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Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools
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Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 44086

Special Issue Editors

Dr. Thomas Baum

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Guest Editor
Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
Interests: spine degenerative changes; finite element analysis; multiple myeloma; vertebral fracture; MDCT; water-fat imaging; whole spine; proton density fat fraction (PDFF); vertebral bone marrow fat; weight loss; magnetic resonance imaging (MRI); magnetic resonance spectroscopy (MRS); bone marrow fat fraction; osteoporosis
Special Issues, Collections and Topics in MDPI journals
Dr. Nico Sollmann

E-Mail Website
Co-Guest Editor
1. Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
2. Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Interests: neuroradiology; neuroimaging; spine imaging; body composition; paraspinal muscles; oncology; MRI; CT
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Imaging of the spine, including radiography, multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI), is one of the most frequently performed exams in clinical routine. This is due to the high prevalence of spinal disorders, e.g., degenerative spine disease, osteoporosis and associated vertebral fractures, traumatic injuries, and tumor diseases. Spine imaging plays a key role in diagnosis, therapy monitoring, and computer-assisted planning of surgical interventions in these disease entities.

The technical improvement of MDCT scanner hardware and the introduction of iterative image reconstruction in MDCT imaging allows a considerable reduction of radiation exposure for image acquisition. Furthermore, advanced analysis approaches, such as finite element analysis, can extract MDCT-based quantitative imaging biomarkers, e.g., for osteoporotic fracture risk prediction. Regarding MRI, considerable research effort has been undertaken to accelerate image acquisition. Furthermore, MRI-based quantitative imaging biomarkers such as the proton density fat fraction have emerged recently, furthering our understanding of the pathophysiological relationships of different anatomical compartments of the spine. Artificial intelligence (AI)-based algorithms may have the potential to assist the radiologist in diagnosis, as well as in automated segmentation of the spine and procedure planning of surgical interventions, in the near future.

In the light of these developments, this Special Issue welcomes original research and review articles. Specific topics of interest include investigations of the human spine ex and in vivo that demonstrate the following:

(I) Advances in image acquisition including radiography, dual-energy X-ray absorptiometry (DXA), multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI);

(II) Novel post-processing methods for image reconstruction or advanced analysis pipelines; and

(III) Advances in automated image segmentation and diagnostic support tools (particularly AI-based approaches).

Dr. Thomas Baum
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (8 papers)

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Editorial

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6 pages, 214 KiB  
Editorial
Editorial on Special Issue “Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools”
by Nico Sollmann and Thomas Baum
Diagnostics 2022, 12(6), 1361; https://doi.org/10.3390/diagnostics12061361 - 1 Jun 2022
Cited by 1 | Viewed by 1506
Abstract
Imaging of the spine, including radiography, computed tomography (CT), and magnetic resonance imaging (MRI), is frequently performed in clinical routine [...] Full article
(This article belongs to the Special Issue Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools)

