Dixon T2 Imaging of Vertebral Bone Edema: Reliability and Comparison with Short Tau Inversion Recovery

Overview

Journal Acta Radiol

Specialty Radiology

Date 2022 Dec 23

PMID 36560906

Authors

Magnhild H Dagestad

Monika K Toppe

Per M Kristoffersen

Elisabeth Gjefsen

Erling Andersen

Jorg Assmus

Nils Vetti

Ansgar Espeland

Affiliations

Soon will be listed here.

Abstract

Background: It is uncertain whether T2-weighted Dixon water images (DixonT2w) and short tau inversion recovery (STIR) are interchangeable when evaluating vertebral bone edema, or if one method is superior or visualizes the edema differently.

Purpose: To compare image quality and Modic change (MC)-related edema between DixonT2w and STIR and estimate inter-observer reliability for MC edema on DixonT2w.

Material And Methods: Consecutive patients (n = 120) considered for the Antibiotics in Modic changes (AIM) trial underwent lumbar 1.5-T magnetic resonance imaging with two-point DixonT2w and STIR. Two radiologists assessed MC-related high-signal lesions on DixonT2w and compared image quality and lesion extent with STIR. Cohen's kappa and mean of differences ± limits of agreement were calculated.

Results: Fat suppression and artefacts were similar on DixonT2w and STIR in 116 of 120 (97%) patients. Lesion conspicuity was similar in 88, better on STIR in 10, and better on DixonT2w in 9 of 107 patients with MC-related high-signal lesions. Contrast-to-noise ratio for STIR versus DixonT2w was 19.1 versus 17.1 (mean of differences 2.0 ± 8.2). Of 228 lesions L4-S1, 215 (94%) had similar extent on DixonT2w and STIR, 11 were smaller/undetected on STIR, and two were smaller/undetected on DixonT2w. Lesions missed on STIR (n = 9) or DixonT2w (n = 1) had a weak signal increase on the other sequence (≤17%; 0% = vertebral body, 100% = cerebrospinal fluid). Inter-observer reliability (mean kappa L4-S1) was very good for presence (0.87), moderate for height (0.44), and good for volume (0.63) of lesions on DixonT2w.

Conclusion: DixonT2w provided similar visualization of MC-related vertebral edema as STIR.

References

Braten L, Schistad E, Espeland A, Kristoffersen P, Haugen A, Marchand G . Association of Modic change types and their short tau inversion recovery signals with clinical characteristics- a cross sectional study of chronic low back pain patients in the AIM-study. BMC Musculoskelet Disord. 2020; 21(1):368. PMC: 7285575. DOI: 10.1186/s12891-020-03381-4. View

Guerini H, Omoumi P, Guichoux F, Vuillemin V, Morvan G, Zins M . Fat Suppression with Dixon Techniques in Musculoskeletal Magnetic Resonance Imaging: A Pictorial Review. Semin Musculoskelet Radiol. 2015; 19(4):335-47. DOI: 10.1055/s-0035-1565913. View

Zanchi F, Richard R, Hussami M, Monier A, Knebel J, Omoumi P . MRI of non-specific low back pain and/or lumbar radiculopathy: do we need T1 when using a sagittal T2-weighted Dixon sequence?. Eur Radiol. 2020; 30(5):2583-2593. PMC: 7160219. DOI: 10.1007/s00330-019-06626-6. View

Cao P, Jiang L, Zhuang C, Yang Y, Zhang Z, Chen W . Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes. Spine J. 2010; 11(2):100-6. DOI: 10.1016/j.spinee.2010.07.001. View

Ladefoged C, Hansen A, Keller S, Holm S, Law I, Beyer T . Impact of incorrect tissue classification in Dixon-based MR-AC: fat-water tissue inversion. EJNMMI Phys. 2015; 1(1):101. PMC: 4545462. DOI: 10.1186/s40658-014-0101-0. View

Kirchgesner T, Perlepe V, Michoux N, Larbi A, Vande Berg B . Fat suppression at 2D MR imaging of the hands: Dixon method versus CHESS technique and STIR sequence. Eur J Radiol. 2017; 89:40-46. DOI: 10.1016/j.ejrad.2017.01.011. View

