RPS 2310 - Imaging of the various pathologies of the spine

Author Block: Y. Kim¹, J. G. Cha², S. Lee¹; ¹Seoul/KR, ²Bucheon/KR
Purpose: To investigate the association between cartilaginous endplate (CEP) abnormalities on 3-dimensional ultrashort echo time MRI with cone trajectory technique (3D UTE) and disc degeneration and endplate Modic change on conventional MRI.
Methods or Background: Ninety one patients (44 men, 47 women, mean age: 55.75 years, range: 19-85 years) underwent MRI of the lumbar spine with conventional sagittal T1, T2-weighted and fat-suppressed T2 weighted fast spin echo sequence and sagittal 3D UTE cone trajectory technique (TR = 16.1 ms, TE = 0.032 ms and 6.6 ms) in 3T MRI. Two musculoskeletal radiologists assessed CEP abnormalities (irregularity, thickening, thinning and defects) of the superior and inferior endplates of the L3-4, L4-5 and L5-S1 discs on 3D UTE and disc degeneration with the Pfirrmann grading system, and presence of Modic change of the endplate on conventional MRI by consensus. The relationship of CEP abnormalities with the disc degeneration and Modic change was tested using Pearson's chi-square test and Spearman's correlation analysis.
Results or Findings: All CEP abnormalities were positively correlated with Pfirrmann grading system (Spearman ρ, 0.31-0.47) and Modic change (Spearman ρ, 0.24-0.50) with statistical significance (p < 0.001 for all Pearson's chi-square and Spearman's correlation analysis).
Conclusion: The CEP abnormality in 3D UTE MRI may be associated with the severity of disc degeneration and the presence of Modic change.
Limitations: The number of patients in the study is relatively small.
MRI findings did not correlate with pathological findings.
The MRI findings did not correlate with the patient's clinical symptoms or prognosis.
This is a cross-sectional study that does not allow for a longitudinal study of the patient.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was designed prospectively, and was approved by the Inha University hospital's review board, and informed consent was obtained from all the participating patients.

Author Block: J. Li¹, J. Liu²; ¹Fujian/CN, ²Xiamen/CN
Purpose: To assess the capability of color-coded Fat-Calcium dual-energy CT (DECT) in identifying spinal occult bone metastases (S-OBMs).
Methods or Background: DECT images of a consecutive series of lung cancer patients were retrospectively analyzed. Two radiologists reviewed conventional CT images and color-coded Fat-Calcium images, recording the locations (diffuse infiltration, focal involvement of vertebral cancellous, vertebral edges, basivertebral venous plexus, and appendages) and number of occult bone metastases (OBMs) identified on the color-coded Fat-Calcium images. Diagnostic performance measures (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy) were then assessed.
Results or Findings: A total of 24 patients were included, comprising 80 spinal occult bone metastases (S-OBMs). Color-coded DECT images show 100% sensitivity, PPV, and accuracy in diagnosing diffusely invasive S-OBMs. The overall sensitivity of color-coded DECT images for focal occult metastases was measured at 96.1%. However, the PPV and accuracy of DECT for focal OBMs were influenced by the lesion’s location. The PPV and accuracy of OBMs in vertebral trabecular regions were higher than those in vertebral edges, basivertebral venous plexus, and attachments (PPV: 81%, 7.7%, 2.0%, and 6.0%, respectively; accuracy: 95.2%, 67.2%, 47.4%, and 14%, respectively). The diagnostic performance for vertebral cancellous regions was the highest, with sensitivity, specificity, PPV, NPV, and accuracy of 94%, 95.5%, 81%, 98.7%, and 95.2%, respectively.
Conclusion: Color-coded Fat-Calcium DECT significantly improves the detection of OBM in the spine.
Limitations: Firstly, it was a retrospective study with a small sample size. Secondly, this study was based on non-enhanced DECT, and whether enhanced DECT could improve diagnostic efficiency requires further study.
Funding for this study: Natural Science Foundation of Fujian Province, China (grant numbers: 2023J01181)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Fujian Cancer Hospital Ethics Committee (K2023-198-01)

