T 1J4, Canada
| | - Christine Sze Wan Law
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Meredith Blair Fenyo
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Gabriella Marie Ello
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Michel Willem Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, 170 Kessels Road, 4111 Brisbane, Australia
| | - James Matthew Elliott
- The University of Sydney, Faculty of Medicine and Health and the Northern Sydney Local Health District, The Kolling Institute, Reserve Road, St Leonards NSW Sydney 2065, Australia
| | - Sean Mackey
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Kenneth Arnold Weber
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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An externally validated deep learning model for the accurate segmentation of the lumbar paravertebral muscles. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2156-2164. [PMID: 35852607 DOI: 10.1007/s00586-022-07320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Imaging studies about the relevance of muscles in spinal disorders, and sarcopenia in general, require the segmentation of the muscles in the images which is very labour-intensive if performed manually and poses a practical limit to the number of investigated subjects. This study aimed at developing a deep learning-based tool able to fully automatically perform an accurate segmentation of the lumbar muscles in axial MRI scans, and at validating the new tool on an external dataset. METHODS A set of 60 axial MRI images of the lumbar spine was retrospectively collected from a clinical database. Psoas major, quadratus lumborum, erector spinae, and multifidus were manually segmented in all available slices. The dataset was used to train and validate a deep neural network able to segment muscles automatically. Subsequently, the network was externally validated on images purposely acquired from 22 healthy volunteers. RESULTS The median Jaccard index for the individual muscles calculated for the 22 subjects of the external validation set ranged between 0.862 and 0.935, demonstrating a generally excellent performance of the network, although occasional failures were noted. Cross-sectional area and fat fraction of the muscles were in agreement with published data. CONCLUSIONS The externally validated deep neural network was able to perform the segmentation of the paravertebral muscles in an accurate and fully automated manner, although it is not without limitations. The model is therefore a suitable research tool to perform large-scale studies in the field of spinal disorders and sarcopenia, overcoming the limitations of non-automated methods.
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De Martino E, Hides J, Elliott JM, Hoggarth MA, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. The Effects of Reconditioning Exercises Following Prolonged Bed Rest on Lumbopelvic Muscle Volume and Accumulation of Paraspinal Muscle Fat. Front Physiol 2022; 13:862793. [PMID: 35774286 PMCID: PMC9237402 DOI: 10.3389/fphys.2022.862793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Reduced muscle size and accumulation of paraspinal muscle fat content (PFC) have been reported in lumbopelvic muscles after spaceflights and head-down tilt (HDT) bed rest. While some information is available regarding reconditioning programs on muscle atrophy recovery, the effects on the accumulation of PFC are unknown. Recently, a device (the Functional Re-adaptive Exercise Device—FRED) has been developed which aims to specifically recruit lumbopelvic muscles. This study aimed to investigate the effects of a standard reconditioning (SR) program and SR program supplemented by FRED (SR + FRED) on the recovery of the lumbopelvic muscles following 60-day HDT bed rest. Twenty-four healthy participants arrived at the facility for baseline data collection (BDC) before the bed rest period. They remained in the facility for 13-day post-HDT bed rest and were randomly allocated to one of two reconditioning programs: SR or SR + FRED. Muscle volumes of the lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles were measured from axial T1-weighted magnetic resonance imaging (MRI) at all lumbar intervertebral disc levels. PFC was determined using a chemical shift-based lipid/water Dixon sequence. Each lumbopelvic muscle was segmented into four equal quartiles (from medial to lateral). MRI of the lumbopelvic region was conducted at BDC, Day-59 of bed rest (HDT59), and Day-13 after reconditioning (R13). Comparing R13 with BDC, the volumes of the LM muscle at L4/L5 and L5/S1, LES at L1/L2, and QL at L3/L4 had not recovered (all—p < 0.05), and the PM muscle remained larger at L1/L2 (p = 0.001). Accumulation of PFC in the LM muscle at the L4/L5 and L5/S1 levels remained higher in the centro-medial regions at R13 than BDC (all—p < 0.05). There was no difference between the two reconditioning programs. A 2-week reconditioning program was insufficient to fully restore all volumes of lumbopelvic muscles and reverse the accumulation of PFC in the muscles measured to BDC values, particularly in the LM muscle at the lower lumbar levels. These findings suggest that more extended reconditioning programs or alternative exercises may be necessary to fully restore the size and properties of the lumbopelvic muscles after prolonged bed rest.
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Affiliation(s)
- Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
- *Correspondence: Enrico De Martino,
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Northern Sydney Local Health District, Faculty of Medicine and Health, The Kolling Institute Sydney, The University of Sydney, Sydney, NSW, Australia
| | - Mark A. Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Jochen Zange
- German Aerospace Center, Institute of Aerospace Medicine, Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jonathan A. Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Sauro E. Salomoni
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tobias Weber
- Space Medicine Team, European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- Space Medicine Team, European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Paul W. Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Perraton Z, Lawrenson P, Mosler AB, Elliott JM, Weber KA, Flack NA, Cornwall J, Crawford RJ, Stewart C, Semciw AI. Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: a scoping review of lateral hip musculature. BMC Musculoskelet Disord 2022; 23:533. [PMID: 35658932 PMCID: PMC9166386 DOI: 10.1186/s12891-022-05439-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Measures of hip muscle morphology and composition (e.g., muscle size and fatty infiltration) are possible with magnetic resonance imaging (MRI). Standardised protocols or guidelines do not exist for evaluation of hip muscle characteristics, hindering reliable and valid inter-study analysis. This scoping review aimed to collate and synthesise MRI methods for measuring lateral hip muscle size and fatty infiltration to inform the future development of standardised protocols. Methods Five electronic databases (Medline, CINAHL, Embase, SportsDISCUS and AMED) were searched. Healthy or musculoskeletal pain populations that used MRI to assess lateral hip muscle size and fatty infiltration were included. Lateral hip muscles of interest included tensor fascia late (TFL), gluteus maximus, gluteus medius, and gluteus minimus. Data on MRI parameters, axial slice location, muscle size and fatty infiltrate measures were collected and analysed. Cross referencing for anatomical locations were made between MRI axial slice and E-12 anatomical plastinate sections. Results From 2684 identified publications, 78 studies contributed data on volume (n = 31), cross sectional area (CSA) (n = 24), and fatty infiltration (n = 40). Heterogeneity was observed for MRI parameters and anatomical boundaries scrutinizing hip muscle size and fatty infiltration. Seven single level axial slices were identified that provided consistent CSA measurement, including three for both gluteus maximus and TFL, and four for both gluteus medius and minimus. For assessment of fatty infiltration, six axial slice locations were identified including two for TFL, and four for each of the gluteal muscles. Conclusions Several consistent anatomical levels were identified for single axial MR slice to facilitate muscle size and fatty infiltration muscle measures at the hip, providing the basis for reliable and accurate data synthesis and improvements in the validity of future between studies analyses. This work establishes the platform for standardised methods for the MRI assessment of lateral hip musculature and will aid in the examination of musculoskeletal conditions around the hip joint. Further studies into whole muscle measures are required to further optimise methodological parameters for hip muscle assessment.
Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05439-x.
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Affiliation(s)
- Zuzana Perraton
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Peter Lawrenson
- School of Allied Health, La Trobe University, Melbourne, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Department of Anatomy, School of Biomedical Sciences, The University of Otago, Dunedin, New Zealand
| | - Andrea B Mosler
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - James M Elliott
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Faculty of Medicine and Health and Northern Sydney Local Health District, The University of Sydney, The Kolling Institute, Sydney, Australia.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - Natasha Ams Flack
- Department of Anatomy, School of Biomedical Sciences, The University of Otago, Dunedin, New Zealand
| | - Jon Cornwall
- University of Otago, Centre for Early Learning in Medicine, Otago Medical School, Dunedin, New Zealand
| | | | | | - Adam I Semciw
- School of Allied Health, La Trobe University, Melbourne, Australia. .,Allied Health Research, Northern Health, Epping, VIC, Australia.