Beaudreuil J, Dieude P, Poiraudeau S, Revel M . Disabling chronic low back pain with Modic type 1 MRI signal: acute reduction in pain with intradiscal corticotherapy. Ann Phys Rehabil Med. 2012; 55(3):139-47. DOI: 10.1016/j.rehab.2012.01.004. View

Maatta J, Karppinen J, Paananen M, Bow C, Luk K, Cheung K . Refined Phenotyping of Modic Changes: Imaging Biomarkers of Prolonged Severe Low Back Pain and Disability. Medicine (Baltimore). 2016; 95(22):e3495. PMC: 4900699. DOI: 10.1097/MD.0000000000003495. View

Albert H, Kjaer P, Jensen T, Sorensen J, Bendix T, Manniche C . Modic changes, possible causes and relation to low back pain. Med Hypotheses. 2007; 70(2):361-8. DOI: 10.1016/j.mehy.2007.05.014. View

10.

Berg L, Gjertsen O, Hellum C, Neckelmann G, Johnsen L, Eide G . Reliability of change in lumbar MRI findings over time in patients with and without disc prosthesis--comparing two different image evaluation methods. Skeletal Radiol. 2012; 41(12):1547-57. DOI: 10.1007/s00256-012-1394-5. View

11.

Dietrich O, Raya J, Reeder S, Reiser M, Schoenberg S . Measurement of signal-to-noise ratios in MR images: influence of multichannel coils, parallel imaging, and reconstruction filters. J Magn Reson Imaging. 2007; 26(2):375-85. DOI: 10.1002/jmri.20969. View

12.

Heynen B, Tamigneaux C, Pasoglou V, Malghem J, Vande Berg B, Kirchgesner T . MRI detection of radiographically occult fractures of the hip and pelvis in the elderly: Comparison of T2-weighted Dixon sequence with T1-weighted and STIR sequences. Diagn Interv Imaging. 2018; 100(3):169-175. DOI: 10.1016/j.diii.2018.11.008. View

13.

Hahn S, Han Lee Y, Suh J . Detection of vertebral metastases: a comparison between the modified Dixon turbo spin echo T weighted MRI and conventional T weighted MRI: a preliminary study in a tertiary centre. Br J Radiol. 2018; 91(1085):20170782. PMC: 6190773. DOI: 10.1259/bjr.20170782. View

14.

Maeder Y, Dunet V, Richard R, Becce F, Omoumi P . Bone Marrow Metastases: T2-weighted Dixon Spin-Echo Fat Images Can Replace T1-weighted Spin-Echo Images. Radiology. 2017; 286(3):948-959. DOI: 10.1148/radiol.2017170325. View

15.

van Vucht N, Santiago R, Lottmann B, Pressney I, Harder D, Sheikh A . The Dixon technique for MRI of the bone marrow. Skeletal Radiol. 2019; 48(12):1861-1874. DOI: 10.1007/s00256-019-03271-4. View

16.

Lee S, Choi D, Shin H, Baek H, Choi H, Park S . FSE T2-weighted two-point Dixon technique for fat suppression in the lumbar spine: comparison with SPAIR technique. Diagn Interv Radiol. 2018; 24(3):175-180. PMC: 5951208. DOI: 10.5152/dir.2018.17320. View

17.

Tavares I, Thomas E, Cyteval C, Picot M, Manna F, Macioce V . Intradiscal glucocorticoids injection in chronic low back pain with active discopathy: A randomized controlled study. Ann Phys Rehabil Med. 2020; 64(2):101396. DOI: 10.1016/j.rehab.2020.05.003. View

18.

Braten L, Rolfsen M, Espeland A, Wigemyr M, Assmus J, Froholdt A . Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial. BMJ. 2019; 367:l5654. PMC: 6812614. DOI: 10.1136/bmj.l5654. View

19.

Storheim K, Espeland A, Grovle L, Skouen J, Assmus J, Anke A . Antibiotic treatment In patients with chronic low back pain and Modic changes (the AIM study): study protocol for a randomised controlled trial. Trials. 2017; 18(1):596. PMC: 5732434. DOI: 10.1186/s13063-017-2306-8. View

20.

Herlin C, Kjaer P, Espeland A, Skouen J, Leboeuf-Yde C, Karppinen J . Modic changes-Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis. PLoS One. 2018; 13(8):e0200677. PMC: 6070210. DOI: 10.1371/journal.pone.0200677. View