Author Block: Y. F. Schwietzer, G. Campbell, N. F. Schubert, I. Fiedler, B. Busse, I. Molwitz; Hamburg/DE
Purpose: To evaluate and validate dual-layer detector spectral-CT fat quantification (dlCT) of the vertebrae bone marrow.
Methods or Background: Isolated human cadaver vertebrae (n=14) of 10 body donors were scanned within 72-96 hours after death using dlCT (CT7500) at 120 kV and a 3T MRI (Ingenia) (Philips Healthcare, the Netherlands). Spherical volumes of interest (VOIs, 11 mm diameter) were placed in the center of all vertebral bodies. Additionally, n=13 patients were prospectively included (mean age 57±9 years; three females) who underwent prior to liver transplantation multiphase dlCT and MR imaging. VOIs were defined at the third lumbar vertebrae.
Within the VOIs fat was quantified in dlCT scans without contrast agent using three-material decomposition for hydroxyapatite, red bone marrow, and fat. Reference values for red bone marrow were generated from the blood pool. MRI fat quantification was performed using mDIXONquant sequences (TE shortest, TR shortest, FA 3°). For statistics, Pearson’s correlations and Bland Altman analysis were employed.
Results or Findings: Ex vivo correlation between dlCT and MRI was high (r2=0.94, p<0.001) with a mean difference of -0.55 [95% intervals of agreement -11.0, 9.9]. In vivo, correlation between dlCT and MRI was moderate (r2=0.47, p=0.01). The mean difference amounted to 14.4 [95% intervals of agreement -3.9, 32.7].
Conclusion: Ex vivo dlCT fat quantification of the vertebral bone marrow delivers reproducable results. In vivo measurements require further calibration of dlCT using MRI and - due to challenges of MRI fat quantification in the presences of bone - preferably histology as a reference.
Limitations: Small sample size due to ongoing recruitment and necessary further calibration of dlCT fat quantification with histological analyses, for which the vertebra are currently prepared by formalin fixation.
Funding for this study: None.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: 2023-300414-WF (Ärztekammer Hamburg)

Author Block: H. P. Dimai, J. Igrec, J. Steiner, R. Riedl, M. Fuchsjäger; Graz/AT
Purpose: Osteoporosis is a condition characterized by low bone mass and increased fracture risk. Vertebral fractures are the most common, often undetected despite serious health consequences. Studies reveal that many fractures are missed in radiographic and CT reports, with false-negative rates ranging from 30% to 84%, highlighting significant underreporting in clinical practice. The study aims to assess recognition rates in chest and abdominal CTs.
Methods or Background: This retrospective analysis included 1,500 CT images from 1,380 patients. Two independent board-certified radiologist with multi-year-experience reviewed each scan for vertebral fractures, noting the number, location, and type of fracture, and classifying them based on the Genant classification system (Grades 2 and 3). Rater agreement was assessed using the Kappa coefficient and AC1 statistic. Fracture documentation rates were calculated based on whether fractures were noted in the formal radiology report summary or only in the free-text narrative. Stratified analysis was performed by patient gender, fracture location, and the presence of multiple fractures.
Results or Findings: Vertebral fractures were found in 11.5% of patients. Agreement between the raters was excellent, with a Kappa value of 0.94 (95% CI: 0.92–0.97) and AC1 of 0.99 (95% CI: 0.98–0.99). However, fractures were documented in the summary in only 14.7% of cases (95% CI: 9.8%–20.9%), while 35.3% were mentioned only in the narrative portion (95% CI: 28.1%–43.0%). Overall, 50% of the fractures were reported in either the summary or the narrative (95% CI: 42.3%–57.8%).
Conclusion: While interrater agreement on fracture detection was high, the rate of documentation, particularly in the structured summary, was low. These findings suggest a need for better reporting protocols to ensure vertebral fractures are clearly communicated, improving patient outcomes and clinical decision-making.
Limitations: n/a
Funding for this study: n/a
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approved by local ethics committee