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5
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Yang Q, Yan D, Wang L, Li K, Liang W, Zhang W, Liu YD, Li XM, Blake GM, Konerth N, Cheng X, Tian W, Hind K. Muscle fat infiltration but not muscle cross-sectional area is independently associated with bone mineral density at the lumbar spine. Br J Radiol 2022; 95:20210371. [PMID: 35333587 PMCID: PMC10996424 DOI: 10.1259/bjr.20210371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/02/2021] [Accepted: 03/14/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Although sarcopenia and osteoporosis are inter-related conditions that are common with advancing age, few studies have explored relationships between muscle quality and bone mineral density (BMD). We investigated age- and sex-specific paraspinal muscle fat infiltration (MFI), muscle cross-sectional area (CSA), and spine volumetric BMD (vBMD) in healthy Chinese adults. METHODS 605 healthy adults aged 20-59 years (340 women, mean age 39.2 years; 265 men, mean age 38.8 years) had axial T2WI MRI imaging of the lumbar spine and CSA (cm2) and MFI (%) were measured in the psoas and multifidus and erector spinae (MF-ES) muscles (L3-L4). MFI measurements were calibrated against a region of interest in an adjacent area of subcutaneous pure fat. L2-L4 vBMD was measured by quantitative CT. Age- and sex-specific subgroups were compared using the Mann-Whitney test. Multiple regression was used to test independent associations of MFI and CSA with vBMD. RESULTS Females had lower CSA and higher MFI than males in both the psoas and MF-ES muscles (p < 0.001). In females and males, MF-ES MFI increased with age (p < 0.001) and in females age-related increases were observed for the psoas muscles (p < 0.05). Greater fat infiltration of the MS-ES muscle unit was associated with lower vBMD in both sexes (p < 0.001) but not with CSA. Following adjustment for demographic variables and CSA, MS-ES MFI remained predictive of vBMD (β = -0.408 to -0.157, p < 0.001). CONCLUSION We have demonstrated that, independent of CSA and demographic variables, MFI of the MF-ES muscles is predictive of lower lumbar spine vBMD in both sexes. ADVANCES IN KNOWLEDGE This is the first study to demonstrate that, independent of muscle size and demographic variables, MFI of the paraspinal MF-ES muscles is predictive of lower lumbar spine vBMD in both sexes.
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Affiliation(s)
- Qian Yang
- Department of Radiology, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, Hubei, China
| | - Dong Yan
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Kai Li
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Wei Liang
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Wei Zhang
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Yan Dong Liu
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Xiao Min Li
- Department of Radiology, Tongji Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, Hubei, China
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, Kings
College London, St Thomas’ Hospital,
London, United Kingdom
| | - Natalie Konerth
- Department of Sport and Exercise Sciences, Durham
University, Durham, United
Kingdom
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan
Hospital, Beijing,
China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan
Hospital, Beijing,
China
| | - Karen Hind
- Department of Sport and Exercise Sciences, Durham
University, Durham, United
Kingdom
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De Martino E, Hides J, Elliott JM, Hoggarth MA, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. Intramuscular lipid concentration increased in localized regions of the lumbar muscles following 60 day bedrest. Spine J 2022; 22:616-628. [PMID: 34813960 DOI: 10.1016/j.spinee.2021.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Prolonged bedrest induces accumulation of intramuscular lipid concentration (ILC) in the lumbar musculature; however, spatial distribution of ILC has not been determined. Artificial gravity (AG) mitigates some adaptations induced by 60 day bedrest by creating a head-to-feet force while participants are in a supine position. PURPOSE To quantify the spatial distribution of accumulation of ILC in the lumbar musculature after 60 day bedrest, and whether this can be mitigated by AG exposure. STUDY DESIGN Prospective longitudinal study. PATIENT SAMPLE Twenty-four healthy individuals (8 females) participated in the study: Eight received 30 min continuous AG (cAG); Eight received 6 × 5 min AG (iAG), interspersed with rests; Eight were not exposed to AG (CRTL). OUTCOME MEASURES From 3T magnetic resonance imaging (MRI), axial images were selected to assess lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 intervertebral disc levels. Chemical shift-based 2-echo lipid and/or water Dixon sequence was used to measure tissue composition. Each lumbar muscle was segmented into four equal quartiles (from medial to lateral). METHODS Participants arrived at the facility for the baseline data collection before undergoing a 60 day strict 6° head-down tilt (HDT) bedrest period. MRI of the lumbopelvic region was conducted at baseline and Day-59 of bedrest. Participants performed all activities, including hygiene, in 6° HDT and were discouraged from moving excessively or unnecessarily. RESULTS At the L4/L5 and L5/S1 intervertebral disc levels, 60-day bedrest induced a greater increase in ILC in medial and lateral regions (∼+4%) of the LM than central regions (∼+2%; p<.05). A smaller increase in ILC was induced in the lateral region of LES (∼+1%) at L1/L2 and L2/L3 than at the centro-medial region (∼+2%; p<.05). There was no difference between CRTL and intervention groups. CONCLUSIONS Inhomogeneous spatial distribution of accumulation of ILC was found in the lumbar musculature after 60 day bedrest. These findings might reflect pathophysiological mechanisms related to muscle disuse and contribute to localized lumbar spine dysfunction. Altered spatial distribution of ILC may impair lumbar spine function after prolonged body unloading, which could increase injury risk to vulnerable soft tissues, such as the lumbar intervertebral discs. These novel results may represent a new biomarker of lumbar deconditioning for astronauts, bedridden, sedentary individuals, or those with chronic back pain. Changes are potentially modifiable but not by the AG protocols tested here.
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Affiliation(s)
- Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom.
