1. MRI-based lesion quality score assessing ossification of the posterior longitudinal ligament of the cervical spine.
- Author
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Hsiung, Wei, Lin, Han-Ying, Lin, Hsi-Hsien, Yao, Yu-Cheng, Wang, Shih-Tien, Chang, Ming-Chau, and Chou, Po-Hsin
- Subjects
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LONGITUDINAL ligaments , *CERVICAL vertebrae , *OSSIFICATION , *MAGNETIC resonance imaging , *RECEIVER operating characteristic curves , *NECK pain - Abstract
• The MRI diagnosis rate for cervical OPLL was inferior to CT scan. • A novel MR T1 & T2 LQ score provides objective value for diagnosing operated OPLL. • T1 LQ score correlated with Hounsfield Units. • The T1 LQ score achieved an AUC of 0.932 with an objective value of 0.467. No method currently exists for MRI-based determination of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine using objective criteria. The purpose of this study was to develop an MRI-based score to determine whether a lesion represents a cervical OPLL lesion and to establish the objective diagnostic value. Retrospective cohort in a single medical institution. Thirty-five patients undergoing surgery for OPLL (Group A) and 99 patients undergoing cervical disc arthroplasty for soft disc herniation (Group B) between 2011 and 2020 were retrospectively included. All OPLL lesions on unenhanced MRI scan were correlated with a corresponding CT scan. Demographics were comparable between the two groups. Using unenhanced magnetic resonance imaging (MRI), the T1- and T2- lesion quality (LQ) scores were calculated. Receiver operating characteristic (ROC) analysis was performed to calculate the area-under-the-curve (AUC) of both LQ scores as a predictor of the presence of OPLL. Computed tomography (CT)-based Hounsfield unit (HU) values of OPLL lesions were obtained and compared with both LQ scores. The LQ scores for MRI scanners from different manufacturers were compared using Student's t test to confirm the validity of the LQ score by scanner type. The regions of interest for signal intensity (SI) were defined as the darkest site of the lesion and the cerebrospinal fluid (CSF) at the cerebellomedullary cistern. The T1 and T2 LQ scores were measured as the ratio of the SI at the darkest site of the lesion divided by the SI of the CSF. The T1 and T2 LQ scores in Group A were significantly lower than those in Group B (p<.001). ROC analysis determined that T1 and T2 LQ scores of 0.46 and 0.07, respectively, could distinguish the presence of OPLL with an accuracy of 0.93 and 0.89, respectively (p<.001). When the T1 LQ score of the lesion is <0.46, a diagnosis of OPLL may be suspected with 100% sensitivity and 92.3% specificity. The HU of the lesion had a moderate negative correlation with the T1 LQ score (r=−0.665, p<.0001). Both LQ scores were unaffected by manufacturer type. This study found a correlation between the MRI-based T1 LQ scores and CT-based HU value for identifying OPLL lesions. Additional studies will be needed to validate that the T1 LQ score from the unenhanced MRI scan can identify cervical OPLL. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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