Author Block: M. Dimitrova, C. Booz, S. Mahmoudi, A. Gökduman, L. D. Grünewald, S. Bernatz, E. Höhne, T. Vogl, I. Yel; Frankfurt/DE
Purpose: This study investigates the diagnostic efficacy of Dual-Energy CT (DECT)-derived collagen maps in evaluating thoracic disk herniation and degeneration.
Methods or Background: A retrospective analysis was conducted involving 51 patients who underwent dual-source DECT (Somatom Force; Siemens Healthineers) and MRI of the thoracic spine within a two-week timeframe. Two blinded radiologists assessed the presence and type of herniation using the North American Spine Society's classification for intervertebral disk pathology, evaluating both conventional grayscale CT and DECT collagen maps. Diagnostic accuracy, sensitivity, and specificity were calculated with MRI as the reference standard. Additionally, subjective assessments of diagnostic confidence and image quality were performed, and inter-reader reliability was evaluated using the intraclass correlation coefficient.
Results or Findings: Analysis of 612 intervertebral disks showed that DECT collagen maps achieved significantly higher sensitivity (98.0%), specificity (97.7%), and diagnostic accuracy (97.7%) compared to conventional CT (sensitivity: 72.0%, specificity: 97.0%, diagnostic accuracy: 96.0%; p < 0.001). Substantial inter-reader reliability was noted (κ=0.76, p < 0.001), with DECT collagen maps providing enhanced diagnostic confidence and image quality (p < 0.001). For assessing disk degeneration, DECT collagen maps demonstrated high sensitivity (83.0%), specificity (81.9%), and diagnostic accuracy (83.4%) in distinguishing non/mild from moderate/severe degeneration, with inter-reader reliability also showing strong agreement (κ=0.82, p < 0.001). Subjective evaluations reported moderate to high diagnostic confidence (median 3.5) and moderate to good image quality (median 3.5).
Conclusion: DECT-derived collagen maps significantly enhance the detection of thoracic disk herniation and degeneration, offering improved diagnostic accuracy, reliability, confidence, and image quality over conventional CT. This imaging technique serves as a valuable alternative for patients who cannot undergo MRI.
Limitations: retrospective study
single-centre Study
small patient group
CT system from a specific vendor
Funding for this study: No funding.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approval by local ethics committee.

Author Block: M. J. Łubiński, A. Majos, P. Kowalski; Lodz/PL
Purpose: Dynamic X-ray is very usefull tool to evaluate cevical spine motion. The aim of this study is to find reference ranges, correlations and practical tips which radiologists can use in cervical spine mobility assesment.
Methods or Background: 288 patients aged 19-78 years old without cervical spine osteoarthritis or suffering from first degree osteoarthritis in Kellgren-Lawrance classtification were examined. We performed lateral X-rays in three projections – neutral, flexion and extension. In the functional X-ray examinations of the cervical spine, the following parameters were assessed: the Cobb angle C2-C7, angular and horizontal segmental mobility and segmental cervical curvature in flexion and extension.
Results or Findings: Reference ranges for extension and flexion C2-C7 Cobb angle, angular and horizontal segmental mobility were found. Analysis showed the biggest mobility of C4-C5 segment. Correlations suggest that horizontal displacement index is the most universal parameter in cervical spine mobility assessment.
Conclusion: A large group of patients and multitude measurements made it possible to find reliable and clinically useful reference ranges and parameters which can be used in routine evaluation of cervical spine functional tests.
Limitations: Not applicable.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable