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, Australia
| | - James M Elliott
- Northwestern University, Feinberg School of Medicine Department of Physical Therapy and Human Movement Sciences, Chicago, IL, USA; Northern Sydney Local Health District and The University of Sydney, Faculty of Medicine and Health, The Kolling Institute Sydney, Australia
| | - Mark A Hoggarth
- Northwestern University, Feinberg School of Medicine Department of Physical Therapy and Human Movement Sciences, Chicago, IL, USA; Northwestern University, McCormick School of Engineering, Department of Biomedical Engineering, Evanston, IL, USA
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- NIHR Oxford Biomedical Research Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jonathan A Cook
- NIHR Oxford Biomedical Research Center, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Center for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sauro E Salomoni
- The University of Queensland, NHMRC Center for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Tobias Weber
- Space Medicine Team (HRE-OM), European Astronaut Center, Cologne, Germany; KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- Space Medicine Team (HRE-OM), European Astronaut Center, Cologne, Germany; KBR GmbH, Cologne, Germany
| | - Paul W Hodges
- The University of Queensland, NHMRC Center for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Hodges PW, Bailey JF, Fortin M, Battié MC. Paraspinal muscle imaging measurements for common spinal disorders: review and consensus-based recommendations from the ISSLS degenerative spinal phenotypes group. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3428-3441. [PMID: 34542672 DOI: 10.1007/s00586-021-06990-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Paraspinal muscle imaging is of growing interest related to improved phenotyping, prognosis, and treatment of common spinal disorders. We reviewed issues related to paraspinal muscle imaging measurement that contribute to inconsistent findings between studies and impede understanding. METHODS Three key contributors to inconsistencies among studies of paraspinal muscle imaging measurements were reviewed: failure to consider possible mechanisms underlying changes in paraspinal muscles, lack of control of confounding factors, and variations in spinal muscle imaging modalities and measurement protocols. Recommendations are provided to address these issues to improve the quality and coherence of future research. RESULTS Possible pathophysiological responses of paraspinal muscle to various common spinal disorders in acute or chronic phases are often overlooked, yet have important implications for the timing, distribution, and nature of changes in paraspinal muscle. These considerations, as well as adjustment for possible confounding factors, such as sex, age, and physical activity must be considered when planning and interpreting paraspinal muscle measurements in studies of spinal conditions. Adoption of standardised imaging measurement protocols for paraspinal muscle morphology and composition, considering the strengths and limitations of various imaging modalities, is critically important to interpretation and synthesis of research. CONCLUSION Study designs that consider physiological and pathophysiological responses of muscle, adjust for possible confounding factors, and use common, standardised measures are needed to advance knowledge of the determinants of variations or changes in paraspinal muscle and their influence on spinal health.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Jeannie F Bailey
- Department of Orthopedic Surgery, University of California, San Francisco, CA, USA
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, Western University, London, ON, Canada
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Tran V, De Martino E, Hides J, Cable G, Elliott JM, Hoggarth M, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. Gluteal Muscle Atrophy and Increased Intramuscular Lipid Concentration Are Not Mitigated by Daily Artificial Gravity Following 60-Day Head-Down Tilt Bed Rest. Front Physiol 2021; 12:745811. [PMID: 34867450 PMCID: PMC8634875 DOI: 10.3389/fphys.2021.745811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
Exposure to spaceflight and head-down tilt (HDT) bed rest leads to decreases in the mass of the gluteal muscle. Preliminary results have suggested that interventions, such as artificial gravity (AG), can partially mitigate some of the physiological adaptations induced by HDT bed rest. However, its effect on the gluteal muscles is currently unknown. This study investigated the effects of daily AG on the gluteal muscles during 60-day HDT bed rest. Twenty-four healthy individuals participated in the study: eight received 30 min of continuous AG; eight received 6 × 5 min of AG, interspersed with rest periods; eight belonged to a control group. T1-weighted Dixon magnetic resonance imaging of the hip region was conducted at baseline and day 59 of HDT bed rest to establish changes in volumes and intramuscular lipid concentration (ILC). Results showed that, across groups, muscle volumes decreased by 9.2% for gluteus maximus (GMAX), 8.0% for gluteus medius (GMED), and 10.5% for gluteus minimus after 59-day HDT bed rest (all p < 0.005). The ILC increased by 1.3% for GMAX and 0.5% for GMED (both p < 0.05). Neither of the AG protocols mitigated deconditioning of the gluteal muscles. Whereas all gluteal muscles atrophied, the ratio of lipids to intramuscular water increased only in GMAX and GMED muscles. These changes could impair the function of the hip joint and increased the risk of falls. The deconditioning of the gluteal muscles in space may negatively impact the hip joint stability of astronauts when reexpose to terrestrial gravity.
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Affiliation(s)
- Vienna Tran
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia
| | - Gordon Cable
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Faculty of Medicine and Health, The Kolling Research Institute Sydney, Northern Sydney Local Health District, The University of Sydney, Sydney, NSW, Australia
| | - Mark Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jonathan A. Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Sauro E. Salomoni
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tobias Weber
- Space Medicine Team (HRE-OM), European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- Space Medicine Team (HRE-OM), European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Paul W. Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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9
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Pacicco T, Ratner S, Xi Y, Yokoo T, Fetzer D, Oz OK, Rubin CD, Chhabra A. Pelvic muscle size and myosteatosis: Relationship with age, gender, and obesity. Indian J Radiol Imaging 2021; 29:155-162. [PMID: 31367086 PMCID: PMC6639865 DOI: 10.4103/ijri.ijri_414_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate interreader performance in the measurement of the cross-sectional area and myosteatosis of pelvic skeletal muscles using fat quantification magnetic resonance imaging (MRI) and correlate with patient anthropomorphic characteristics. Materials and Methods A Health Insurance Portability and Accountability Act-compliant retrospective cross-sectional study was performed. Between January and April 2016, 61 patients (26 males and 35 females) underwent a lumbosacral plexus 3T MRI with a modified three-dimensional spoiled gradient echo sequence dedicated to fat quantification (mDixon Quant; Philips Healthcare). Two independent reviewers outlined muscle cross-sectional area on axial images using a freehand region of interest tool and documented proton-density fat fraction (FF) and muscle area (cm2) of the psoas, gluteus medius, gluteus maximus, and rectus femoris muscles on each side. Interreader agreement was assessed by intraclass correlation coefficient (ICC), and correlation between the measurements and subject's age, gender, and body mass index (BMI) was assessed using multiple linear regression analysis. Results Excellent interreader agreement was obtained (ICC ≥0.74) for all muscle groups except for the left gluteus medius area and right psoas FF which showed good agreement (0.65 and 0.61, respectively). Statistically significant (P ≤ 0.05) positive correlation was seen between the gluteal muscle FF and area with BMI, and rectus muscle FF with age and BMI. Statistically significant negative correlation between the rectus femoris area and age was also observed. Conclusion Fat quantification MRI is a highly reproducible imaging technique for the assessment of myosteatosis and muscle size. Intramuscular FF and cross-sectional area were correlated with age and BMI across multiple muscle groups.
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Affiliation(s)
- Thomas Pacicco
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shayna Ratner
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Yin Xi
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Takeshi Yokoo
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA.,Advanced Imaging Research Center, UT Southwestern School of Medicine, Dallas, TX, USA
| | - David Fetzer
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Orhan K Oz
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Craig D Rubin
- Geriatric Division, Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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10
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De Martino E, Hides J, Elliott JM, Hoggarth M, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. Lumbar muscle atrophy and increased relative intramuscular lipid concentration are not mitigated by daily artificial gravity after 60-day head-down tilt bed rest. J Appl Physiol (1985) 2021; 131:356-368. [PMID: 34080918 DOI: 10.1152/japplphysiol.00990.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exposure to axial unloading induces adaptations in paraspinal muscles, as shown after spaceflights. This study investigated whether daily exposure to artificial gravity (AG) mitigated lumbar spine flattening and muscle atrophy associated with 60-day head-down tilt (HDT) bed rest (Earth-based space analog). Twenty-four healthy individuals participated in the study: 8 received 30-min continuous AG; 8 received 6 × 5-min AG interspersed with rest periods; and 8 received no AG exposure (control group). Magnetic resonance imaging (MRI) of the lumbopelvic region was conducted at baseline (BDC) and at day 59 of HDT (HDT59). Longitudinal relaxation time (T1)-weighted images were used to assess morphology of the lumbar spine (spinal length, intervertebral disk angles, disk area) and volumes of the lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 vertebral levels. A chemical shift-based two-point lipid/water Dixon sequence was used to evaluate muscle composition. Results showed that spinal length and disk area increased (P < 0.05); intervertebral disk angles (P < 0.05) and muscle volumes of LM, LES, and QL reduced (P < 0.01); and lipid-to-water ratio for the LM and LES muscles increased (P < 0.01) after HDT59 in all groups. Neither of the AG protocols mitigated the lumbar spinae deconditioning induced by HDT bed rest. The increase in lipid-to-water ratio in LM and LES muscles indicates an increased relative intramuscular lipid concentration. Altered muscle composition in atrophied muscles may impair lumbar spine function after body unloading, which could increase injury risk to vulnerable soft tissues. This relationship needs further investigation.NEW & NOTEWORTHY This study presents novel insights into the morphological adaptations occurring in the lumbar spine after 60-day head-down bed rest and the potential role of artificial gravity (AG) to mitigate them. Results demonstrated no protective effect of AG protocols used in this study. In atrophied paraspinal muscles, the ratio of lipids versus intramuscular water increased in the postural lumbar muscles, which could impair muscle function during upright standing. These findings have relevance for future space explorations.
