General Spine

Sedat, Alibek, M.D.
Hubertus, Gloger, M.D., Non ASSR Member

Paper/Non-Mentor

Purpose

To study the value of a 3D T2w MR sequence in comparison to conventional 2D T2w sequences within a routine cervical and lumbar spine MR protocol with special focus on detectability of pathology (e.g. disc herniation, neuroforaminal or spinal stenosis) and scan time.

Methods & Materials

Istitutional review board apporval was obtained. A total of 30 patients (15 cervial, 15 lumbar spine MRIs) were examined with a routine sequence protocol approved by local medical authorities. The cervical spine protocol consisted of a sagittal T2w and T1w sequence (FOV 25×25 cm, Matrix 256×256, Slice Thickness: 3 mm, Gap: 0,3 mm), transverse T2w sequence and a coronal T2 STIR sequence (FOV 20×18 cm, Matrix 288×224, Slice thickness: 3 mm, GAP: 0,3 mm). The lumbar spine protocol consisted of a sagittal T2w, T1w and coronal T2 STIR sequence (FOV 30×30 cm, Matrix 512×256, Slice Thickness: 4 mm, Gap: 0.4 mm), and a transverse T2w sequence (FOV 24×24 cm, Matrix 384×256, Slice thickness: 4 mm, Gap: 0.4 mm). An additional 3D T2w sequence (CUBE: FOV 300×270 mm, Slice thickness 1,0 mm, Matrix 288×288) in sagittal orientation was used in all patients for study purposes. Two radiologists who were blinded for patient´s history retrospectively reviewed the images and compared detectability of pathologies in consensus. All 2D sequences were reviewed on a 2D DICOM viewer, 3D CUBE sequence was reviewed interactively on a 3D DICOM viewer.

Results

In all patients all MR sequences were performed succesfully and without significant motion artefacts. 3D CUBE sequence was equal in detection of all pathologies seen with conventional T2w/T1w sequences in routine protocols. Cervical spine: in 66,7% (n=10) of patients protrusion of a disc was depicted in the cervical spine. Disc extrusion, stenosis of unilateral neuroforamen, syrinx and dorsla displacement of anterior dura was seen in 6,7% (n=1) of patients. Lumbar spine: in 40% (n=6) of patients protrusion of a disc was depicted in the lumbar spine. Disc extrusion was seen in 26.7% (n=4), stenosis of unilateral neuroforamen was seen in 6,7% (n=1) of patients.
Total imaging time for conventional MR seuqences ranged between 14-17 minutes, 3D CUBE took about 4,5 minutes.

Conclusion

3D CUBE MR sequence seems to be feasible for use within a routine cervical and lumbar scan protocol. Detection of pathology is equal to conventional MR sequences. Given that medical authorities (esp. local insurance companies) accepted the use of this sequence, e.g. T2w sagittal and transverse sequence could be replaced and exam time could be saved without penalty in image quality.