Research

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13 pages, 1712 KiB  
Article
Proton Density Fat Fraction Spine MRI for Differentiation of Erosive Vertebral Endplate Degeneration and Infectious Spondylitis
by Frederic Carsten Schmeel, Asadeh Lakghomi, Nils Christian Lehnen, Robert Haase, Mohammed Banat, Johannes Wach, Nikolaus Handke, Hartmut Vatter, Alexander Radbruch, Ulrike Attenberger and Julian Alexander Luetkens
Diagnostics 2022, 12(1), 78; https://doi.org/10.3390/diagnostics12010078 - 30 Dec 2021
Cited by 5 | Viewed by 5266
Abstract
Vertebral Modic type 1 (MT1) degeneration may mimic infectious disease on conventional spine magnetic resonance imaging (MRI), potentially leading to additional costly and invasive investigations. This study evaluated the diagnostic performance of the proton density fat fraction (PDFF) for distinguishing MT1 degenerative endplate [...] Read more.
Vertebral Modic type 1 (MT1) degeneration may mimic infectious disease on conventional spine magnetic resonance imaging (MRI), potentially leading to additional costly and invasive investigations. This study evaluated the diagnostic performance of the proton density fat fraction (PDFF) for distinguishing MT1 degenerative endplate changes from infectious spondylitis. A total of 31 and 22 patients with equivocal diagnosis of MT1 degeneration and infectious spondylitis, respectively, were retrospectively enrolled in this IRB-approved retrospective study and examined with a chemical-shift encoding (CSE)-based water-fat 3D six-echo modified Dixon sequence in addition to routine clinical spine MRI. Diagnostic reference standard was established according to histopathology or clinical and imaging follow-up. Intravertebral PDFF [%] and PDFFratio (i.e., vertebral endplate PDFF/normal vertebrae PDFF) were calculated voxel-wise within the single most prominent edematous bone marrow lesion per patient and examined for differences between MT1 degeneration and infectious spondylitis. Mean PDFF and PDFFratio of infectious spondylitis were significantly lower compared to MT1 degenerative changes (mean PDFF, 4.28 ± 3.12% vs. 35.29 ± 17.15% [p < 0.001]; PDFFratio, 0.09 ± 0.06 vs. 0.67 ± 0.37 [p < 0.001]). The areas under the curve (AUC) and diagnostic accuracies were 0.977 (p < 0.001) and 98.1% (cut-off at 12.9%) for PDFF and 0.971 (p < 0.001) and 98.1% (cut-off at 0.27) for PDFFratio. Our data suggest that quantitative evaluation of vertebral PDFF can provide a high diagnostic accuracy for differentiating erosive MT1 endplate changes from infectious spondylitis. Full article
(This article belongs to the Special Issue Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools)
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10 pages, 764 KiB  
Article
Lumbar Stabilization with DSS-HPS® System: Radiological Outcomes and Correlation with Adjacent Segment Degeneration
by Andrea Angelini, Riccardo Baracco, Alberto Procura, Ugo Nena and Pietro Ruggieri
Diagnostics 2021, 11(10), 1891; https://doi.org/10.3390/diagnostics11101891 - 13 Oct 2021
Cited by 3 | Viewed by 2283
Abstract
Arthrodesis has always been considered the main treatment of degenerative lumbar disease. Adjacent segment degeneration is one of the major topics related to fusion surgery. Non-fusion surgery may prevent this because of the protective effect of persisting segmental motion. The aims of the [...] Read more.
Arthrodesis has always been considered the main treatment of degenerative lumbar disease. Adjacent segment degeneration is one of the major topics related to fusion surgery. Non-fusion surgery may prevent this because of the protective effect of persisting segmental motion. The aims of the study were (1) to describe the radiological outcomes in the adjacent vertebral segment after lumbar stabilization with DSS-HPS® system and (2) to verify the hypothesis that this system prevents the degeneration of the adjacent segment. This is a retrospective monocentric analysis of twenty-seven patients affected by degenerative lumbar disease underwent spinal hybrid stabilization with the DSS-HPS® system between January 2016 and January 2019. All patients completed 1-year radiological follow-up. Preoperative X-rays and magnetic resonance images, as well as postoperative radiographs at 1, 6 and 12 months, were evaluated by one single observer. Pre- and post-operative anterior and posterior disc height at the dynamic (DL) and adjacent level (AL) were measured; segmental angle (SA) of the dynamized level were measured. There was a statistically significant decrease of both anterior (p = 0.0003 for the DL, p = 0.036 for the AL) and posterior disc height (p = 0.00000 for the DL, p = 0.00032 for the AL); there were a statistically significant variations of the segmental angle (p = 0.00000). Eleven cases (40.7%) of radiological progression of disc degeneration were found. The DSS-HPS® system does not seem to reduce progression of lumbar disc degeneration in a radiologic evaluation, both in the dynamized and adjacent level. Full article
(This article belongs to the Special Issue Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools)
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12 pages, 1908 KiB  
Article
The Association of Lumbar Disc Herniation with Lumbar Volumetric Bone Mineral Density in a Cross-Sectional Chinese Study
