Diagnostic Capability of Low-versus High-field MRI for Lumbar Degenerative Disease SP13

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1 Diagnostic Capability of Low-versus High-field MRI for Lumbar Degenerative Disease SP13 Ryan K.L.Lee, James F. Griffith, Alex W.H.Ng, Eshter H.Y. Hung, Joyce H.Y. Leung Department of Imaging and Interventional Radiology, Prince Of Wales Hospital, The Chinese University of Hong Kong

2 Introduction Low field MRI has advantage of easier installation, lower purchase and maintenance cost as well as ease of use Main limitation currently to more widespread usage of low-field whole-body MRI systems is impaired spatial resolution compared to higher strength whole-body MR systems

3 Introduction Lumbar spine MRI is singularly most common reason for MRI referral with tens of thousands of these examinations being performed worldwide on a daily basis Also likely to be one of prime indications for referral on low field strength systems It would clearly be helpful to know diagnostic capability in this area of low field systems compared to higher field systems

4 Aim To investigate diagnostic capability of low-field (0.25T) MRI compared to high-field (3T) MRI for degenerative disease of the lumbar spine

5 Inclusion Patients with sciatica or neurogenic claudication referred for MRI examination of lumbosacral spine studied Between Jan 2009 and June 2013 Either unilateral/ bilateral sciatic pain or numbness or symptoms of neurogenic claudication provoked by either walking or prolonged standing Symptoms persisted after medical treatment for at least 3 months

6 MRI Examination All patients underwent MRI of the lumbar spine on both low-field 0.25T (G-Scan Esaote, Genoa, Italy) and high field 3.0 T (Achieva TX-series, Philips Medical Systems, Best, Netherlands) whole body MR systems within 90 days of each other

7 0.25T MRI Sequences for 0.25T MRI : - axial T2-weighted GE 3D (TE: 10ms, TR: 5ms, flap angle : 70, field of view: 210x210mm, matrix 512x512, reconstructed slice thickness 4.0mm) - sagittal T2-weighted TSE (TE: 100ms, TR: 3980ms, 4-mm thickness, field of view: 320x320mm, matrix 512x512) - sagittal T1-weighted TSE (TE: 20ms, TR:680ms, 4-mm thickness, field of view: 330x330mm, matrix 512x512) Total scan duration : 24 minutes

8 3.0 T MRI Sequences for 3.0T MRI : - axial T2-weighted TSE (TE: 130ms, TR: 2650ms, 4-mm thickness, field of view: 500x176mm, matrix 512x512) - sagittal T1-weighted TSE (TE: 7.9ms, TR:400ms, 4-mm thickness, field of view: 160x300mm, matrix 512x512) - sagittal T2-weighted TSE(TE: 120ms, TR: 2045ms, 4-mm thickness, field of view: 160x300mm, matrix 512x512) Total scan duration : 17 minutes

9 T1W sagittal 0.25T 3.0T

10 T2W sagittal 0.25T 3.0T

11 T2W axial 0.25T 3.0T

12 MRI Assessment Overall quality of the 0.25T and 3.0T image datasets assessed Those cases with significant motion artifact excluded from further analysis Intervertebral disc herniation, central spinal canal stenosis, lateral recess stenosis, exit foraminal stenosis, and nerve root compression at L3/4, L4/5 and L5/S1 evaluated By two radiologists (R.K.L.L, J.H.Y.L) for both 0.25T and 3T studies

13 MRI Assessment To reach consensus in these readings, radiologists evaluated the cases together A time gap of at least 2 weeks between evaluation of the low- and high- field MRI studies to minimize risk of the radiologists remembering specific image findings

14 Disc Herniation Disc herniation assessed on both T2-weighted axial and sagittal images Grade 0 : absent Grade 1 : mild Grade 2 : moderate Grade 3 : severe

15 Central Canal Stenosis Central spinal canal stenosis assessed on both T2-weighted axial and sagittal images Grade 0 : absent Grade 1 : mild with reduction of anteroposterior diameter of spinal canal up to 1/3 original diameter Grade 2 : moderate with reduction of anteroposterior diameter of spinal canal up to 2/3 original diameter Grade 3 : severe with reduction of anteroposterior diameter of spinal canal by >2/3 original diameter