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Affiliation(s)
- Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Julie Hides
- School of Allied Health Sciences, Griffith University, Nathan Campus, Brisbane, Queensland, Australia
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine Northwestern University, Chicago, Illinois.,Kolling Research Institute, Faculty of Medicine and Health, The University of Sydney and Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- NIHR Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jonathan A Cook
- NIHR Oxford Biomedical Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sauro E Salomoni
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Tobias Weber
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency (ESA), Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- European Astronaut Centre, Space Medicine Team (HRE-OM), European Space Agency (ESA), Cologne, Germany.,KBR GmbH, Cologne, Germany
| | - Paul W Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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11
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Han G, Jiang Y, Zhang B, Gong C, Li W. Imaging Evaluation of Fat Infiltration in Paraspinal Muscles on MRI: A Systematic Review with a Focus on Methodology. Orthop Surg 2021; 13:1141-1148. [PMID: 33942525 PMCID: PMC8274185 DOI: 10.1111/os.12962] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose Numerous studies have applied a variety of methods to assess paraspinal muscle degeneration. However, the methodological differences in imaging evaluation may lead to imprecise or inconsistent results. This article aimed to provide a pragmatic summary review of the current imaging modalities, measurement protocols, and imaging parameters in the evaluation of paraspinal muscle fat infiltration (FI) in MRI studies. Methods Web of Science, EMBASE, and PubMed were searched from January 2005 to March 2020 to identify studies that examined the FI of paraspinal muscles on MRI among patients with lumbar degenerative diseases. Results Intramyocellular lipids measured by magnetic resonance spectroscopy and FI measured by chemical‐shift MRI were both correlated to low back pain and several degenerative lumbar diseases, whereas results on the relationship between FI and degenerative lumbar pathologies using conventional MRI were conflicting. Multi‐segment measurement of FI at the lesion segment and adjacent segments could be a prognostic indicator for lumbar surgery. Most studies adopted the center of the intervertebral disc or endplate as the level of slice to evaluate the FI. Compared with visual semiquantitative assessment, quantitative parameters appeared to be precise for eliminating individual or modality differences. It has been demonstrated that fat CSA/total CSA (based on area) and muscle–fat index (based on signal intensity) as quantitative FI parameters are associated with multiple lumbar diseases and clinical outcomes after surgery. Conclusion Having a good command of the methodology of paraspinal muscle FI on MRI was effective for diagnosis and prognosis in clinical practice.
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Affiliation(s)
- Gengyu Han
- Third Hospital Orthopaedics Department, Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Yu Jiang
- Third Hospital Orthopaedics Department, Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Bo Zhang
- Peking University Health Science Center, Beijing, China
| | - Chunjie Gong
- Peking University Health Science Center, Beijing, China
| | - Weishi Li
- Third Hospital Orthopaedics Department, Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
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12
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Pai S A, Zhang H, Shewchuk JR, Al Omran B, Street J, Wilson D, Doroudi M, Brown SHM, Oxland TR. Quantitative identification and segmentation repeatability of thoracic spinal muscle morphology. JOR Spine 2020; 3:e1103. [PMID: 33015576 PMCID: PMC7524235 DOI: 10.1002/jsp2.1103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/19/2020] [Accepted: 06/01/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE MRI derived spinal-muscle morphology measurements have potential diagnostic, prognostic, and therapeutic applications in spinal health. Muscle morphology in the thoracic spine is an important determinant of kyphosis severity in older adults. However, the literature on quantification of spinal muscles to date has been limited to cervical and lumbar regions. Hence, we aim to propose a method to quantitatively identify regions of interest of thoracic spinal muscle in axial MR images and investigate the repeatability of their measurements. METHODS Middle (T4-T5) and lower (T8-T9) thoracic levels of six healthy volunteers (age 26 ± 6 years) were imaged in an upright open scanner (0.5T MROpen, Paramed, Genoa, Italy). A descriptive methodology for defining the regions of interest of trapezius, erector spinae, and transversospinalis in axial MR images was developed. The guidelines for segmentation are laid out based on the points of origin and insertion, probable size, shape, and the position of the muscle groups relative to other recognizable anatomical landmarks as seen from typical axial MR images. 2D parameters such as muscle cross-sectional area (CSA) and muscle position (radius and angle) with respect to the vertebral body centroid were computed and 3D muscle geometries were generated. Intra and inter-rater segmentation repeatability was assessed with intraclass correlation coefficient (ICC (3,1)) for 2D parameters and with dice coefficient (DC) for 3D parameters. RESULTS Intra and inter-rater repeatability for 2D and 3D parameters for all muscles was generally good/excellent (average ICC (3,1) = 0.9 with ranges of 0.56-0.98; average DC = 0.92 with ranges from 0.85-0.95). CONCLUSION The guidelines proposed are important for reliable MRI-based measurements and allow meaningful comparisons of muscle morphometry in the thoracic spine across different studies globally. Good segmentation repeatability suggests we can further investigate the effect of posture and spinal curvature on muscle morphology in the thoracic spine.
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Affiliation(s)
- Anoosha Pai S
- School of Biomedical EngineeringUniversity of British ColumbiaVancouverCanada
- ICORDUniversity of British ColumbiaVancouverCanada
| | - Honglin Zhang
- Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
| | | | - Bedoor Al Omran
- Department of RadiologyVancouver General HospitalVancouverCanada
| | - John Street
- ICORDUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
| | - David Wilson
- ICORDUniversity of British ColumbiaVancouverCanada
- Centre for Hip Health and MobilityUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
| | - Majid Doroudi
- Department of Cellular and Physiological SciencesUniversity of British ColumbiaVancouverCanada
| | - Stephen H. M. Brown
- Department of Human Health and Nutritional SciencesUniversity of GuelphGuelphCanada
| | - Thomas R. Oxland
- ICORDUniversity of British ColumbiaVancouverCanada
- Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
- Department of Mechanical EngineeringUniversity of British ColumbiaVancouverCanada
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13
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Smith AC, Albin SR, Abbott R, Crawford RJ, Hoggarth MA, Wasielewski M, Elliott JM. Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery. Sci Rep 2020; 10:11471. [PMID: 32651447 PMCID: PMC7351986 DOI: 10.1038/s41598-020-68452-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/22/2020] [Indexed: 02/08/2023] Open
Abstract
Previous preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixty-one participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1–Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD.
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Affiliation(s)
- Andrew C Smith
- School of Physical Therapy, Regis University, Denver, CO, USA
| | | | - Rebecca Abbott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | | | - Mark A Hoggarth
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James M Elliott
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Faculty of Medicine and Health, The Northern Sydney Local Health District, The Kolling Institute, The University of Sydney, St. Leonards, NSW, 2065, Australia.
