Cervical spine degenerative disease: a comparative study between computed tomography and magnetic resonance imaging findings Poster No.: C-2517 Congress: ECR 2012 Type: Scientific Paper Authors: M. Papavasilopoulou, A. Marinos, K. SPANAKIS, P. Maidas, E. Magkanas, A. Karantanas; Iraklion/GR Keywords: DOI: Musculoskeletal spine, Musculoskeletal joint, Musculoskeletal bone, CT, MR, Comparative studies, Hernia 10.1594/ecr2012/C-2517 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 14
Purpose Based upon the observation that reports of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) concerning degenerative changes of the cervical spine (pathology at Luschka, Facets and intervertebral discs) of the same patient are often dissimilar, we tried to investigate the nature of these differences with both methods. Page 2 of 14
Methods and Materials We retrospectively evaluated the exams of 27 patients above 50-years-old. The time difference between CT and MRI was less than 6 months. For each method and individual intervertebral spaces, one independent reader (resident) rated the pathology of the Facets, Luschka and intervertebral disks. Pathology at Facet joints was listed as sclerosis (1), moderate osteophytes with mild foraminal stenosis (2) and severe osteophytes-severe stenosis (3). Pathology indicated by the two methods at Luskha joints was listed as mild foraminal stenosis (1), moderate foraminal stenosis (2) and severe- complete foraminal stenosis (3). The type of intervertebral disc herniation was listed as posterior central, RT/LT paracentral and foraminal. The rating used for characterization of the degree of disc herniation involved mild imprinting of the thecal sac (1), complete effacement of the subarachnoid space (2) and pressure on the spinal cord (3) (figure 1). 43 parameters (5,3%) were excluded as non diagnostic (trauma patients - artefacts ). In total, 767 parameters were studied and rated. Page 3 of 14
Images for this section: Fig. 1: The form used by the independent readers for registering the imaging findings Page 4 of 14
Results The first assessment, indicated 365 differences between the two methods (46.7%). A specialized musculoskeletal Radiologist with 25 years of experience on the field, reviewed the parameters under debate and the differences were reduced by 19.6% down to 215 (28%). Pseudohernia at the C2-C3 intervertebral disk was only noticed with CT and rated as central 1 in 12 patients (44.4%), while MR in the same patients depicted normal intervertebral disc (figure 2). In 79 cases (10.3%), MRI depicted pathology not indicated by CT or rated the pathology with higher score. The difference in the sensitivity of MR imaging findings concerned 14 facets, 45 Luschka (56%)(figures 3, 5, 6,7) and 20 intervertebral disc hernias (figure 8). In 106 parameters (13.8%), CT depicted higher rate of pathology in 68 facets (figures 4, 9), 22 Luschka and 16 hernias (figure 5). MR images were not able to depict traumatic changes indicated by CT (figure 10). In the absence of pathology, the two methods showed identical findings in 151 parameters, most of them in C2-C3 intervertebral space. Page 5 of 14
Images for this section: Fig. 2: pseudohernia at C2-C3, was only depicted by CT-no hernia indicated in MR images Page 6 of 14
Fig. 3: Rrating of Luschka pathology bilateral by two methods. CT rates pathology with 2 (moderate foraminal stenosis) while MR rates it with 3 (severe - complete foraminal stenosis) Fig. 4: CT rates Facet pathology bilateral with 2 (moderate osteophytes-mild foraminal stenosis). MR rates them with 1 (sclerosis) Page 7 of 14
Fig. 5: Rating of the C3-C4 and C4-C5 hernias on CT as posterior central 2 (complete effacement of the subarachnoid space) Fig. 6: Same patient as in figure 5, Rating on MR. Images at the level of C3-C4 and C4- C5. Hernia was rated as central 3 (pressure on spinal cord) on C3-C4 and as central 1 (mild imprinting of the thecal sac) on C4-C5. Luschka pathology at C3-C4 was listed as RT 1 (mild foraminal stenosis) and LT 2 (moderate foraminal stenosis). In total, higher rated pathology at C3-C4 compared to previous (figure 5) and following (figure 7) images showing the same patient's CT. Page 8 of 14
Fig. 7: Same patient.c3-c4,ct-bone window. Rating of the pathology at Luschka.RT:0 (normal foramen) LT: 1 (mild foraminal stenosis). Page 9 of 14
Fig. 8: No disc herniation was indicated by CT, while MRI depicts a central 3 (pressure on the spinal cord) hernia. Page 10 of 14
Fig. 9: Rating of Facet pathology with 2 (moderate osteophytes-mild foraminal stenosis) based on CT images and with 1 (sclerosis) based on MR images Fig. 10: Trauma not indicated by MR image Page 11 of 14
Conclusion Regarding cervical spine degenerative disease, CT and MRI often illustrate different types of pathology. This study showed higher rates of recognition of pathology at the Facets with CT and at Luscha with MRI. CT often discloses pseudohernia at the C2-C3 intervertebral space. The high rates of agreement between the two methods in the absence of pathology, indicate the high negative predictive value of CT and MRI, when they are both used to determine the presence of degenerative disease. Our results highlight the importance of careful clinical examination for proper interpretation of imaging findings. Page 12 of 14
References 1.Clinical usefulness of CT-myelogram comparing with the MRI in degenerative cervical spinal disorders: is CTM still useful for primary diagnostic tool?song KJ, Choi BW, Kim GH, Kim JR. J Spinal Disord Tech. 2009 Jul;22(5):353-7. 2.The Relationship between Disc Degeneration and Morphologic Changes in the Intervertebral Foramen of the Cervical Spine: A Cadaveric MRI and CT Study, Hong Moon Sohn, Jae Won You, and Jun Young Lee, J Korean Med Sci. 2004 February; 19(1): 101-106. 3.Imaging cervical myelo- and radiculopathy.roth C, Papanagiotou P, Krick C, Reith W, Grunwald IQ.Radiologe. 2006 Nov;46(11):993-1000 4.Review of existing grading systems for cervical or lumbar disc and facet joint degeneration.kettler A, Wilke HJ. Eur Spine J. 2006 Jun;15(6):705-18. Epub 2005 Sep 20. Page 13 of 14
Personal Information M.Papavasilopoulou,A.Marinos,K.Spanakis,P.Maidas,E.Magkanas, A.Karantanas. Department of Radiology,University Hospital of Iraklion, Stavrakia, Iraklion, Crete, Greece mail to :mariapapavasilopoulou@gmail.com Page 14 of 14