by Jian Geng, Ling Wang, Qing Li, Pengju Huang, Yandong Liu, Glen M. Blake, Wei Tian and Xiaoguang Cheng
Diagnostics 2021, 11(6), 938; https://doi.org/10.3390/diagnostics11060938 - 24 May 2021
Cited by 12 | Viewed by 7756
Abstract
Little is known about the effect of lumbar intervertebral disc herniation (LDH) on lumbar bone mineral density (BMD), and few previous studies have used quantitative computed tomography (QCT) to assess whether the staging of LDH correlates with lumbar vertebral trabecular volumetric bone mineral [...] Read more.
Little is known about the effect of lumbar intervertebral disc herniation (LDH) on lumbar bone mineral density (BMD), and few previous studies have used quantitative computed tomography (QCT) to assess whether the staging of LDH correlates with lumbar vertebral trabecular volumetric bone mineral density (Trab.vBMD). To explore the relationship between lumbar Trab.vBMD and LDH, seven hundred and fifty-four healthy participants aged 20–60 years were enrolled in the study from an ongoing study on the degeneration of the spine and knee between June 2014 and 2017. QCT was used to measure L2–4 Trab.vBMD and lumbar spine magnetic resonance images (MRI) were performed to assess the incidence of disc herniation. After 9 exclusions, a total of 322 men and 423 women remained. The men and women were divided into younger (age 20–39 years) and older (age 40–60 years) groups and further into those without LDH, with a single LDH segment, and with ≥2 segments. Covariance analysis was used to adjust for the effects of age, BMI, waistline, and hipline on the relationship between Trab.vBMD and LDH. Forty-one younger men (25.0%) and 59 older men (37.3%) had at least one LDH segment. Amongst the women, the numbers were 46 (22.5%) and 80 (36.4%), respectively. Although there were differences in the characteristics data between men and women, the difference in Trab.vBMD between those without LDH and those with single and ≥2 segments was not statistically significant (p > 0.05). These results remained not statistically significant after further adjusting for covariates (p > 0.05). No associations between lumbar disc herniation and vertebral trabecular volumetric bone mineral density were observed in either men or women. Full article
(This article belongs to the Special Issue Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools)
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14 pages, 16222 KiB  
Article
Comparison of MRI Visualization Following Minimally Invasive and Open TLIF: A Retrospective Single-Center Study
by Vadim A. Byvaltsev, Andrei A. Kalinin, Morgan B. Giers, Valerii V. Shepelev, Yurii Ya. Pestryakov and Mikhail Yu. Biryuchkov
Diagnostics 2021, 11(5), 906; https://doi.org/10.3390/diagnostics11050906 - 19 May 2021
Cited by 8 | Viewed by 4703
Abstract
Analysis of magnetic resonance image (MRI) quality after open (Op)-transforaminal interbody fusion (TLIF) and minimally invasive (MI)-TLIF with the implantation of structurally different systems has not previously been performed. The objective of this study was to conduct a comparative analysis of the postoperative [...] Read more.
Analysis of magnetic resonance image (MRI) quality after open (Op)-transforaminal interbody fusion (TLIF) and minimally invasive (MI)-TLIF with the implantation of structurally different systems has not previously been performed. The objective of this study was to conduct a comparative analysis of the postoperative MRI following MI and Op one-segment TLIF. Material and Methods: The nonrandomized retrospective single-center study included 80 patients (46 men and 24 women) aged 48 + 14.2 years. In group I (n = 20) Op-TLIF with open transpedicular screw fixation (TSF) was performed, in II group (n = 60), the MI-TLIF technique was used: IIa (n = 20)—rigid interspinous stabilizer; IIb (n = 20)—unilateral TSF and contralateral facet fixation; IIc (n = 20)—bilateral TSF. Results: Comparison of the quality of postoperative imaging in IIa and IIb subgroups showed fewer MRI artifacts and a significantly greater MR deterioration after Op and MI TSF. Comparison of the multifidus muscle area showed less atrophy after MI-TLIF and significantly greater atrophy after Op-TLIF. Conclusion: MI-TLIF and Op-TLIF with TSF have comparable postoperative MR artifacts at the operative level, with a greater degree of muscle atrophy using the Op-TLIF. Rigid interspinous implant and unilateral TSF with contralateral facet fixation have less artifacts and changes in the multifidus muscle area. Full article
(This article belongs to the Special Issue Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools)
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16 pages, 2545 KiB  
Article
Detection of Degenerative Changes on MR Images of the Lumbar Spine with a Convolutional Neural Network: A Feasibility Study
by Nils Christian Lehnen, Robert Haase, Jennifer Faber, Theodor Rüber, Hartmut Vatter, Alexander Radbruch and Frederic Carsten Schmeel
Diagnostics 2021, 11(5), 902; https://doi.org/10.3390/diagnostics11050902 - 19 May 2021
Cited by 26 | Viewed by 7485
Abstract