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14
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Teraguchi M, Cheung JPY, Karppinen J, Bow C, Hashizume H, Luk KDK, Cheung KMC, Samartzis D. Lumbar high-intensity zones on MRI: imaging biomarkers for severe, prolonged low back pain and sciatica in a population-based cohort. Spine J 2020; 20:1025-1034. [PMID: 32135303 DOI: 10.1016/j.spinee.2020.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There is often discrepancy between clinical presentation and lumbar magnetic resonance imaging (MRI) findings. PURPOSE The purpose of this study was to assess the relationship of high-intensity zones (HIZs) on MRI with low back pain (LBP), sciatica, and back-related disability. STUDY DESIGN Cross-sectional, population-based Southern Chinese cohort study. PATIENT SAMPLE Of 1,414 possible participants, data from 1,214 participants (453 males, 761 females; mean age of 48.1±6.3 years) were included. OUTCOME MEASURES Presence of single-level, homogeneous multilevel (same type HIZs of morphology and topography) and heterogeneous multilevel (mixed type HIZs of morphology and topography) HIZs and other MRI phenotypes were assessed at each level with T2-weighted 3T sagittal MRI of L1-S1. Associations with LBP, sciatica and Oswestry Disability Index were correlated with HIZ profiles. RESULTS In all, 718 individuals had HIZs (59.1%). Disc degeneration/displacement were more prevalent in HIZ individuals (p<.001). HIZ subjects experienced prolonged severe LBP more frequently (39.6% vs. 32.5%; p<.05) and had higher Oswestry Disability Index scores (10.7±13.7 vs. 8.9±11.3; p<.05). Posterior multilevel HIZ were significantly associated with prolonged severe LBP (OR: 2.18; 95% CI:1.42-3.37; p<.05) in comparison to anterior only, anterior/posterior or other patterns of HIZ. Multilevel homogeneous or heterogeneous HIZs were significantly associated with prolonged, severe LBP (OR: 1.53-1.57; p<.05). Individuals with homogeneous HIZs had a higher risk of sciatica (OR: 1.51, 95% CI: 1.01-2.27; p<.05). CONCLUSIONS This is the first large-scale study to note that lumbar HIZs, and specific patterns therein, are potentially clinically-relevant imaging biomarkers that are independently and significantly associated with prolonged/severe LBP and sciatica. HIZs, especially homogenous multilevel HIZ, should be noted in the global pain imaging phenotype assessment.
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Affiliation(s)
- Masatoshi Teraguchi
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China; Spine Care Center, Wakayama Medical University, Kihoku Hospital, Ito, Wakayama, Japan; Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Finnish Institute of Occupational Health, Oulu, Finland
| | - Cora Bow
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Keith D K Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA.
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15
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Elliott JM, Smith AC, Hoggarth MA, Albin SR, Weber KA, Haager M, Fundaun J, Wasielewski M, Courtney DM, Parrish TB. Muscle fat infiltration following whiplash: A computed tomography and magnetic resonance imaging comparison. PLoS One 2020; 15:e0234061. [PMID: 32484835 PMCID: PMC7266316 DOI: 10.1371/journal.pone.0234061] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/18/2020] [Indexed: 01/17/2023] Open
Abstract
Here we present a secondary analysis from a parent database of 97 acutely injured participants enrolled in a prospective inception cohort study of whiplash recovery after motor vehicle collision (MVC). The purpose was to investigate the deep and superficial neck extensor muscles with peri-traumatic computed tomography (CT) and longitudinal measures of magnetic resonance imaging (MRI) in participants with varying levels of whiplash-related disability. Thirty-six underwent standard care imaging of the cervical spine with CT at a level-1 trauma designated emergency department. All 36 participants were assessed with MRI of the cervical spine at <1-week, 2-weeks, 3-, and 12-months post-injury and classified into three groups using initial pain severity and percentage scores on the Neck Disability Index (recovered (NDI of 0–8%), mild (NDI of 10–28%), or severe (NDI ≥ 30%)) at 3-months post MVC. CT muscle attenuation values were significantly correlated to muscle fat infiltration (MFI) on MRI at one-week post MVC. There was no significant difference in muscle attenuation across groups at the time of enrollment. A trend of lower muscle attenuation in the deep compared to the superficial extensors was observed in the severe group. MFI values in the deep muscles on MRI were significantly higher in the severe group when compared to the mild group at 1-year post MVC. This study provides further evidence that the magnitude of 1) deep MFI appears unique to those at risk of and eventually transitioning to chronic WAD and that 2) pre- or peri-traumatic muscular health, determined by CT muscle attenuation, may be contribute to our understanding of long-term recovery.
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Affiliation(s)
- James M. Elliott
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, & The Northern Sydney Local Health District, The Kolling Research Institute, St. Leonards, New South Wales, Australia
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
| | - Andrew C. Smith
- School of Physical Therapy, Regis University, Denver, CO, United States of America
| | - Mark A. Hoggarth
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
| | - Stephanie R. Albin
- School of Physical Therapy, Regis University, Denver, CO, United States of America
| | - Ken A. Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Systems Neuroscience and Pain Lab, Stanford University, Palo Alto, California, United States of America
| | - Mat Haager
- School of Physical Therapy, Regis University, Denver, CO, United States of America
| | - Joel Fundaun
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - D. Mark Courtney
- Department of Emergency Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Todd B. Parrish
- Department of Anesthesiology, Perioperative and Pain Medicine, Systems Neuroscience and Pain Lab, Stanford University, Palo Alto, California, United States of America
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Geography of Lumbar Paravertebral Muscle Fatty Infiltration: The Influence of Demographics, Low Back Pain, and Disability. Spine (Phila Pa 1976) 2019; 44:1294-1302. [PMID: 30946297 DOI: 10.1097/brs.0000000000003060] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE We quantified fatty infiltration (FI) geography of the lumbar spine to identify whether demographics, temporal low back pain (LBP), and disability influence FI patterns. SUMMARY OF BACKGROUND DATA Lumbar paravertebral muscle FI has been associated with age, sex, LBP, and disability; yet, FI accumulation patterns are inadequately described to optimize interventions. METHODS This cross-sectional study employed lumbar axial T1-weighted magnetic resonance imaging in 107 Southern-Chinese adults (54 females, 53 males). Single-slices at the vertebral inferior end-plate per lumbar level were measured for quartiled-FI, and analyzed against demographics, LBP, and disability (Oswestry Disability Index). RESULTS Mean FI% was higher in females, on the right, increased per level caudally, and from medial to lateral in men (P < 0.05). FI linearly increased with age for both sexes (P < 0.01) and was notably higher at L 4&5 than L1, 2&3 for cases aged 40 to 65 years. BMI and FI were unrelated in females and inversely in males (P < 0.001). Females with LBPweek and males with LBPyear had 1.7% (each) less average FI (P < 0.05) than those without pain at that time-point. Men locating their LBP in the back had less FI than those without pain (P < 0.001). Disability was unrelated to FI for both sexes (P > 0.05). CONCLUSION Lumbar paravertebral muscle FI predominates in the lower lumbar spine, notably for those aged 40 to 65, and depends more on sagittal than transverse distribution. Higher FI in females and differences of mean FI between sexes for BMI, LBP, and disabling Oswestry Disability Index suggest sex-differential accumulation patterns. Our study contradicts pain models rationalizing lumbar muscle FI and may reflect a normative sex-dependent feature of the natural history of lumbar paravertebral muscles. LEVEL OF EVIDENCE 2.
