DOI QR코드

DOI QR Code

Evaluating Paraspinal Back Muscles Using Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): Reliability Analysis and Correlation with Intervertebral Disc Pathology

  • Hwang, Eunjin (Department of Radiology, Hallym University Dongtan Sacred Heart Hospital) ;
  • Antony, Chermaine Deepa (Department of Radiology, Hallym University Dongtan Sacred Heart Hospital) ;
  • Choi, Jung-Ah (Department of Radiology, Hallym University Dongtan Sacred Heart Hospital) ;
  • Kim, Minsu (Department of Radiology, Hallym University Dongtan Sacred Heart Hospital) ;
  • Khil, Eun Kyoung (Department of Radiology, Hallym University Dongtan Sacred Heart Hospital) ;
  • Choi, Il (Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital)
  • Received : 2021.01.26
  • Accepted : 2021.04.12
  • Published : 2021.06.30

Abstract

Purpose: To investigate the reliability of CT and MRI for quantitative and qualitative analyses of lumbar paraspinal muscle fatty infiltration (PSFI) and correlation of PSFI with intervertebral disc pathology. Materials and Methods: Lumbar spine CT and MRI of 36 subjects were reviewed retrospectively. Two observers independently outlined lumbar paraspinal muscles at each mid-intervertebral disc level. Paraspinal muscles on CT and MRI were graded according to the Goutallier grading system (GGS). The area, mean value, and standard deviation (SD) of the Hounsfield unit (HU) were obtained. Intervertebral discs were assessed on axial image of T2WI at each level. Correlations between qualitative and quantitative data and intervertebral disc pathology, age, and sex were evaluated. Results: Inter- and intra-observer agreements for results of GGS on MRI were substantial (κ = 0.79) and moderate (κ = 0.59), respectively. Inter- and intra-observer agreements for results of GGS on CT were almost perfect (κ = 0.88) and substantial (κ = 0.66), respectively. Quantitative measurements of HU showed almost perfect inter- and intra-observer reliabilities (κ = 0.82 and κ = 0.99, respectively). There were statistically significant correlations between intervertebral disc pathology and PSFI at L1-2, L2-3, and L4-5 levels on MRI and at L1-2 and L3-4 levels on CT. Age showed significant correlation with results of GGS at all levels on CT and MRI. Conclusion: This study showed that GGS results and HU measurements could be useful for evaluating PSFI because they showed correlations with intervertebral disc pathology results at certain levels.

Keywords

Acknowledgement

This study was supported by KSMRM and Korean Society of MSK MRI.

References

  1. Kim WH, Lee SH, Lee DY. Changes in the cross-sectional area of multifidus and psoas in unilateral sciatica caused by lumbar disc herniation. J Korean Neurosurg Soc 2011;50:201-204 https://doi.org/10.3340/jkns.2011.50.3.201
  2. Lonnemann ME, Paris SV, Gorniak GC. A morphological comparison of the human lumbar multifidus by chemical dissection. J Man Manip Ther 2008;16:E84-92 https://doi.org/10.1179/jmt.2008.16.4.84E
  3. Parkkola R, Kormano M. Lumbar disc and back muscle degeneration on MRI: correlation to age and body mass. J Spinal Disord 1992;5:86-92 https://doi.org/10.1097/00002517-199203000-00011
  4. Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine (Phila Pa 1976) 2004;29:E515-519 https://doi.org/10.1097/01.brs.0000144405.11661.eb
  5. Yong-Hing K, Kirkaldy-Willis WH. The pathophysiology of degenerative disease of the lumbar spine. Orthop Clin North Am 1983;14:491-504 https://doi.org/10.1016/S0030-5898(20)31329-8
  6. Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 2000;55:145-149 https://doi.org/10.1053/crad.1999.0340
  7. Crawford RJ, Volken T, Valentin S, Melloh M, Elliott JM. Rate of lumbar paravertebral muscle fat infiltration versus spinal degeneration in asymptomatic populations: an age-aggregated cross-sectional simulation study. Scoliosis Spinal Disord 2016;11:21 https://doi.org/10.1186/s13013-016-0080-0
  8. Crawford RJ, Elliott JM, Volken T. Change in fatty infiltration of lumbar multifidus, erector spinae, and psoas muscles in asymptomatic adults of Asian or Caucasian ethnicities. Eur Spine J 2017;26:3059-3067 https://doi.org/10.1007/s00586-017-5212-6
  9. Boutin RD, Yao L, Canter RJ, Lenchik L. Sarcopenia: current concepts and imaging implications. AJR Am J Roentgenol 2015;205:W255-266 https://doi.org/10.2214/AJR.15.14635
  10. Deng CY, Lin YC, Wu JS, et al. Progressive sarcopenia in patients with colorectal cancer predicts survival. AJR Am J Roentgenol 2018;210:526-532 https://doi.org/10.2214/AJR.17.18020
  11. Battaglia PJ, Maeda Y, Welk A, Hough B, Kettner N. Reliability of the Goutallier classification in quantifying muscle fatty degeneration in the lumbar multifidus using magnetic resonance imaging. J Manipulative Physiol Ther 2014;37:190-197 https://doi.org/10.1016/j.jmpt.2013.12.010
  12. Keller A, Gunderson R, Reikeras O, Brox JI. Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine (Phila Pa 1976) 2003;28:1455-1460 https://doi.org/10.1097/01.BRS.0000067094.55003.AD
  13. Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg 2018;126:1763-1768 https://doi.org/10.1213/ane.0000000000002864
  14. Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968;70:213-220 https://doi.org/10.1037/h0026256
  15. Bierry G, Kremer S, Kellner F, Abu Eid M, Bogorin A, Dietemann JL. Disorders of paravertebral lumbar muscles: from pathology to cross-sectional imaging. Skeletal Radiol 2008;37:967-977 https://doi.org/10.1007/s00256-008-0494-8
  16. Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol 2011;84:709-713 https://doi.org/10.1259/bjr/58136533
  17. Kalichman L, Klindukhov A, Li L, Linov L. Indices of paraspinal muscles degeneration: reliability and association with facet joint osteoarthritis: feasibility study. Clin Spine Surg 2016;29:465-470 https://doi.org/10.1097/BSD.0b013e31828be943
  18. Sun D, Liu P, Cheng J, Ma Z, Liu J, Qin T. Correlation between intervertebral disc degeneration, paraspinal muscle atrophy, and lumbar facet joints degeneration in patients with lumbar disc herniation. BMC Musculoskelet Disord 2017;18:167 https://doi.org/10.1186/s12891-017-1522-4
  19. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 2000;9:266-272 https://doi.org/10.1007/s005860000190
  20. Storheim K, Holm I, Gunderson R, Brox JI, Bo K. The effect of comprehensive group training on cross-sectional area, density, and strength of paraspinal muscles in patients sick-listed for subacute low back pain. J Spinal Disord Tech 2003;16:271-279 https://doi.org/10.1097/00024720-200306000-00008
  21. Kalichman L, Hodges P, Li L, Guermazi A, Hunter DJ. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J 2010;19:1136-1144 https://doi.org/10.1007/s00586-009-1257-5
  22. Bulcke JA, Termote JL, Palmers Y, Crolla D. Computed tomography of the human skeletal muscular system. Neuroradiology 1979;17:127-136 https://doi.org/10.1007/BF00339869
  23. Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976) 1993;18:830-836 https://doi.org/10.1097/00007632-199306000-00004
  24. Mengiardi B, Schmid MR, Boos N, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology 2006;240:786-792 https://doi.org/10.1148/radiol.2403050820