Mapping the medullar adiposity of lumbar spine in MRI: A feasibility study

PURPOSE

The bone medullar adiposity is a marker of bone quality to the point that there is a need to investigate the factors which influence or not the density and distribution of this fat in the spine, especially at the lumbar level. The purpose was to test the feasibility of a Dixon three-point technique and investigate the vertebral marrow fat distribution.

MATERIAL AND METHODS

A sagittal sequence Iterative Decomposition of Water and Fat with Echo Asymmetry and Least-squares Estimation (IDEAL) IQ was performed on the lumbar spine of 46 subjects who were not suffering from any bone disease (21 women and 25 men, aged 18-77 years). Medulla adiposity was determined directly from the measurement of the fat fraction in each vertebral body (T12 to S1) obtained on the fat cartography automatically generated by the IDEAL sequence.

RESULTS

Average vertebral fat fraction was 36.48% (SD 12.82), with a tendency to increase with age and to higher values among men. We observed a craniocaudal gradient of the fat fraction (β = 1.37; p < 0,001; SD 0.11) increasing with age in the lumbar spine from T12 to L5. Through multivariate analysis, this gradient was adjusted for sex, weight and height of the subjects.

CONCLUSION

This feasibility study shows the existence of a physiological craniocaudal gradient of vertebral medullar adiposity from T12 to L5. This gradient increases with age but it is independent of sex or BMI. The IDEAL sequence allows quick and reproducible measurement of the spine vertebral medullar adiposity.

Edge detector-based automatic segmentation of the skin layers and application to moisturization in high-resolution 3 Tesla magnetic resonance imaging

INTRODUCTION

Previous studies have demonstrated the feasibility to explore moisturization with quantification imaging based on T2 mapping. The aim of this study was to describe and validate the first robust automated method to segment the first layers of the skin.

MATERIALS AND METHODS

Data were picked from a previous study that included 35 healthy subjects who underwent a 3T MRI (multi spin echo calculation T2-weighted sequence) with a microscopic coil on the left heel before and one hour after moisturization. The automatic algorithm was composed of the T2 map generation, a Canny filter, a selection of boundaries, and a local regression to delimitate stratum corneum, epidermis, and dermis. An automated affine registration was applied between the exams before and after moisturization.

RESULTS

The failure rate of the algorithm was below 5%. Mean computation time was 139.12s. There was a significant and strong correlation between the automatic measurements and the manual ones for the T2 values (ρ: 0.905, P < 0.001) and for the thickness measurements (ρ: 0.8663; P < 0.001). For registration, mean of the Dice index was 0.64 [0.47; 0.80] and of the Hausdorff distance was 0.29 mm 95% CI: [0.28; 0.30].

CONCLUSION

The proposed automatic method to study the first skin layers in 3T MRI using micro-coils was robust and described T2 values and thickness measurements with a strong correlation to manual measurements. The use of an automated affine registration could also permit the generation of a mapping for a visual assessment of moisturization.

Psoas proximal insertion as a simple and reliable landmark for numbering lumbar vertebrae on MRI of the lumbar spine

OBJECTIVE

To evaluate the value of psoas muscle proximal insertion for correct numbering of the lumbar vertebrae in MRI, in particular in case of lumbosacral transitional vertebra (LSTV).

METHODS

Two radiologists assessed 477 MRI scans of the lumbar spine with a sagittal localizer sequence on the whole spine for numbering vertebrae caudally from C2. Proximal insertion of the psoas was determined as the most proximal vertebra with psoas over half of its body on coronal T2 STIR sequence. The last lumbar vertebra was named considering both its number and the presence or absence of LSTV according to Castellvi classification. These same parameters were also assessed on 207 PET-CT scans of another cohort including the whole spine.

RESULTS

Proximal insertion of the psoas was L1 in 94.1% of cases: 98.5% in case of modal anatomy, 81.4% in case of LSTV, and 51.7% in case of missing or supernumerary lumbar vertebra without LSTV. There was no statistically significant difference between MRI and CT data. The inter-reader agreement for determination of psoas proximal insertion was excellent (kappa = 0.96).

CONCLUSION

Proximal insertion of the psoas muscle is a helpful marker for correct numbering of the lumbar vertebrae in MRI and to detect a complete lumbosacral segmentation anomaly.

KEY POINTS

• Proximal insertion of the psoas muscle can be easily identified on a coronal T2 STIR sequence. • Psoas proximal insertion on the spine almost always designates the first lumbar vertebra and is helpful to accurately number all lumbar vertebrae, especially in case of lumbosacral transitional vertebra. • Conversely, when psoas muscle does not insert five lumbar bodies above the apparent lumbosacral joint, the probability of variation in the number of lumbar vertebrae is high.