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Abstract
Persistent spinal (traumatic and nontraumatic) pain is common and contributes to high societal and personal costs globally. There is an acknowledged urgency for new and interdisciplinary approaches to the condition, and soft tissues, including skeletal muscles, the spinal cord, and the brain, are rightly receiving increased attention as important biological contributors. In reaction to the recent suspicion and questioned value of imaging-based findings, this paper serves to recognize the promise that the technological evolution of imaging techniques, and particularly magnetic resonance imaging, is allowing in characterizing previously less visible morphology. We emphasize the value of quantification and data analysis of several contributors in the biopsychosocial model for understanding spinal pain. Further, we highlight emerging evidence regarding the pathobiology of changes to muscle composition (eg, atrophy, fatty infiltration), as well as advancements in neuroimaging and musculoskeletal imaging techniques (eg, fat-water imaging, functional magnetic resonance imaging, diffusion imaging, magnetization transfer imaging) for these important soft tissues. These noninvasive and objective data sources may complement known prognostic factors of poor recovery, patient self-report, diagnostic tests, and the "-omics" fields. When combined, advanced "big-data" analyses may assist in identifying associations previously not considered. Our clinical commentary is supported by empirical findings that may orient future efforts toward collaborative conversation, hypothesis generation, interdisciplinary research, and translation across a number of health fields. Our emphasis is that magnetic resonance imaging technologies and research are crucial to the advancement of our understanding of the complexities of spinal conditions. J Orthop Sports Phys Ther 2019;49(5):320-329. Epub 26 Mar 2019. doi:10.2519/jospt.2019.8793.
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Gadermayr M, Li K, Müller M, Truhn D, Krämer N, Merhof D, Gess B. Domain-specific data augmentation for segmenting MR images of fatty infiltrated human thighs with neural networks. J Magn Reson Imaging 2019; 49:1676-1683. [PMID: 30623506 DOI: 10.1002/jmri.26544] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fat-fraction has been established as a relevant marker for the assessment and diagnosis of neuromuscular diseases. For computing this metric, segmentation of muscle tissue in MR images is a first crucial step. PURPOSE To tackle the high degree of variability in combination with the high annotation effort for training supervised segmentation models (such as fully convolutional neural networks). STUDY TYPE Prospective. SUBJECTS In all, 41 patients consisting of 20 patients showing fatty infiltration and 21 healthy subjects. Field Strength/Sequence: The T1 -weighted MR-pulse sequences were acquired on a 1.5T scanner. ASSESSMENT To increase performance with limited training data, we propose a domain-specific technique for simulating fatty infiltrations (i.e., texture augmentation) in nonaffected subjects' MR images in combination with shape augmentation. For simulating the fatty infiltrations, we make use of an architecture comprising several competing networks (generative adversarial networks) that facilitate a realistic artificial conversion between healthy and infiltrated MR images. Finally, we assess the segmentation accuracy (Dice similarity coefficient). STATISTICAL TESTS A Wilcoxon signed rank test was performed to assess whether differences in segmentation accuracy are significant. RESULTS The mean Dice similarity coefficients significantly increase from 0.84-0.88 (P < 0.01) using data augmentation if training is performed with mixed data and from 0.59-0.87 (P < 0.001) if training is conducted with healthy subjects only. DATA CONCLUSION Domain-specific data adaptation is highly suitable for facilitating neural network-based segmentation of thighs with feasible manual effort for creating training data. The results even suggest an approach completely bypassing manual annotations. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 3.
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Affiliation(s)
- Michael Gadermayr
- Institute of Imaging & Computer Vision, RWTH Aachen University, Aachen, Germany.,Salzburg University of Applied Sciences, Salzburg, Austria
| | - Kexin Li
- Institute of Imaging & Computer Vision, RWTH Aachen University, Aachen, Germany
| | - Madlaine Müller
- Department of Neurology, RWTH University Hospital Aachen, Aachen, Germany
| | - Daniel Truhn
- Department of Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Nils Krämer
- Department of Radiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Dorit Merhof
- Institute of Imaging & Computer Vision, RWTH Aachen University, Aachen, Germany
| | - Burkhard Gess
- Department of Neurology, RWTH University Hospital Aachen, Aachen, Germany
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Borga M. MRI adipose tissue and muscle composition analysis-a review of automation techniques. Br J Radiol 2018; 91:20180252. [PMID: 30004791 PMCID: PMC6223175 DOI: 10.1259/bjr.20180252] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/12/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023] Open
Abstract
MRI is becoming more frequently used in studies involving measurements of adipose tissue and volume and composition of skeletal muscles. The large amount of data generated by MRI calls for automated analysis methods. This review article presents a summary of automated and semi-automated techniques published between 2013 and 2017. Technical aspects and clinical applications for MRI-based adipose tissue and muscle composition analysis are discussed based on recently published studies. The conclusion is that very few clinical studies have used highly automated analysis methods, despite the rapidly increasing use of MRI for body composition analysis. Possible reasons for this are that the availability of highly automated methods has been limited for non-imaging experts, and also that there is a limited number of studies investigating the reproducibility of automated methods for MRI-based body composition analysis.
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Affiliation(s)
- Magnus Borga
- Department
of Biomedical Engineering and Center for Medical Image Science and
Visualization (CMIV), Linköping University,
Linköping, Sweden
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Elliott JM, Hancock MJ, Crawford RJ, Smith AC, Walton DM. Advancing imaging technologies for patients with spinal pain: with a focus on whiplash injury. Spine J 2018; 18:1489-1497. [PMID: 28774580 PMCID: PMC6874915 DOI: 10.1016/j.spinee.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/11/2017] [Accepted: 06/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Radiological observations of soft-tissue changes that may relate to clinical symptoms in patients with traumatic and non-traumatic spinal disorders are highly controversial. Studies are often of poor quality and findings are inconsistent. A plethora of evidence suggests some pathoanatomical findings from traditional imaging applications are common in asymptomatic participants across the life span, which further questions the diagnostic, prognostic, and theranostic value of traditional imaging. Although we do not dispute the limited evidence for the clinical importance of most imaging findings, we contend that the disparate findings across studies may in part be due to limitations in the approaches used in assessment and analysis of imaging findings. PURPOSE This clinical commentary aimed to (1) briefly detail available imaging guidelines, (2) detail research-based evidence around the clinical use of findings from advanced, but available, imaging applications (eg, fat and water magnetic resonance imaging and magnetization transfer imaging), and (3) introduce how evolving imaging technologies may improve our mechanistic understanding of pain and disability, leading to improved treatments and outcomes. STUDY DESIGN/SETTING A non-systematic review of the literature is carried out. METHODS A narrative summary (including studies from the authors' own work in whiplash injuries) of the available literature is provided. RESULTS An emerging body of evidence suggests that the combination of existing imaging sequences or the use of developing imaging technologies in tandem with a good clinical assessment of modifiable risk factors may provide important diagnostic information toward the exploration and development of more informed and effective treatment options for some patients with traumatic neck pain. CONCLUSIONS Advancing imaging technologies may help to explain the seemingly disconnected spectrum of biopsychosocial signs and symptoms of traumatic neck pain.