Our objective was to evaluate the diagnostic performance of a convolutional neural network (CNN) trained on multiple MR imaging features of the lumbar spine, to detect a variety of different degenerative changes of the lumbar spine. One hundred and forty-six consecutive patients underwent [...] Read more.
Our objective was to evaluate the diagnostic performance of a convolutional neural network (CNN) trained on multiple MR imaging features of the lumbar spine, to detect a variety of different degenerative changes of the lumbar spine. One hundred and forty-six consecutive patients underwent routine clinical MRI of the lumbar spine including T2-weighted imaging and were retrospectively analyzed using a CNN for detection and labeling of vertebrae, disc segments, as well as presence of disc herniation, disc bulging, spinal canal stenosis, nerve root compression, and spondylolisthesis. The assessment of a radiologist served as the diagnostic reference standard. We assessed the CNN’s diagnostic accuracy and consistency using confusion matrices and McNemar’s test. In our data, 77 disc herniations (thereof 46 further classified as extrusions), 133 disc bulgings, 35 spinal canal stenoses, 59 nerve root compressions, and 20 segments with spondylolisthesis were present in a total of 888 lumbar spine segments. The CNN yielded a perfect accuracy score for intervertebral disc detection and labeling (100%), and moderate to high diagnostic accuracy for the detection of disc herniations (87%; 95% CI: 0.84, 0.89), extrusions (86%; 95% CI: 0.84, 0.89), bulgings (76%; 95% CI: 0.73, 0.78), spinal canal stenoses (98%; 95% CI: 0.97, 0.99), nerve root compressions (91%; 95% CI: 0.89, 0.92), and spondylolisthesis (87.61%; 95% CI: 85.26, 89.21), respectively. Our data suggest that automatic diagnosis of multiple different degenerative changes of the lumbar spine is feasible using a single comprehensive CNN. The CNN provides high diagnostic accuracy for intervertebral disc labeling and detection of clinically relevant degenerative changes such as spinal canal stenosis and disc extrusion of the lumbar spine. Full article
(This article belongs to the Special Issue Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools)
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14 pages, 1987 KiB  
Article
Texture Features of Proton Density Fat Fraction Maps from Chemical Shift Encoding-Based MRI Predict Paraspinal Muscle Strength
by Michael Dieckmeyer, Stephanie Inhuber, Sarah Schlaeger, Dominik Weidlich, Muthu Rama Krishnan Mookiah, Karupppasamy Subburaj, Egon Burian, Nico Sollmann, Jan S. Kirschke, Dimitrios C. Karampinos and Thomas Baum
Diagnostics 2021, 11(2), 239; https://doi.org/10.3390/diagnostics11020239 - 4 Feb 2021
Cited by 11 | Viewed by 2803
Abstract
Texture analysis (TA) has shown promise as a surrogate marker for tissue structure, based on conventional and quantitative MRI sequences. Chemical-shift-encoding-based MRI (CSE-MRI)-derived proton density fat fraction (PDFF) of paraspinal muscles has been associated with various medical conditions including lumbar back pain (LBP) [...] Read more.
Texture analysis (TA) has shown promise as a surrogate marker for tissue structure, based on conventional and quantitative MRI sequences. Chemical-shift-encoding-based MRI (CSE-MRI)-derived proton density fat fraction (PDFF) of paraspinal muscles has been associated with various medical conditions including lumbar back pain (LBP) and neuromuscular diseases (NMD). Its application has been shown to improve the prediction of paraspinal muscle strength beyond muscle volume. Since mean PDFF values do not fully reflect muscle tissue structure, the purpose of our study was to investigate PDFF-based TA of paraspinal muscles as a predictor of muscle strength, as compared to mean PDFF. We performed 3T-MRI of the lumbar spine in 26 healthy subjects (age = 30 ± 6 years; 15 females) using a six-echo 3D spoiled gradient echo sequence for chemical-shift-encoding-based water–fat separation. Erector spinae (ES) and psoas (PS) muscles were segmented bilaterally from level L2–L5 to extract mean PDFF and texture features. Muscle flexion and extension strength was measured with an isokinetic dynamometer. Out of the eleven texture features extracted for each muscle, Kurtosis(global) of ES showed the highest significant correlation (r = 0.59, p = 0.001) with extension strength and Variance(global) of PS showed the highest significant correlation (r = 0.63, p = 0.001) with flexion strength. Using multivariate linear regression models, Kurtosis(global) of ES and BMI were identified as significant predictors of extension strength (R2adj = 0.42; p < 0.001), and Variance(global) and Skewness(global) of PS were identified as significant predictors of flexion strength (R2adj = 0.59; p = 0.001), while mean PDFF was not identified as a significant predictor. TA of CSE-MRI-based PDFF maps improves the prediction of paraspinal muscle strength beyond mean PDFF, potentially reflecting the ability to quantify the pattern of muscular fat infiltration. In the future, this may help to improve the pathophysiological understanding, diagnosis, monitoring and treatment evaluation of diseases with paraspinal muscle involvement, e.g., NMD and LBP. Full article
(This article belongs to the Special Issue Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools)
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Review