Author Block: G. C. Feuerriegel, D. Meyer, D. Fitze, J. Hanimann, C. Stern, S. Fröhlich, J. Scherr, J. Spörri, R. Sutter; Zurich/CH
Purpose: To longitudinally assess and compare spinal structural abnormalities in adolescent competitive alpine skiers over 48 months and to compare MRI findings in asymptomatic and symptomatic skiers and explore their clinical relevance.
Methods or Background: Adolescent competitive alpine skiers recruited for a cross-sectional MRI investigation underwent a 3T MR imaging of the lumbar spine at baseline and after 48 months. All MR images were assessed for structural changes occurring in the intervertebral disc, vertebral body and facet joints. At both baseline and follow-up, athletes' low back pain (LBP) symptoms were assessed and Athletes were classified as symptomatic if at least one 'substantial' episode of health problems related to back overuse had occurred in the 12 months prior to the MRI examination. The Wilcoxon signed-rank test and Pearson's chi-squared test were used to compare the measurements.
Results or Findings: A total of 63 athletes (mean age at follow-up 19.6±1.2 years, 25 female) were included in the study. A significant increase in LBP affecting training and competition was observed at follow-up (P = 0.04). Of the athletes with LBP, 63% (n=16) reported recurrent LBP, 14% (n=4) reported permanent backpain, and 26% (n=7) reported one-time LBP since baseline. Assessment of structural changes revealed a significant increase in the number of athletes with disc dehydration (P < 0.001), disc protrusions (P = 0.002) or disc extrusions (P = 0.04). Overall, structural abnormalities did not correlate with LBP (P>0.05).
Conclusion: Overuse related structural changes progress during adolescence and are not self-limiting. However, structural changes are not directly correlated with LBP. This finding may facilitate the development of appropriate treatment and prevention strategies that do not focus solely on spinal changes.
Limitations: Structural abnormalities were only assessed by MRI and not confirmed by other modalities.
Funding for this study: This study was generously supported by the Balgrist Foundation.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Cantonal Ethics Committee Zurich

Author Block: D. Bianco, F. Zaottini, S. Rinaldi, M. Pansecchi, M. Hamedani, S. Massucco, E. Rovetta, C. Martinoli; Genova/IT
Purpose: We aimed to evaluate the feasibility of a quantitative multiparametric MRI protocol of lumbo-sacral plexus and proximal sciatic nerve to differentiate patients affected by Charcot-Marie-Tooth type 1A (CMT1A) neuropathy from controls and to correlate these imaging parameters with clinical grading scale of disease's severity.
Methods or Background: Patients with clinical, electrophysiological and genetical proven CMT1a were prospectively enrolled.
The 3T MRI protocol included the following sequences: Diffusion Tensor Imaging, 2 points T2 DIXON, T1 mapping and T2 mapping. The MR parameters were independently measured by two radiologists. The same day of MRI examination, the CMT1a patients were clinically assessed using CMTNS score and Berg Balance Score (BBS). An age and sex matched control group without clinical signs of neuropathy (NN) was enrolled.
Results or Findings: n=11 patients (7 f,4 m), 47.57 yo ± 14.39 and n= 8 NN controls (5 f, 3 m) 46.5 yo ± 14.39 underwent MRI. The interobserver reliability of measurements was good (ICC=0,65). Lumbosacral plexus roots and sciatic nerve cross sectional area, Fractional Anisotropy (FA), T1 and T2 relaxation time were significantly different between the two groups (p<0,05). Bilateral L5 and S1 T1 relaxation values and FA significantly correlated with CMTNS (respectively R=0.86, p=0.013 and R=0,77, p=0,04) and BBS (respectively R=0.62, p=0.041 and R= 0.75, p=0,042). Sciatic Nerve FA demonstrated strong correlations with both CMTNS (R=0.92, p=0.010) and BBS (R=0.89, p=0.019).
Conclusion: These findings suggest that FA and T1 relaxation time of the lumbosacral plexus and sciatic nerve are the MRI parameters that better correlate with balance performance and overall functional disability in CMT1A patients, representing potential biomarker for disease severity and longitudinal evaluation.
Limitations: Small sample size.
Funding for this study: The study was funded by the Italian Ministry of health trough the public grant BANDO RICERCA FINALIZZATA 2021.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Comitato Etico Territoriale - Regione Liguria

