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Ultrashort Time-to-Echo Magnetic Resonance Imaging at 3 T for the Detection of Spondylolysis in Cadaveric Spines: Comparison With CT
- Source :
- Investigative radiology, vol 54, iss 1
- Publication Year :
- 2018
-
Abstract
- ObjectivesThe objective of this study was to compare the diagnostic performance and confidence of conventional, optimized, and ultrashort time to echo (UTE) magnetic resonance (MR) protocols for detection of simulated lumbar spondylolysis in human cadavers. In addition, we sought to demonstrate the feasibility of the UTE technique in subjects with and without spondylolysis.Materials and methodsFour human lumbar spine specimens with 46 individual pars interarticularis were randomly left intact (n = 26) or received experimental osteotomy (n = 20) using a microsurgical saw to simulate spondylolysis. The specimens were imaged using a computed tomography (CT) scan along with 3 "Tiers" of MR protocols at 3 T: Tier 1, conventional lumbar MR protocol; Tier 2, optimized conventional protocol consisting of a sagittal oblique spoiled gradient recall echo and axial oblique T1 and short tau inversion recovery sequences; and Tier 3, a sagittal UTE MR sequence. Two blinded readers evaluated the images using a 4-point scale (1 = spondylolysis certainly absent, 2 = probably absent, 3 = probably present, 4 = certainly present) at each individual pars. For each imaging protocol, diagnostic performance (sensitivity, specificity, and area under the receiver operating characteristic curve, using the surgical osteotomy as the reference) and confidence were assessed and compared using the McNemar test. Furthermore, 2 human subjects were imaged with the conventional and UTE MR protocols to demonstrate feasibility in vivo.ResultsDiagnostic performance was moderate for Tiers 1 and 2, with a moderate sensitivity (0.70 to 0.75) and high (1.00) specificity. In contrast, CT and Tier 3 UTE MR imaging had both high sensitivity (1.00) and specificity (1.00). The sensitivities of CT or Tier 3 were statistically greater than Tier 1 sensitivity (P = 0.041) and neared statistical significance when compared with Tier 2 sensitivity (P = 0.074). Area under the receiver operating characteristic curve was also significantly greater for CT and Tier 3 (each area = 1.00), compared with the areas for Tier 1 (0.89, P = 0.037) or Tier 2 (0.873, P = 0.024). Diagnostic confidences of CT or Tier 3 were much greater than other Tiers: Both Tiers 1 and 2 had a large percentage of uncertain (>60%, P < 0.001) or wrong interpretations (>10%, P < 0.001), unlike CT or Tier 3 (0% uncertain or wrong interpretations). Preliminary in vivo UTE images clearly depicted intact and fractured pars.ConclusionsOur study demonstrated that the detection of pars fractures using a single sagittal UTE MR sequence is superior in performance and confidence to conventional and optimized MR protocols at 3 T, whereas matching those from CT evaluation. Furthermore, we demonstrated the feasibility of in vivo application of the UTE sequence in subjects with and without spondylolysis.
- Subjects :
- Male
detection
Spondylolysis
030218 nuclear medicine & medical imaging
0302 clinical medicine
diagnostic performance
spondylolysis
Tomography
health care economics and organizations
Human cadaver
pars interarticularis
Lumbar Vertebrae
medicine.diagnostic_test
10042 Clinic for Diagnostic and Interventional Radiology
Echo (computing)
General Medicine
Middle Aged
Magnetic Resonance Imaging
X-Ray Computed
Nuclear Medicine & Medical Imaging
Biomedical Imaging
Female
CT
MRI
Clinical Sciences
education
610 Medicine & health
Sensitivity and Specificity
ultrashort time to echo
Article
03 medical and health sciences
Lumbar
pars defect
Cadaver
Clinical Research
medicine
2741 Radiology, Nuclear Medicine and Imaging
Humans
Radiology, Nuclear Medicine and imaging
business.industry
Reproducibility of Results
Magnetic resonance imaging
medicine.disease
diagnostic confidence
ROC Curve
UTE
Cadaveric spasm
business
Nuclear medicine
Tomography, X-Ray Computed
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15360210
- Volume :
- 54
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Investigative radiology
- Accession number :
- edsair.doi.dedup.....100bade5d04ea131264013a7bad706aa