MR Imaging of Lumbar Spondylolysis: Signal Intensity Change in the Pars Interarticularis and Adjacent Structures

Jang, Suk Whan; Lee, Ghi Jai; Shim, Jae Chan; Kim, Ho Kyun

Abstract

PURPOSE: To assess changes in MR signal intensity in the pars interarticularis and adjacent structures in pa-tients with lumbar spondylolysis.
MATERIALS AND METHODS
The MR images of 36 patients with lumbar spondylolysis, confirmed by plain radiographs, were retrospectively analyzed. Using a 1.0T unit, we evaluated the signal intensity of a total of 216 parts interarticulares and adjacent structures from L3 to L5, as seen on sagittal images, and differences between areas with and without spondylolysis. The signal intensity of T1-and T2-weighted images was graded 0 (more hypointense than spinal body), 1(as isointense as spinal body), 2(more hyperintense than spinal body and more hypointense than epidural fat), or 3(as isointense as epidural fat). Signal intensity change in end-plates and degree of spondylolisthesis were analyzed, and the relationship between these factors was deter-mined.
RESULTS
Spondylolysis was noted at L5 in 61 cases, at L4 in 22, and of L3 in no case. In three cases spondylolysis was unilateral, and in the remainder it was bilateral. The degree of signal intensity was the same on T1- and T2-weighted images, and no case was grade 0. Eighty-six of 133 areas without spondylolysis were grade 1, 43 were grade 2, and four were grade 3. In 42 of 47 cases, signal intensity change was localized at pedicles. Among 83 areas with spondylolysis, on the other hand, nine were grade 1, 48 were grade 2, and 26 were grade 3. Signal intensity change was most commonly observed at the pars interarticularis, pedicle, and lamina (50/74) (p<0.001). Signal intensity change at the pars interarticularis and adjacent structures was accompanied in most cases by degenerative endplate change(10/11) and spondylolisthesis(11/13) (p<0.001).
CONCLUSION
In patients with spondylolysis, signal intensity was frequently higher at the pars interarticularis and adjacent structures, and is thought to have a close relationship with degenerative endplate change and spondylolisthesis. Increases in signal intensity at the pars interarticularis and adjacent structures can help diagnose spondylolysis in patients without spondylolisthesis.