Author Block: N. Andjelic¹, N. Holl², B. Klaan², M-A. Weber²; ¹Sremska Kamenica/RS, ²Rostock/DE
Purpose: This study aimed to evaluate the T2 relaxation times of the cartilage layer of the pubic symphysis in male athletes with osteitis pubis and examine the correlation between these values, pubic bone marrow edema (BME), the pubic symphysis width, and the presence of cleft injuries.
Methods or Background: Sixty-two male athletes (median age, 28 years) presenting with groin pain were examined using a 3-Tesla MRI system. T2 mapping was applied using a T2W sequence to assess the pubic symphysis in three ways: interpubic disc, articular cartilage, and the entire hyaline-fibrocartilage complex. T2 relaxation times were measured, and BME and cleft injuries were identified. Correlations between T2 values, symphyseal width, and the presence of BME and pubic cleft injuries were explored.
Results or Findings: The median T2 relaxation times for the hyaline-fibrocartilage complex, interpubic disc, and articular cartilage were 49.7 ms, 54.6 ms, and 46.2 ms, respectively, with significant differences between (p-value < 0.001), and a notable distinction between the right and left sides of the articular cartilage. Athletes with BME had higher T2 relaxation times for the hyaline-fibrocartilage complex and interpubic disc (p-value < 0.01) but not for the articular cartilage. A moderate positive correlation (r = 0.4) was found between symphysis width and T2 relaxation times.
Conclusion: T2 mapping provides valuable insights into the structural changes in the pubic symphysis in athletes with osteitis pubis. Higher T2 relaxation times in the interpubic disc and whole symphyseal hyaline/fibrocartilage complex are associated with BME, suggesting their potential use in evaluating osteitis pubis.
Limitations: The study was limited to male patients, and the absence of an asymptomatic control group is a notable limitation. Additionally, the pre-screening of all participants introduces a potential selection bias due to the study design.
Funding for this study: This research project was part of the ESOR Bracco Research Fellowship 2024
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the Ethical Committee of Rostock University (approval No. A 2020-0040)

Author Block: A. Lubansu, P. Pandin; Brussels/BE
Purpose: Current image-guided navigation systems in spine surgery rely on ionizing radiation from intraoperative fluoroscopy or CT scans. This study evaluates the feasibility and utility of fusing intraoperative ultrasound (US) imaging with preoperative lumbar CT scans to create a novel US-guided spinal navigation system, aiming to reduce radiation exposure.
Methods or Background: Over one year, 25 patients undergoing lumbar spine surgery participated in this study. Cortical borders of spinal structures were co-registered and fused with preoperative CT scans. The accuracy and time required for co-registration were assessed. When navigation accuracy was within 2mm, various spinal procedures, including screw removal or placement and canal or foraminal recalibration, were performed using the system.
Results or Findings: Accurate co-registration was achieved in under 10 minutes for all cases. Anatomical landmarks for co-registration varied depending on the target region (sacrum, sacroiliac joint, lumbosacral junction, or lumbar vertebrae). The system facilitated percutaneous screw placement, intradural lesion localization, and optimal neural structure decompression. No complications related to US-guided navigation occurred. The total radiation dose was reduced compared to conventional non-navigated procedures.
Conclusion: This preliminary experience suggests that US-guided navigation for spinal procedures is feasible, accurate, safe, and potentially beneficial in reducing radiation exposure. The system demonstrated versatility across various spinal regions and procedures. Further research with larger cohorts and more indications is needed to fully understand the potential advantages and limitations of this innovative navigation system.
Limitations: This study is limited by its small sample size and single-center design. A direct comparison with conventional navigation techniques was not assessed. The learning curve for implementing this new technique was not evaluated.
Funding for this study: No
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable