Korean J Radiol.  2019 Apr;20(4):641-648. 10.3348/kjr.2018.0632.

Coronal Three-Dimensional Magnetic Resonance Imaging for Improving Diagnostic Accuracy for Posterior Ligamentous Complex Disruption In a Goat Spine Injury Model

• Zhu X
• Wang J
• Zhou D
• Feng C
• Dong Z
• Yu H

• KMID: 2440487
• DOI: http://doi.org/10.3348/kjr.2018.0632

Abstract

OBJECTIVE
The purpose of this study was to investigate whether three-dimensional (3D) magnetic resonance imaging could improve diagnostic accuracy for suspected posterior ligamentous complex (PLC) disruption.
MATERIALS AND METHODS
We used 20 freshly harvested goat spine samples with 60 segments and intact surrounding soft tissue. The animals were aged 1-1.5 years and consisted of 8 males and 12 females, which were sexually mature but had not reached adult weights. We created a paraspinal contusion model by percutaneously injecting 10 mL saline into each side of the interspinous ligament (ISL). All segments underwent T2-weighted sagittal and coronal short inversion time inversion recovery (STIR) scans as well as coronal and sagittal 3D proton density-weighted spectrally selective inversion recovery (3D-PDW-SPIR) scans acquired at 1.5T. Following scanning, some ISLs were cut and then the segments were re-scanned using the same magnetic resonance (MR) techniques. Two radiologists independently assessed the MR images, and the reliability of ISL tear interpretation was assessed using the kappa coefficient. The chi-square test was used to compare the diagnostic accuracy of images obtained using the different MR techniques.
RESULTS
The interobserver reliability for detecting ISL disruption was high for all imaging techniques (0.776-0.949). The sensitivity, specificity, and diagnostic accuracy of the coronal 3D-PDW-SPIR technique for detecting ISL tears were 100, 96.9, and 97.9%, respectively, which were significantly higher than those of the sagittal STIR (p = 0.000), coronal STIR (p = 0.000), and sagittal 3D-PDW-SPIR (p = 0.001) techniques.
CONCLUSION
Compared to other MR methods, coronal 3D-PDW-SPIR provides a more accurate diagnosis of ISL disruption. Adding coronal 3D-PDW-SPIR to a routine MR protocol may help to identify PLC disruptions in cases with nearby contusion.

Keyword

Spine; Animal model; Trauma; MRI

MeSH Terms

Adult
Animals
Contusions
Diagnosis
Female
Goats*
Humans
Ligaments*
Magnetic Resonance Imaging*
Male
Models, Animal
Protons
Sensitivity and Specificity
Spine*
Tears
Weights and Measures
Protons

Figure

• 

  Fig. 1 Percutaneous ISL resection.Posteroanterior (A) and lateral (B) fluoroscopic views show metal crochet hook tip (white arrows) placed in anterior portion of interspinous space, which was identified between two adjacent spinous processes (stars). C. ISL was successfully cut out (black arrow) as shown in following dissection. ‘Stars’ in image C indicate spinous processes. ISL = interspinous ligament

• 

  Fig. 2 ISL injuries displayed using different magnetic resonance techniques.Coronal 3D-PDW-SPIR (A) and STIR (B) images show discontinuity of black stripe (i.e., ISL) and discrete fluid crossing ISL (black arrows) indicating ligamentous disruption. On sagittal 3D-PDW-SPIR (C, D) and STIR (E, F) images, area of linear high signal intensity in interspinous space suggests ISL disruption (white arrows), whereas areas of diffuse high signal intensity suggest adjacent soft tissue contusion (stars). STIR = short inversion time inversion recovery, 3D-PDW-SPIR = three-dimensional proton density-weighted spectrally selective inversion recovery

• 

  Fig. 3 Normal ISL appearance.Sagittal 3D-PDW-SPIR (A) and STIR (B) images display ISL as diffuse homogeneous low signal intensity (stars) with ill-defined border in interspinous space. On coronal 3D-PDW-SPIR (C) and STIR (D), ISL presents as black stripe (arrows) between spinous processes with well-defined border.

• 

  Fig. 4 Free fluid in facet joints in normal spinal specimen.Midline sagittal STIR image (A) depicts fluid (white arrow) within ISL communicating with facet joints (black arrows) shown on coronal 3D-PDW-SPIR image (B).

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