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Affiliation(s)
- James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N. Michigan Ave, Suite 1100, Chicago, IL, USA; School of Health and Rehabilitation Sciences, The University of Queensland, Australia; Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, 2 Technology Pl, Macquarie Park, Sydney, NSW 2113, Australia
| | - Rebecca J Crawford
- Zürich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland
| | - Andrew C Smith
- Regis University School of Physical Therapy, 3333 Regis Boulevard, Denver, CO 80221, USA
| | - David M Walton
- School of Physical Therapy, Western University, Room 1588, London, Ontario N6G 1H1, Canada
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Elliott JM, Cornwall J, Kennedy E, Abbott R, Crawford RJ. Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: part II - cervical spine musculature. BMC Musculoskelet Disord 2018; 19:171. [PMID: 29807530 PMCID: PMC5972401 DOI: 10.1186/s12891-018-2074-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/04/2018] [Indexed: 01/15/2023] Open
Abstract
Background It has been suggested that the quantification of paravertebral muscle composition and morphology (e.g. size/shape/structure) with magnetic resonance imaging (MRI) has diagnostic, prognostic, and therapeutic potential in contributing to overall musculoskeletal health. If this is to be realised, then consensus towards standardised MRI methods for measuring muscular size/shape/structure are crucial to allow the translation of such measurements towards management of, and hopefully improved health for, those with some musculoskeletal conditions. Following on from an original paper detailing methods for measuring muscles traversing the lumbar spine, we propose new methods based on anatomical cross-reference that strive towards standardising MRI-based quantification of anterior and posterior cervical spine muscle composition. Methods In this descriptive technical advance paper we expand our methods from the lumbar spine by providing a detailed examination of regional cervical spine muscle morphology, followed by a comprehensive description of the proposed technique defining muscle ROI from axial MRI. Cross-referencing cervical musculature and vertebral anatomy includes an innovative comparison between axial E12 sheet-plastinates derived from cadaveric material to a series of axial MRIs detailing commonly used sequences. These images are shown at different cervical levels to illustrate differences in regional morphology. The method for defining ROI for both anterior (scalenes group, sternocleidomastoid, longus colli, longus capitis) and posterior (multifidus, semispinalis cervicis, semispinalis capitis, splenius capitis) cervical muscles is then described and discussed in relation to existing literature. Results A series of steps towards standardising the quantification of cervical spine muscle quality are described, with concentration on the measurement of muscle volume and fatty infiltration (MFI). We offer recommendations for imaging parameters that should additionally inform a priori decisions when planning investigations of cervical muscle tissues with MRI. Conclusions The proposed method provides an option rather than a final position for quantifying cervical spine muscle composition and morphology using MRI. We intend to stimulate discussion towards establishing measurement consensus whereby data-pooling and meaningful comparisons between imaging studies (primarily MRI) investigating cervical muscle quality becomes available and the norm.
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Affiliation(s)
- James M Elliott
- Faculty of Health Sciences, The University of Sydney, Northern Sydney Local Health District, St Leonards, Australia 75 East Street Lidcombe NSW, Sydney, 2141, Australia. .,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA. .,Honorary Fellow School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia.
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ewan Kennedy
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Abbott R, Peolsson A, West J, Elliott JM, Åslund U, Karlsson A, Leinhard OD. The qualitative grading of muscle fat infiltration in whiplash using fat and water magnetic resonance imaging. Spine J 2018; 18:717-725. [PMID: 28887274 PMCID: PMC8845185 DOI: 10.1016/j.spinee.2017.08.233] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/30/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The development of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance imaging (MRI) is required for quantitative analysis and presents as a barrier for clinical translation. PURPOSE The purpose of this work was to establish a qualitative MRI measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild or moderate WAD, and healthy controls. STUDY DESIGN/SETTING This is a cross-sectional study. PATIENT SAMPLE Thirty-one subjects with WAD and 31 age- and sex-matched controls were recruited from an ongoing randomized controlled trial. OUTCOME MEASURES The cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). Muscle fat infiltration was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. The participants with WAD were divided in two groups: mild or moderate and severe based on Neck Disability Index % scores. METHODS The mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U test. Receiver operator characteristic (ROC) analyses were carried out to evaluate the validity of the qualitative method. RESULTS Twenty (65%) patients had mild or moderate disability and 11 (35%) were considered severe. Inter- and intra-rater reliability was excellent when grading was averaged by level or when frequency of grade II was considered. Statistically significant differences (p<.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% confidence interval 0.59-0.94) for discrimination of WAD participants. CONCLUSIONS These preliminary results suggest a qualitative MRI measure for MFI is reliable and valid, and may prove useful toward the classification of WAD in radiology practice.
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Affiliation(s)
- Rebecca Abbott
- Department of Physical Therapy and Human Movement Sciences, NU-PTHMS, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 1100, Chicago, IL, 60611 USA
| | - Anneli Peolsson
- Department of Medical and Health Sciences, Physiotherapy, IMH kansli, Sandbacksgatan 7, 3 tr, Campus US, Linköping University, 58183 Linköping, Sweden
| | - Janne West
- Department of Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV)/ Division of Radiological Services, IMH, Linköping University, SE-581 85 Linköping, Sweden
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, NU-PTHMS, Feinberg School of Medicine, Northwestern University, 645 North Michigan Ave, Suite 1100, Chicago, IL, 60611 USA,School of Health and Rehabilitation Sciences, The University of Queensland, Australia,Zurich University of Applied Sciences, Gertrudstrasse 15, 8400 Winterthur, Switzerland
| | - Ulrika Åslund
- Department of Medical and Health Sciences, Physiotherapy, IMH kansli, Sandbacksgatan 7, 3 tr, Campus US, Linköping University, 58183 Linköping, Sweden
| | - Anette Karlsson
- Center for Medical Image Science and Visualization (CMIV)/ Department of Biomedical Engineering, Linköping University, SE 58183 Linköping, Sweden
| | - Olof Dahlqvist Leinhard
- Department of Medical and Health Sciences, and Center for Medical Image Science and Visualization (CMIV)/Division of Radiological Sciences, IMH, Linköping University, SE-581 85 Linköping, Sweden.
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Gadermayr M, Disch C, Müller M, Merhof D, Gess B. A comprehensive study on automated muscle segmentation for assessing fat infiltration in neuromuscular diseases. Magn Reson Imaging 2018; 48:20-26. [DOI: 10.1016/j.mri.2017.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/07/2017] [Accepted: 12/09/2017] [Indexed: 01/20/2023]
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Lollert A, Stihl C, Hötker AM, Mengel E, König J, Laudemann K, Gökce S, Düber C, Staatz G. Quantification of intramuscular fat in patients with late-onset Pompe disease by conventional magnetic resonance imaging for the long-term follow-up of enzyme replacement therapy. PLoS One 2018; 13:e0190784. [PMID: 29315315 PMCID: PMC5760036 DOI: 10.1371/journal.pone.0190784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/20/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate a quantitative method based on conventional T1-weighted magnetic resonance (MR) imaging to assess fatty muscular degeneration in patients with late-onset Pompe disease and to compare it with semi-quantitative visual evaluation (the Mercuri score). In addition, a long-term retrospective data analysis was performed to evaluate treatment response to enzyme replacement therapy with alglucosidase alfa. METHODS MR images of the lumbar spine were acquired in 41 patients diagnosed with late-onset Pompe disease from 2006 through 2015. Two independent readers retrospectively evaluated fatty degeneration of the psoas and paraspinal muscles by applying the Mercuri score. Quantitative semi-automated muscle and fat tissue separation was performed, and inter-observer agreement and correlations with clinical parameters were assessed. Follow-up examinations were performed in 13 patients treated with alglucosidase alfa after a median of 39 months; in 7/13 patients, an additional follow-up examination was completed after a median of 63 months. RESULTS Inter-observer agreement was high. Measurements derived from the quantitative method correlated well with Medical Research Council scores of muscle strength, with moderate correlations found for the 6-minute walk test, the 4-step stair climb test, and spirometry in the supine position. A significant increase in the MR-derived fat fraction of the psoas muscle was found between baseline and follow-up 1 (P = 0.016), as was a significant decrease in the performance on the 6-minute walk test (P = 0.006) and 4-step stair climb test (P = 0.034), as well as plasma creatine kinase (P = 0.016). No statistically significant difference in clinical or MR-derived parameters was found between follow-up 1 and follow-up 2. CONCLUSIONS Quantification of fatty muscle degeneration using the semi-automated method can provide a more detailed overview of disease progression than semi-quantitative Mercuri scoring. MR-derived data correlated with clinical symptoms and patient exercise capacity. After an initial worsening, the fat fraction of the psoas muscle and performance on the 6-minute walk test stayed constant during long-term follow-up under enzyme replacement therapy.