16 Lateral Recess Stenosis Lateral recess stenosis assessed on T2-weighted axial imaging using the 4-point grading scale (Weishaupt) Grade 0 : absent Grade 1 : mild with nerve root contact though no deviation Grade 2 : moderate with nerve root deviation Grade 3 : severe with nerve root compression

17 Intervertebral Foraminal Stenosis Intervertebral foraminal stenosis assessed on T2-weighted parasagittal images according to 4-point grading scale (Wildermuth) Grade 0 : absent Grade 1 : mild with deformity of epidural fat surrounding the exiting nerve root Grade 2 : moderate with epidural fat only partially surround the nerve root Grade 3 : severe with complete obliteration of foraminal epidural fat

18 Nerve Root Compression Descending and exiting nerve root compression Grade 0 : absent Grade 1 : present

19 Statistics SPSS software (version 14.0, SPSS) for Windows used for all statistical analyses mean ± standard deviation (sd) Kappa statistics : analyze agreement in grading of disc protrusion, central canal stenosis, lateral recess stenosis, exit foraminal stenosis, and nerve root compression between 0.25T and 3.0T MRI studies Agreement criteria : r>0.8 excellent, r: good, r: moderate, r: fair, r<0.2 poor

20 Statistics McNemar test was used to compare portion of the different grading of the above MRI parameters as well as motion artifact at both 0.25T and 3.0T Probability p level of regarded as statistically significant.

21 Results Total 100 patients Mean age: 56.3 year (range 32-80) F:M = 59:41 14 patients with motion artifact excluded : T alone (n=10) - 3.0T alone (n=2) - Both 0.25T and 3.0T (n=2)

22 0.25T 3.0T Kappa value McNemar test, Number Number (p value) p value Central canal stenosis Grade Grade () Grade Grade L3/4 Disc herniation Grade Grade () Grade Grade Exit foraminal Grade narrowing Grade () Grade Grade Lateral recess Grade L narrowing Grade () Grade Grade Descending nerve root Grade compression Grade () Exiting nerve root Grade compression Grade () Exit foraminal Grade narrowing Grade () Grade Grade Lateral recess Grade R narrowing Grade () Grade Grade Descending nerve root Grade compression Grade () Exiting nerve root Grade compression ()

23 0.25T 3.0T Kappa value McNemar test, Number Number (p value) p value Central canal stenosis Grade Grade () Grade Grade Disc herniation Grade Grade () Grade L4/5 Grade Exit foraminal Grade narrowing Grade () Grade Grade Lateral recess Grade L narrowing Grade () Grade Grade Descending nerve root Grade compression Grade () Exiting nerve root Grade compression Grade () Exit foraminal Grade narrowing Grade () Grade Grade Lateral recess Grade R narrowing Grade () Grade Grade Descending nerve root Grade compression Grade () Exiting nerve root Grade compression ()

24 0.25T 3.0T Kappa value McNemar test, Number Number (p value) p value Central canal stenosis Grade Grade () L5/S1 Grade Grade Disc herniation Grade Grade () Grade Grade Exit foraminal Grade narrowing Grade () Grade Grade L Lateral recess Grade narrowing Grade () Grade Grade Descending nerve root Grade compression Grade () Exiting nerve root Grade compression Grade () Exit foraminal Grade narrowing Grade () Grade Grade Lateral recess Grade R narrowing Grade () Grade Grade Descending nerve root Grade compression Grade () Exiting nerve root Grade compression ()

25 Results Excellent agreement between 0.25T and 3.0T MRI with regard to grading presence and severity of disc herniation (r = , p < 0.05), central canal stenosis (r = , p < 0.05), lateral recess stenosis (r = , p ) and exit foramen stensosis (r = , all p < 0.05)

26 Results Descending or exiting nerve root compression occurred in 52% of patients at either L3/4, L4/5 or L5/S1 levels With good agreement between 0.25T and 3T MRI (r = , all p ) Number of MRI scans with motion artifact significantly higher at 0.25T than 3.0T (n = 12 in 0.25T vs n= 4 in 3T, p = 0.037)

27 Conclusion Good to excellent reliability between 0.25T and 3T MRI was found for specific features of lumbar disc degeneration Though 0.25 T MRI was more susceptible to motion artifact probably due to longer scanning time

28 End Thank You

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