Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Magnetic Resonance-Based Grading of Psoas and Paraspinal Muscle Edema: Is It Helpful in Diagnosing Lumbar Transverse Process Fractures?

요근과 척추주위 등 근육 부종의 자기공명영상 기반 등급화: 요추 횡돌기 골절 진단에 도움이 되는가?

  • Jeong, Hyunseok (Department of Radiology, Kyung Hee University Hospital at Gangdong) ;
  • Jin, Wook (Department of Radiology, Kyung Hee University Hospital at Gangdong) ;
  • Park, Yong Sung (Department of Radiology, Kyung Hee University Hospital at Gangdong) ;
  • Yun, Seong Jong (Department of Radiology, Kyung Hee University Hospital at Gangdong) ;
  • Park, So Young (Department of Radiology, Kyung Hee University Hospital at Gangdong) ;
  • Park, Ji Seon (Department of Radiology, College of Medicine, Kyung Hee University) ;
  • Ryu, Kyung Nam (Department of Radiology, College of Medicine, Kyung Hee University)
  • 정현석 (강동경희대학교병원 영상의학과) ;
  • 진욱 (강동경희대학교병원 영상의학과) ;
  • 박용성 (강동경희대학교병원 영상의학과) ;
  • 윤성종 (강동경희대학교병원 영상의학과) ;
  • 박소영 (강동경희대학교병원 영상의학과) ;
  • 박지선 (경희대학교 의과대학 영상의학교실) ;
  • 유경남 (경희대학교 의과대학 영상의학교실)
  • Received : 2018.01.09
  • Accepted : 2018.05.19
  • Published : 2018.10.01
⟨ Previous Next ⟩

Abstract

Purpose: To determine the reliability of edema grading of the psoas and paraspinal muscles on axial T2-weighted magnetic resonance (MR) image (T2WI) for the detection of lumbar transverse process (TP) fractures. Materials and Methods: A retrospective review of lumbar spine MR images of 56 patients (mean age = 56.1 years, age range = 17-87 years, male:female = 28:28) was conducted by 2 radiologists. Based on the axial T2WI at the disc level, the paraspinal muscles were classified into 4 compartments and muscle edema (increased signal intensity on axial T2WI) grading performed for each quadrant. Results: A total of 486 TPs (with fracture: 24, without fracture: 462) of 56 patients were evaluated. Muscle edema grade showed moderate correlation with the presence of TP fracture (${\rho}=0.466$). When the total score of muscle edema was 2.50, the receiver operating characteristic curve showed a sensitivity of 72.7% and a specificity of 90.7%. A higher edema grade had a significantly higher probability of concomitant TP fracture [any sided (total): odds ratio = 1.704 (95% confidence interval = 1.410-2.060)]. Conclusion: Edema grading of the psoas and paraspinal muscles on axial T2WI of lumbar spine can be helpful in the detection of TP fracture.

목적: 요추 횡돌기 골절의 진단에서 축 방향 T2 강조 자기공명영상에서 요근과 척추 주위 등 근육 부종 등급화의 신뢰성을 알아보고자 하였다. 대상과 방법: 2명의 영상의학과 의사가 56명 환자(평균연령: 56.1세, 연령범위: 17-87세, 남자:여자 = 28명:28명)의 요추 자기공명영상을 후향적으로 분석하였다. 디스크 레벨에서 축 방향 T2 강조영상를 기반으로 척추 주위의 근육은 4구역으로 분류하고 근육 부종(축 방향 T2 강조영상에의 신호 강도 증가) 등급을 매겼다. 결과: 56명의 환자, 총 486개의 횡돌기(골절: 24건, 정상: 462건)가 평가되었다. 근육 부종 등급은 횡돌기 골절과 중등도의 상관관계를 보여주었다(${\rho}=0.466$). Receiver operating characteristic curve 분석에서 근육 부종 등급 총점의 cut-off 값을 2.50으로 정했을 때 횡돌기 골절 진단의 민감도는 72.7%, 특이도는 90.7%였다. 근육 부종 등급이 높을수록 횡돌기 골절의 가능성이 유의하게 높았다[양면(전체): 교차비 1.704 (95% 신뢰 구간 1.410-2.060)]. 결론: 요추 자기공명영상 축 방향 T2 강조영상에서 요근과 등 주위 근육 부종의 등급화는 횡돌기 골절을 놓치지 않는데 도움이 된다.

Keywords

References

  1. Patten RM, Gunberg SR, Brandenburger DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology 2000;215:831-834
  2. Miller CD, Blyth P, Civil ID. Lumbar transverse process fractures--a sentinel marker of abdominal organ injuries. Injury 2000;31:773-776
  3. Flanders AE, Schaefer DM, Doan HT, Mishkin MM, Gonzalez CF, Northrup BE. Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit. Radiology 1990;177:25-33
  4. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817-831
  5. Krueger MA, Green DA, Hoyt D, Garfin SR. Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop Relat Res 1996;327:191-195
  6. Tucker C. The mechanics of sports injuries: an osteopathic approach. 2nd ed. Oxford: Blackwell Scientific Publications;1990
  7. Bali K, Kumar V, Krishnan V, Meena D, Rawall S. Multiple lumbar transverse process stress fractures as a cause of chronic low back ache in a young fast bowler - a case report. Sports Med Arthrosc Rehabil Ther Technol 2011;3:8
  8. Rogers LF. Radiology of skeletal trauma. 2nd ed. New York: Churchill Livingstone;1992. p.564.
  9. May DA, Disler DG, Jones EA, Balkissoon AA, Manaster BJ. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls. Radiographics 2000;20 Supple 1:S295-S315
  10. Berry GE, Adams S, Harris MB, Boles CA, McKernan MG, Collinson F, et al. Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. J Trauma 2005;59:1410-1413; discussion 1413
  11. Martina Udovicic, Ksenija Bazdaric, Lidija Bilic-Zulle, Mladen Petrovecki. What we need to know when calculating the coefficient of correlation? Biochemia Medica 2007;17:10-15
  12. Researchers at the University of Alabama. Spinal cord lnjury statistics. Available at: www.sci-info-pages.com/factsheets. html, Accessed on May 22, 2008
  13. Gamanagatti S, Rathinam D, Rangarajan K, Kumar A, Farooque K, Sharma V. Imaging evaluation of traumatic thoracolumbar spine injuries: radiological review. World J Radiol 2015;7:253-265
  14. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 2013;38:2028-2037
  15. Looby S, Flanders A. Spine Trauma. Radiol Clin N Am 2011; 49:129-163
  16. Kwon JA, Hwang JY, Kim MJ, Kwon HY, Kim DH. Importance of Bone marrow and soft tissue edema to improve the diagnostic accuracy of lumbosacral MRI for transverse process fractures and sacral fractures. J Korean Soc Radiol 2018;78:107-114