Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Eur Radiol. 2022 Aug;32(8):5650-5658. doi: 10.1007/s00330-022-08613-w. Epub 2022 Mar 8.
To evaluate quantitative parameters to identify the anatomic variation lumbosacral transitional vertebrae (LSTV) and compare them with the landmarks commonly used at present.
A total of 2,845 PET/CT scans were reviewed, and the patients with 23 and 25 presacral vertebrae were included. The quantitative parameters, including the anterior-edge vertebral angle (AVA) of the lowest lumbar-type vertebra, the ratio of the length of the inferior endplate to that of the superior endplate (RISE) of the uppermost sacral-type vertebra and the lumbosacral intervertebral disc angle (LSIVDA), and the anatomical landmarks, including the iliac crest tangent (ICT) level, the iliolumbar ligament (ILL) origin level and psoas proximal insertion, were all evaluated to determine their ability to identify LSTV.
The values of AVA and RISE were significantly different between the LSTV group and the control group, and between subgroups of LSTV. The cutoff value for AVA was 73.0°, with an accuracy, sensitivity, and specificity of 91.1%, 77.5%, and 88.3%, and that for RISE was 0.79, with an accuracy, sensitivity, and specificity of 90.3%, 77.5%, and 94.2%, while that for LSIVDA was 14.15°, with an accuracy, sensitivity, and specificity of 75.9%, 65.7%, and 78.3%, to differentiate L5 sacralization from S1 lumbarization. For differentiating the controls from LSTV, the accuracy, sensitivity, and specificity of the ICT level and proximal psoas insertion were 78.0%, 70.2%, and 95.0%, versus 71.7%, 61.7%, and 94.0%.
Compared with the anatomical landmarks, the quantitative measurements at the lumbosacral junction, including AVA and RISE, may be more helpful for differentiating subgroups of LSTV especially if only lumbar spine imaging is available.
• The quantitative parameters, the anterior-edge vertebral angle (AVA) of the lowest lumbar-type vertebra and the ratio of the length of the inferior endplate to that of the superior endplate (RISE) of the uppermost sacral-type vertebra, are more helpful for distinguishing L5 sacralization from S1 lumbarization than the previously proposed anatomic landmarks. • AVA and RISE represent relevant changes in the curvature at the lumbosacral region and the shape of the transitional vertebral body, respectively. • AVA and RISE are easily assessed, with high intra- and inter-reader reliability.
评估定量参数以识别腰骶移行椎（LSTV）的解剖变异，并将其与目前常用的标志进行比较。
共回顾了 2845 例 PET/CT 扫描，纳入了 23 个和 25 个前置骶椎的患者。评估了定量参数，包括最低腰椎型椎体前缘椎体角（AVA）、最上骶椎下终板长度与上终板长度的比值（RISE）和腰骶椎间盘角（LSIVDA），以及解剖标志，包括骼嵴切线（ICT）水平、髂腰韧带（ILL）起点水平和腰大肌近端插入点，以确定它们识别 LSTV 的能力。
LSTV 组与对照组、LSTV 亚组之间的 AVA 和 RISE 值差异均有统计学意义。AVA 的截断值为 73.0°，其准确性、敏感度和特异度分别为 91.1%、77.5%和 88.3%，RISE 的截断值为 0.79，其准确性、敏感度和特异度分别为 90.3%、77.5%和 94.2%，而 LSIVDA 的截断值为 14.15°，其准确性、敏感度和特异度分别为 75.9%、65.7%和 78.3%，以区分 L5 骶化和 S1 腰化。对于将对照组与 LSTV 区分开来，ICT 水平和腰大肌近端插入的准确性、敏感度和特异度分别为 78.0%、70.2%和 95.0%，而分别为 71.7%、61.7%和 94.0%。
与解剖标志相比，腰骶交界处的定量测量值，包括 AVA 和 RISE，对于区分 LSTV 亚组可能更有帮助，特别是如果仅进行腰椎影像学检查。
定量参数，即最低腰椎型椎体的前缘椎体角（AVA）和最上骶椎下终板长度与上终板长度的比值（RISE），比先前提出的解剖标志更有助于区分 L5 骶化和 S1 腰化。
AVA 和 RISE 分别代表腰骶区曲率和过渡椎体形状的相关变化。
AVA 和 RISE 易于评估，具有较高的内部和内部读者可靠性。
