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Background: The reliability and diagnostic accuracy of commonly used diagnostic imaging modalities in the classification of lumbosacral transitional vertebrae (LSTV) are poorly known, and comparative studies are scarce., Purpose: To compare the diagnostic performance of conventional radiography (CR), computed tomography (CT), and magnetic resonance imaging (MRI) in classifying LSTVs., Material and Methods: In this retrospective cross-sectional study, a total of 852 patients undergoing lumbar imaging studies using all three modalities were initially assessed for the presence of LSTV using CT scans. In total, 100 patients with LSTV anatomy were identified. Four readers performed blinded and independent evaluations of these 100 patients on each modality, and an experienced fellowship-trained radiologist performed a gold standard read using all three modalities. Inter-reader reliability metrics were analyzed in comparison to the gold standard. Statistical software R (4.2.1) was used for the analyses., Results: We found superior diagnostic efficacy for CT: the sensitivity, specificity, accuracy, and balanced accuracy were 76%, 93%, 77%, and 84%, respectively. For MRI, the metrics were 54%, 88%, 56%, and 68%, and for CR 32%, 85%, 42%, and 59%, respectively. Inter-reader reliability was found to be good for CT (κ = 0.63-0.71) and fair for both CR (κ = 0.16-0.32) and MRI (κ = 0.24-0.56)., Conclusion: CT had the highest diagnostic performance in all measured metrics with good inter-reader reliability. MRI and CR showed fairly poor sensitivity and accuracy, and thus consideration should be used when classifying LSTVs with these two modalities., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

For this historical review, we searched a database containing all the articles published in Acta Radiologica during its 100-year history to find those on the use of information technology (IT) in radiology. After reading the full texts, we selected the presented articles according to major radiology IT domains such as teleradiology, picture archiving and communication systems, image processing, image analysis, and computer-aided diagnostics in order to describe the development as it appeared in the journal. Publications generally follow IT megatrends, but because the contents of Acta Radiologica are mainly clinically oriented, some technology achievements appear later than they do in journals discussing mainly imaging informatics topics.

Background Spinal disorders are a major public health problem. Appropriate diagnostic imaging is an essential part in the management of back complaints. Nevertheless, inappropriate imaging increases population collective dose and health costs without improving outcome. Purpose To determine the effects of active implementation of referral guidelines on the number and justification of spine radiography in primary care in one city. Material and Methods Specified guidelines for spine radiography were distributed to referring practitioners altogether three times during the study period. Educational lectures were provided before the guidelines were taken into use. The guidelines were also made available via the intranet. The number of spine radiography referrals during similar 6-month periods in the year preceding the interventions and the following 2 years was analyzed. Justification of 448 spine radiographs was assessed similarly. Results After interventions, the total number of spine radiography examinations decreased by 48% (P < 0.001) and that of cervical spine radiography by 46% ( P < 0.001), thoracic spine by 53% ( P < 0.001), and lumbar spine by 47% ( P < 0.001). The results persisted after 1-year follow-up. Before interventions, 24% of the cervical, 46% of the thoracic, and 32% of the lumbar spine radiography referrals were justified. After interventions, only justification of lumbar spine radiography improved significantly, 64% being justified ( P = 0.005). Conclusion Spine radiography in primary care can be reduced significantly by active referral guideline implementation. The proportion of inappropriate radiography was unexpectedly high. Thus, further education and studies concerning the appropriate use of spinal radiography seems to be needed.

Background: Recent studies indicate that diminished blood flow may cause low back symptoms and intervertebral disc degeneration., Purpose: To explore the association between lumbar arterial stenosis as detected by two-dimensional time-of-flight magnetic resonance angiography (2D TOF-MRA) and lumbar pain symptoms in an occupational cohort of middle-aged Finnish males., Material and Methods: 228 male subjects aged 36 to 55 years (mean 47 years) were imaged with 2D TOF-MRA. Additionally, 20 randomly selected subjects were scanned with contrast-enhanced MRA (ceMRA). In each subject, the first (L1) to fourth (L4) segmental lumbar arteries were evaluated for lumbar artery stenosis using a dichotomic scale. One subject was excluded because of poor image quality, reducing the study population to 227 subjects. Logistic regression analysis was used to evaluate the association between arterial stenosis in 2D TOF-MRA and low back pain and sciatica symptoms (intensity, duration, frequency)., Results: Comparing 2D TOF-MRA and ceMRA images, the kappa value (95% confidence interval) was 0.52 (0.31-0.73). The intraobserver reliability kappa value for 2D TOF-MRA was 0.85 (0.77-0.92), and interobserver kappa was 0.57 (0.49-0.65). The sensitivity of 2D TOF-MRA in detecting stenosis was 0.58, the accuracy 0.89, and the specificity 0.94. In 97 (43%) subjects all arteries were normal, whereas 130 (57%) had at least one stenosed artery. The left L4 artery was most often affected. The degree of arterial stenosis was associated with intensity of low back and sciatic pain, and sciatica pain duration during the past 3 months., Conclusion: 2D TOF-MRA is an acceptable imaging method for arterial stenosis compared to ceMRA. Arterial stenosis was associated with subjective pain symptoms, indicating a role of decreased nutrition in spinal disorders.

