Department of Radiology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
Department of Radiology B, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
Eur Radiol. 2021 Dec;31(12):9380-9389. doi: 10.1007/s00330-021-07946-2. Epub 2021 May 15.
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.
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.
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% ).
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.
• 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.
评估一种磁共振成像（MRI）方案的诊断性能和观察者间一致性，该方案仅包括矢状 T2 加权 Dixon 脂肪和水图像，作为一种替代方案，该方案包括矢状 T1 加权序列和 T2 加权 Dixon 水图像作为参考标准，用于腰椎退行性椎间盘疾病伴 Modic 改变。
本回顾性研究纳入 2017 年 2 月至 2019 年 3 月期间因腰痛接受腰椎 MRI 检查的 114 例患者。所有 MRI 均显示至少在一个椎骨水平存在 Modic 改变。两位放射科医生阅读标准方案，1 个月后阅读替代方案。所有 MRI 均评估 Modic 改变（类型、位置、范围）以及结构改变（终板缺损、小关节病、椎管狭窄、椎间孔狭窄、Schmorl 结节、脊椎滑脱、椎间盘膨出和退变）。评估了观察者间的一致性，以及以标准方案作为参考标准的诊断性能。
观察者间的一致性为中度至极好（kappa 值范围为 0.51 至 0.92）。替代方案对任何 Modic 改变的检测具有良好的诊断性能（敏感性为 100.00%[95%CI，99.03-100.00%]；特异性为 98.89%[95%CI，98.02-99.44%]），以及对每个 Modic 亚型和结构变量的检测（敏感性分别为 100%，范围为 88.43%至 99.75%；特异性分别为 97.62%至 100%和 99.58%至 99.91%）。
与 T1 加权图像相比，结合 T2 加权 Dixon 水图像的 T2 加权 Dixon 脂肪图像在腰椎退行性椎间盘疾病伴 Modic 改变中提供了良好的诊断性能，因此可以缩短方案。
与 T1 加权序列相比，结合 T2 加权 Dixon 水图像的 T2 加权 Dixon 脂肪图像（与 T2 加权序列相比）可在腰椎退行性椎间盘疾病伴 Modic 改变中提供良好的诊断性能。
替代方案（包括矢状 T2 加权 Dixon 脂肪和水图像）的观察者间一致性对于除小关节病以外的所有研究变量均为中等至高。
在这种临床情况下，可以提出一种包括 T2 加权 Dixon 序列而不包括 T1 加权序列的缩短 MRI 方案。
