Sisi Yang1, Louis Lassalle2,3, Ahmed Mekki4, Gautier Appert5, François Rannou6,7,8, Christelle Nguyen6,7,8, Marie-Martine Lefèvre-Colau6, Céline Mutschler3, Jean-Luc Drapé2, Antoine Feydy2. 1. Department of Radiology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. sisi.yang@aphp.fr. 2. Department of Radiology B, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. 3. Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), 20 rue Leblanc, 75015, Paris, France. 4. Department of Radiology, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), 104 Boulevard Raymond Poincaré, 92380, Garches, France. 5. Center for Research in Economics and Statistics (CREST) (Unité mixte de recherche, Centre National de la Recherche Scientifique CNRS 9194), Ecole Nationale de la Statistique et de l'Administration Economique (ENSAE), 5 avenue Henry le Chatelier, 91764, Palaiseau, France. 6. Department of Rehabilitation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. 7. Université de Paris, Faculté de Santé, UFR Médecine de Paris Centre, 75006, Paris, France. 8. INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, 75006, Paris, France.
Abstract
OBJECTIVES: To evaluate the diagnostic performance and interobserver agreement of a magnetic resonance imaging (MRI) protocol that only includes sagittal T2-weighted Dixon fat and water images as an alternative to a standard protocol that includes both sagittal T1-weighted sequence and T2-weighted Dixon water images as reference standard in lumbar degenerative disc disease with Modic changes. METHODS: From February 2017 to March 2019, 114 patients who underwent lumbar spine MRI for low back pain were included in this retrospective study. All MRI showed Modic changes at least at one vertebral level. Two radiologists read the standard protocol and 1 month later the alternative protocol. All MRI were assessed for Modic changes (types, location, extension) as well as structural changes (endplate defects, facet arthropathy, spinal stenosis, foraminal stenosis, Schmorl nodes, spondylolisthesis, disc bulges, and degeneration). Interobserver agreement was assessed, as well as diagnostic performance using the standard protocol as reference standard. RESULTS: Interobserver agreement was moderate to excellent (kappa ranging from 0.51 to 0.92). Diagnostic performance of the alternative protocol was good for detection of any Modic change (sensitivity = 100.00% [95% CI, 99.03-100.00]; specificity = 98.89% [95% CI, 98.02-99.44]), as well as for detection of each Modic subtype and structural variables (sensitivity respectively 100% and ranging from 88.43 to 99.75% ; specificity ranging respectively from 97.62 to 100% and 99.58 to 99.91% ). CONCLUSIONS: Combined with T2-weighted Dixon water images, T2-weighted Dixon fat images provide good diagnostic performance compared to T1-weighted images in lumbar degenerative disc disease with Modic changes, and could therefore allow for a shortened protocol. KEY POINTS: • Combined with T2-weighted Dixon water images, T2-weighted Dixon fat images (in comparison to T1-weighted sequence) can provide good diagnostic performance in lumbar degenerative disc disease with Modic changes. • Interobserver agreement of the alternative protocol including sagittal T2-weighted Dixon fat and water images was substantial to excellent for every studied variable except for facet arthropathy. • A shortened MRI protocol including T2-weighted Dixon sequence without T1-weighted sequence could be proposed in this clinical setting.
OBJECTIVES: To evaluate the diagnostic performance and interobserver agreement of a magnetic resonance imaging (MRI) protocol that only includes sagittal T2-weighted Dixon fat and water images as an alternative to a standard protocol that includes both sagittal T1-weighted sequence and T2-weighted Dixon water images as reference standard in lumbar degenerative disc disease with Modic changes. METHODS: From February 2017 to March 2019, 114 patients who underwent lumbar spine MRI for low back pain were included in this retrospective study. All MRI showed Modic changes at least at one vertebral level. Two radiologists read the standard protocol and 1 month later the alternative protocol. All MRI were assessed for Modic changes (types, location, extension) as well as structural changes (endplate defects, facet arthropathy, spinal stenosis, foraminal stenosis, Schmorl nodes, spondylolisthesis, disc bulges, and degeneration). Interobserver agreement was assessed, as well as diagnostic performance using the standard protocol as reference standard. RESULTS: Interobserver agreement was moderate to excellent (kappa ranging from 0.51 to 0.92). Diagnostic performance of the alternative protocol was good for detection of any Modic change (sensitivity = 100.00% [95% CI, 99.03-100.00]; specificity = 98.89% [95% CI, 98.02-99.44]), as well as for detection of each Modic subtype and structural variables (sensitivity respectively 100% and ranging from 88.43 to 99.75% ; specificity ranging respectively from 97.62 to 100% and 99.58 to 99.91% ). CONCLUSIONS: Combined with T2-weighted Dixon water images, T2-weighted Dixon fat images provide good diagnostic performance compared to T1-weighted images in lumbar degenerative disc disease with Modic changes, and could therefore allow for a shortened protocol. KEY POINTS: • Combined with T2-weighted Dixon water images, T2-weighted Dixon fat images (in comparison to T1-weighted sequence) can provide good diagnostic performance in lumbar degenerative disc disease with Modic changes. • Interobserver agreement of the alternative protocol including sagittal T2-weighted Dixon fat and water images was substantial to excellent for every studied variable except for facet arthropathy. • A shortened MRI protocol including T2-weighted Dixon sequence without T1-weighted sequence could be proposed in this clinical setting.
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