Background: Changes in T2 relaxation time (T2-TR) and apparent diffusion coefficients (ADC) have been suggested to appear in the intervertebral disc before morphological changes. Such sensitive imaging methods could be beneficial in the targeting and follow-up of intradiscal gene therapy., Purpose: To investigate the sensitivity of quantitative magnetic resonance (MR) imaging methods (T2-TR and ADC) in early disc degeneration, using an experimental porcine intervertebral disc injury model, and to investigate their sensitivity in depicting biochemically controlled degenerative changes in the disc., Material and Methods: Six juvenile pigs underwent experimental annular stab incisions, one superficial and one reaching the nucleus pulposus. The animals underwent repeated 1.5T MR imaging and were sacrificed 4 or 8 weeks after operation. Presence of degenerative changes was controlled with biochemical analysis., Results: Discs with full-thickness annular incisions lost 30% of their sagittal mid-slice nucleus pulposus area in 2 weeks (P<0.05). T2-TRs of the respective discs were on average 73% of the control discs (P<0.05). Discs with full-thickness annular lesions showed increased ADC values 4 weeks and reduced ADC values 8 weeks after the operation, compared to control discs (P<0.05). Biochemical analysis showed changes consistent with early degeneration., Conclusion: Early traumatic or degenerative changes are detectable with both T2-TR and ADC. The ADC in the early phase after experimental trauma seems to initially increase before decreasing.

Purpose: To evaluate the reliability of a structured 5-min evaluation of multidetector computed tomography (MDCT) images from the scanner's console in high-energy trauma patients., Material and Methods: Forty patients were scanned with four-slice MDCT using a standardized trauma protocol. Image evaluation covered the thorax, abdomen, and pelvis. The radiologist scrolled axial images on the scanner's console using three different window settings (lung, soft tissue, and bone) and performed a prospective structured evaluation of the traumatic lesions. The findings were compared to the final radiological diagnosis of the MDCT data made on a PACS workstation, the operative findings, and the clinical follow-up., Results: Evaluation from the scanner's console enabled the diagnosis of all potential life-threatening injuries, the sensitivity for all injuries being 60% and specificity 98%., Conclusion: A PACS workstation is needed for the final diagnosis of all injuries, but this rapid screening method can reliably detect all injuries that require instant care.

Purpose: To describe the in vivo appearance of magnetic resonance imaging (MRI) diskograms of normal and degenerated lumbar intervertebral disks, and to evaluate the differences in imaging findings between sequential diagnostic MRI and MRI diskography., Material and Methods: Nine consecutive patients underwent MRI-guided diskography in order to determine possible pain provocation during puncture and contrast medium injection. All patients had preceding clinical suspicion of lumbar diskogenic pain and findings of lumbar disk degeneration in diagnostic (MRI, computed tomography (CT), plain radiography). A 0.23T open MRI scanner with interventional tools was used for imaging and instrument guidance. On all patients, a complementary diagnostic MRI study of the lumbar spine before and after the MRI-guided disk injection was performed, and subsequent axial MRI diskograms were obtained., Results: A total of 25 disk punctures were initialized, and 25 MRI diskograms were obtained and their expression described. There was a correlation between the degenerative disk findings visualized by diagnostic MRI and MRI diskograms., Conclusion: The use of gadolinium contrast media in MRI-guided diskography enables the evaluation of MRI diskograms. Our results suggest that MRI-guided diskography can be used to substitute conventional diskography or CT-diskography and as an augmenting method to assess diagnostic information upon degenerative processes of the lumbar spine.

Magnetic resonance imaging (MRI) has emerged as a potential guidance tool for a variety of procedures. Diagnostic and therapeutic procedures using either open surgical or percutaneous access are performed. They span from simple lesion targeting and biopsy to complex applications requiring multiple tasks performed simultaneously or in rapid succession. These tasks include instrument guidance and therapy monitoring as well as procedural follow-up. The interventional use of MRI (IMRI) is increasing steadily. This article reviews the prerequisites, systems, and clinical interventional procedures of IMRI.