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Affiliation(s)
- André Lollert
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- * E-mail:
| | - Clemens Stihl
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Andreas M. Hötker
- Department of Diagnostic and Interventional Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Eugen Mengel
- Villa Metabolica, Center of Pediatric and Adolescent Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jochem König
- Institute for Medical Biostatistics, Epidemiology and Informatics, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Katharina Laudemann
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Seyfullah Gökce
- Villa Metabolica, Center of Pediatric and Adolescent Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Gundula Staatz
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Abstract
STUDY DESIGN A retrospective observational study. OBJECTIVE This study examined the role of skeletal muscles in the spinal alignment of lumbar degenerative kyphosis (LDK). SUMMARY OF BACKGROUND DATA Adult spinal deformity (ASD) may present as LDK, which is unusual in that it typically lacks any coronal deformity. METHODS This retrospective study included 367 female patients with ASD. Demographic and radiographic data from LDKs were compared with those with other ASD. The LDK multifidus was also subjected to histological analysis. The muscle volume and strength were analyzed using whole-body dual x-ray absorptiometry and pulmonary function tests. Magnetic resonance images were used to determine the cross-sectional area (CSA) and fatty infiltration area (FIA) of the psoas and multifidus. RESULTS A total of 52 patients (15%) were classified as LDK. Compared with other ASDs, those with LDK had a significantly larger sagittal vertical axis (16.3 ± 5.0 cm), and pelvic incidence minus lumbar lordosis (52.8° ± 9.2°). The LDK had significantly lower CSA and higher FIA of the multifidus, but not in the psoas (multifidus CSA 223 ± 96 vs. 477 ± 129 mm, P < 0.001; FIA 82% vs. 31%, P < 0.001). Eighty-six percent of LDK had a multifidus CSA of less than 300 mm, and 82% had an FIA of more than 80%. Whole-body dual x-ray absorptiometry showed no significant difference in the other body sections between LDK and other ASDs. The percent-predicted peak expiratory flow was within normal range in 82% of the LDK. LDK multifidus specimens revealed diffuse, nonuniform muscular fibers and growth of the interstitium and adipose tissue, with no muscular inflammation. We redefined LDK as drop body syndrome, a distinct form of ASD. CONCLUSION Significantly decreased CSA and increased FIA of the multifidus were observed in LDK, whereas the muscle strength and volume of the other body sections were normal. These findings strongly suggest the presence of isolated lumbar extensor myopathy in LDK. LEVEL OF EVIDENCE 4.
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Ntilikina Y, Bahlau D, Garnon J, Schuller S, Walter A, Schaeffer M, Steib JP, Charles YP. Open versus percutaneous instrumentation in thoracolumbar fractures: magnetic resonance imaging comparison of paravertebral muscles after implant removal. J Neurosurg Spine 2017; 27:235-241. [DOI: 10.3171/2017.1.spine16886] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVEPercutaneous instrumentation in thoracolumbar fractures is intended to decrease paravertebral muscle damage by avoiding dissection. The aim of this study was to compare muscles at instrumented levels in patients who were treated by open or percutaneous surgery.METHODSTwenty-seven patients underwent open instrumentation, and 65 were treated percutaneously. A standardized MRI protocol using axial T1-weighted sequences was performed at a minimum 1-year follow-up after implant removal. Two independent observers measured cross-sectional areas (CSAs, in cm2) and region of interest (ROI) signal intensity (in pixels) of paravertebral muscles by using OsiriX at the fracture level, and at cranial and caudal instrumented pedicle levels. An interobserver comparison was made using the Bland-Altman method. Reference ROI muscle was assessed in the psoas and ROI fat subcutaneously. The ratio ROI-CSA/ROI-fat was compared for patients treated with open versus percutaneous procedures by using a linear mixed model. A linear regression analyzed additional factors: age, sex, body mass index (BMI), Pfirrmann grade of adjacent discs, and duration of instrumentation in situ.RESULTSThe interobserver agreement was good for all CSAs. The average CSA for the entire spine was 15.7 cm2 in the open surgery group and 18.5 cm2 in the percutaneous group (p = 0.0234). The average ROI-fat and ROI-muscle signal intensities were comparable: 497.1 versus 483.9 pixels for ROI-fat and 120.4 versus 111.7 pixels for ROI-muscle in open versus percutaneous groups. The ROI-CSA varied between 154 and 226 for open, and between 154 and 195 for percutaneous procedures, depending on instrumented levels. A significant difference of the ROI-CSA/ROI-fat ratio (0.4 vs 0.3) was present at fracture levels T12–L1 (p = 0.0329) and at adjacent cranial (p = 0.0139) and caudal (p = 0.0100) instrumented levels. Differences were not significant at thoracic levels. When adjusting based on age, BMI, and Pfirrmann grade, a significant difference between open and percutaneous procedures regarding the ROI-CSA/ROI-fat ratio was present in the lumbar spine (p < 0.01). Sex and duration of instrumentation had no significant influence.CONCLUSIONSPercutaneous instrumentation decreased muscle atrophy compared with open surgery. The MRI signal differences for T-12 and L-1 fractures indicated less fat infiltration within CSAs in patients who received percutaneous treatment. Differences were not evidenced at thoracic levels, where CSAs were smaller. Fat infiltration was not significantly different at lumbar levels with either procedure in elderly patients with associated discopathy and higher BMI. In younger patients, there was less fat infiltration of lumbar paravertebral muscles with percutaneous procedures.
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Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging: a proposed method for the lumbar spine with anatomical cross-reference. BMC Musculoskelet Disord 2017; 18:25. [PMID: 28103921 PMCID: PMC5247810 DOI: 10.1186/s12891-016-1378-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/22/2016] [Indexed: 12/21/2022] Open
Abstract
Background There is increasing interest in paravertebral muscle composition as a potential prognostic and diagnostic element in lumbar spine health. As a consequence, it is becoming popular to use magnetic resonance imaging (MRI) to examine muscle volume and fatty infiltration in lumbar paravertebral muscles to assess both age-related change and their clinical relevance in low back pain (LBP). A variety of imaging methods exist for both measuring key variables (fat, muscle) and for defining regions of interest, making pooled comparisons between studies difficult and rendering post-production analysis of MRIs confusing. We therefore propose and define a method as an option for use as a standardized MRI procedure for measuring lumbar paravertebral muscle composition, and to stimulate discussion towards establishing consensus for the analysis of skeletal muscle composition amongst clinician researchers. Method In this descriptive methodological study we explain our method by providing an examination of regional lumbar morphology, followed by a detailed description of the proposed technique. Identification of paravertebral muscles and vertebral anatomy includes axial E12 sheet-plastinates from cadaveric material, combined with a series of axial MRIs that encompass sequencing commonly used for investigations of muscle quality (fat-water DIXON, T1-, and T2-weighted) to illustrate regional morphology; these images are shown for L1 and L4 levels to highlight differences in regional morphology. The method for defining regions of interest (ROI) for multifidus (MF), and erector spinae (ES) is then described. Results Our method for defining ROIs for lumbar paravertebral muscles on axial MRIs is outlined and discussed in relation to existing literature. The method provides a foundation for standardising the quantification of muscle quality that particularly centres on examining fatty infiltration and composition. We provide recommendations relating to imaging parameters that should additionally inform a priori decisions when planning studies examining lumbar muscle tissues with MRI. Conclusions We intend this method to provide a platform towards developing and delivering meaningful comparisons between MRI data on lumbar paravertebral muscle quality.
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