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Spinal Neurosarcoidosis: Rapid MRI Assessment 2012

General Spine

Kenneth, L, Weiss, MD
Yichun, Lin, MA, Non ASSR Member
Achala, S, Vagal, Non ASSR Member
Jane, L, Weiss, BSN, Non ASSR Member
Elyse, E, Lower, Non ASSR Member
Robert, P, Baughman, MD, Non ASSR Member

Poster

Purpose

To study the frequency and distribution of spinal involvement in neurosarcoidosis patients detectable with a rapid fat-water separated MRI survey technique; and assess inter-rater reliability.

Methods & Materials

In this prospective, IRB and HIPAA compliant study, 31 Interstitial Lung Disease/Sarcoid Clinic patients receiving systemic therapy with known neurosarcoidosis and symptoms suggesting spinal disease, were imaged from 3/22/08 -9/23/09. After completing their contrast-enhanced clinical brain MRI, all received rapid Automated Spine Survey Iterative Scan Technique (ASSIST) imaging to include phase-based fat-water separation sequencing with 2D FSE IDEAL[1] (Fig 1a) and/or 3D SPGR DE[2] (Fig 1b); the latter performed in 25/31 patients required 42 sec total scan time. Five patients were scanned twice and one three times for a total of 37 investigational spine exams. All but one was scanned at 3.0 T, the sole exception, having a programmable shunt, was imaged at 1.5T. Two neuroradiologists independently reviewed all images, scoring the presence of sarcoid-consistent medullary, intradural, dural, epidural or vertebral involvement at the cervical, thoracic, and lumbar sacral levels. Where discordant, the scoring of the more senior reader was taken as the standard. Kappa analysis was performed to determine reproducibility (inter-rater agreement).

Results

Eight of 31 patients (26%) had sarcoid consistent spine lesions. Most of these patients (6/8) had multi-level (C, T, or LS) disease, including 8 cervical, 6 thoracic, and 3 lumbar-sacral. Steroid induced epidural lipomatosis was incidentally noted in one patient without evidence of spinal sarcoid. Inter-rater weighted kappas were good to excellent for the presence of a spinal abnormality ( .744 ), vertebral lesions (.941) , and intramedullary lesions (.839); with less agreement for the intradural, dural, and epidural categories.

Conclusion

Rapid post-contrast fat/water separated ASSIST detected spinal involvement, commonly multilevel, in approximately one fourth of our patients; with good to excellent inter-rater agreement in regards to the presence of a spinal abnormality and more specifically the presence of vertebral or intramedullary lesions. The technique may be a useful adjunct to routine brain scanning in neurosarcoidosis patients.

References/Financial Disclosures

[1] Weiss, KL, Sun D, Cornelius RS, Weiss JL. Iterative Decomposition of Water and Fat with Echo Asymmetric and Least-Squares Estimation (IDEAL) Automated Spine Survey Iterative Scan Technique (ASSIST). Magnetic Resonance Insights: 2008:1 1-6 [2] Weiss KL, Richards CR, Sun D, Weiss JL. Sub-minute Fat-Water Separated Dual Echo Automated Spine Survey Iterative Scan Technique (ASSIST DE). AJNR Am. J. Neuroradiol. 2009; 30:1840-1846 This work was presented in part at the ASNR 2010. I have proprietary interests in ASSIST technology.

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