Article

Comparison of Magnetic Resonance Imaging and Computed Tomography in Predicting Facet Arthrosis in the Cervical Spine

Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA.
Spine (Impact Factor: 2.3). 02/2009; 34(1):65-8. DOI: 10.1097/BRS.0b013e3181919526
Source: PubMed

ABSTRACT

Retrospective review.
To determine the ability of magnetic resonance imaging (MRI) and computed tomography (CT) to predict the presence of cervical facet arthrosis.
In the Food and Drug Administration Investigational Device Exemption trials of cervical disc arthroplasty (CDA), the presence of facet arthrosis on CT was a contraindication to the insertion of a CDA. Most surgeons routinely obtain an MRI, but not necessarily a CT before performing surgery in the cervical spine. We sought to determine if the MRI alone is adequate to assess for the presence of facet arthrosis.
Three experienced spine surgeons retrospectively evaluated CT scans and MRIs of the same patients, obtained within 30 days of each other in a blinded, random fashion. Reviewers graded each of the MRI and CT scan as normal or abnormal on 3 separate occasions and if the facet was abnormal, each reviewer graded the degree of arthrosis. The radiologist's evaluation for each study was compared with our results.
Of 594 facets analyzed, 43.1% were categorized as normal on CT, and of those, MRI concordance was only 63.7% with moderate/substantial intermethod agreement. Furthermore, MRI was concordant only 15.9% of the time in patients with ankylosed facet joints on CT. CT inter-rater reliability showed substantial agreement for diagnoses of both normal and ankylosis and fair agreement for lesser degrees of facet arthrosis. MRI inter-rater reliability showed fair/moderate agreement in normal and ankylosed segments and only slight agreement with lesser degrees of facet arthrosis. CT intrarater reliability showed substantial agreement in normal or ankylosed joints, but only fair agreement for all other categories; MRI showed only fair agreement.
The ability of MRI to adequately determine the presence or amount of facet arthrosis is not reliable. Additionally, for abnormal facets, MRI was not reliable in adequately determining the degree of arthrosis. Our data suggest that computed tomography remains necessary in diagnosing facet arthrosis before CDA.

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    • "Thus, glands, muscles and other soft tissues should be contoured by referring to MRI. On the other hand, CT can more reliably indicate bone boundaries and joint structures [39]. Thus, the TMJ, middle/ inner ear and mandible, which are mainly defined by bone limit, could be contoured based on CT alone. "
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    ABSTRACT: To recommend contouring methods and atlas of organs at risk (OARs) for nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy, in order to help reach a consensus on interpretations of OARs delineation. Two to four contouring methods for the middle ear, inner ear, temporal lobe, parotid gland and spinal cord were identified via systematic literature review; their volumes and dosimetric parameters were compared in 41 patients. Areas under the receiver operating characteristic curves for temporal lobe contouring were compared in 21 patients with unilateral temporal lobe necrosis (TLN). Various contouring methods for the temporal lobe, middle ear, inner ear, parotid gland and spinal cord lead to different volumes and dosimetric parameters (P<0.05). For TLN, D1 of PRV was the most relevant dosimetric parameter and 64Gy was the critical point. We suggest contouring for the temporal lobe, middle ear, inner ear, parotid gland and spinal cord. A CT-MRI fusion atlas comprising 33 OARs was developed. Different dosimetric parameters may hinder the dosimetric research. The present recommendation and atlas, may help reach a consensus on subjective interpretation of OARs delineation to reduce inter-institutional differences in NPC patients.
    Full-text · Article · Apr 2014 · Radiotherapy and Oncology
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    • "Thus, glands, muscles and other soft tissues should be contoured by referring to MRI. On the other hand, CT can more reliably indicate bone boundaries and joint structures [39]. Thus, the TMJ, middle/ inner ear and mandible, which are mainly defined by bone limit, could be contoured based on CT alone. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and purpose To recommend contouring methods and atlas of organs at risk (OARs) for nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy, in order to help reach a consensus on interpretations of OARs delineation. Methods and materials Two to four contouring methods for the middle ear, inner ear, temporal lobe, parotid gland and spinal cord were identified via systematic literature review; their volumes and dosimetric parameters were compared in 41 patients. Areas under the receiver operating characteristic curves for temporal lobe contouring were compared in 21 patients with unilateral temporal lobe necrosis (TLN). Results Various contouring methods for the temporal lobe, middle ear, inner ear, parotid gland and spinal cord lead to different volumes and dosimetric parameters (P < 0.05). For TLN, D1 of PRV was the most relevant dosimetric parameter and 64 Gy was the critical point. We suggest contouring for the temporal lobe, middle ear, inner ear, parotid gland and spinal cord. A CT–MRI fusion atlas comprising 33 OARs was developed. Conclusions Different dosimetric parameters may hinder the dosimetric research. The present recommendation and atlas, may help reach a consensus on subjective interpretation of OARs delineation to reduce inter-institutional differences in NPC patients.
    Full-text · Article · Jan 2014
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    • "Some disagreement exists on the ability of radiologic imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), to diagnose facet joint disease and predict its response to diagnostic nerve blocks [2,6-8]. However some studies have reported that bone scintigraphy with single photon emission computed tomography (SPECT) has a high sensitivity and specificity in diagnosing facet joint disease [9-11]. "
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    ABSTRACT: Facet joint disease plays a major role in axial low-back pain. Few diagnostic tests and imaging methods for identifying this condition exist. Single photon emission computed tomography (SPECT) is reported that it has a high sensitivity and specificity in diagnosing facet disease. We prospectively evaluated the use of bone scintigraphy with SPECT for the identification of patients with low back pain who would benefit from medial branch block. SPECT was performed on 33 patients clinically suspected of facet joint disease. After SPECT, an ultrasound guided medial branch block was performed on all patients. On 28 SPECT-positive patients, medial branch block was performed based on the SPECT findings. On 5 negative patients, medial branch block was performed based on clinical findings. For one month, we evaluated the patients using the visual analogue scale (VAS) and Oswestry disability index. SigmaStat and paired t-tests were used to analyze patient data and compare results. Of the 33 patients, the ones who showed more than 50% reduction in VAS score were assigned 'responders'. SPECT positive patients showed a better response to medial branch blocks than negative patients, but no changes in the Oswestry disability index were seen. SPECT is a sensitive tool for the identification of facet joint disease and predicting the response to medial branch block.
    Full-text · Article · Jun 2011 · The Korean journal of pain
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