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15 pages, 1979 KiB  
Review
Novel Magnetic Resonance Imaging Tools for the Diagnosis of Degenerative Disc Disease: A Narrative Review
by Carlo A. Mallio, Gianluca Vadalà, Fabrizio Russo, Caterina Bernetti, Luca Ambrosio, Bruno Beomonte Zobel, Carlo C. Quattrocchi, Rocco Papalia and Vincenzo Denaro
Diagnostics 2022, 12(2), 420; https://doi.org/10.3390/diagnostics12020420 - 6 Feb 2022
Cited by 20 | Viewed by 10506
Abstract
Low back pain (LBP) is one of the leading causes of disability worldwide, with a significant socioeconomic burden on healthcare systems. It is mainly caused by degenerative disc disease (DDD), a progressive, chronic, and age-related process. With its capacity to accurately characterize intervertebral [...] Read more.
Low back pain (LBP) is one of the leading causes of disability worldwide, with a significant socioeconomic burden on healthcare systems. It is mainly caused by degenerative disc disease (DDD), a progressive, chronic, and age-related process. With its capacity to accurately characterize intervertebral disc (IVD) and spinal morphology, magnetic resonance imaging (MRI) has been established as one of the most valuable tools in diagnosing DDD. However, existing technology cannot detect subtle changes in IVD tissue composition and cell metabolism. In this review, we summarized the state of the art regarding innovative quantitative MRI modalities that have shown the capacity to discriminate and quantify changes in matrix composition and integrity, as well as biomechanical changes in the early stages of DDD. Validation and implementation of this new technology in the clinical setting will allow for an early diagnosis of DDD and ideally guide conservative and regenerative treatments that may prevent the progression of the degenerative process rather than intervene at the latest stages of the disease. Full article
(This article belongs to the Special Issue Spine Imaging: Novel Image Acquisition Techniques and Analysis Tools)
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