Cargando…

Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine

BACKGROUND: Magnetic Resonance Imaging (MRI) is commonly used to assess the health of the lumbar spine and supporting structures. Studies have suggested that fatty infiltration of the posterior lumbar muscles is important in predicting responses to treatment for low back pain. However, methodologica...

Descripción completa

Detalles Bibliográficos
Autores principales: Berry, David B., Padwal, Jennifer, Johnson, Seth, Parra, Callan L., Ward, Samuel R., Shahidi, Bahar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938809/
https://www.ncbi.nlm.nih.gov/pubmed/29734942
http://dx.doi.org/10.1186/s12891-018-2059-x
_version_ 1783320850769903616
author Berry, David B.
Padwal, Jennifer
Johnson, Seth
Parra, Callan L.
Ward, Samuel R.
Shahidi, Bahar
author_facet Berry, David B.
Padwal, Jennifer
Johnson, Seth
Parra, Callan L.
Ward, Samuel R.
Shahidi, Bahar
author_sort Berry, David B.
collection PubMed
description BACKGROUND: Magnetic Resonance Imaging (MRI) is commonly used to assess the health of the lumbar spine and supporting structures. Studies have suggested that fatty infiltration of the posterior lumbar muscles is important in predicting responses to treatment for low back pain. However, methodological differences exist in defining the region of interest (ROI) of a muscle, which limits the ability to compare data between studies. The purpose of this study was to determine reliability and systematic differences within and between two commonly utilized methodologies for ROI definitions of lumbar paraspinal muscle. METHODS: T2-weighted MRIs of the mid-L4 vertebrae from 37 patients with low back pain who were scheduled for lumbar spine surgery were included from a hospital database. Fatty infiltration for these patients ranged from low to high, based on Kjaer criteria. Two methods were used to define ROI: 1) segmentation of the multifidus and erector spinae based on fascial planes including epimuscular fat, and 2) segmentation of the multifidus and erector spinae based on visible muscle boundaries, which did not include epimuscular fat. Total cross sectional area (tCSA), fat signal fraction (FSF), muscle cross sectional area, and fat cross sectional area were measured. Degree of agreement between raters for each parameter was assessed using intra-class correlation coefficients (ICC) and area fraction of overlapping voxels. RESULTS: Excellent inter-rater agreement (ICC > 0.75) was observed for all measures for both methods. There was no significant difference between area fraction overlap of ROIs between methods. Method 1 demonstrated a greater tCSA for both the erector spinae (14–15%, p < 0.001) and multifidus (4%, p < 0.016) but a greater FSF only for the erector spinae (11–13%, p < 0.001). CONCLUSION: The two methods of defining lumbar spine muscle ROIs demonstrated excellent inter-rater reliability, although significant differences exist as method 1 showed larger CSA and FSF values compared to method 2. The results of this study confirm the validity of using either method to measure lumbar paraspinal musculature, and that method should be selected based on the primary outcome variables of interest.
format Online
Article
Text
id pubmed-5938809
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-59388092018-05-11 Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine Berry, David B. Padwal, Jennifer Johnson, Seth Parra, Callan L. Ward, Samuel R. Shahidi, Bahar BMC Musculoskelet Disord Research Article BACKGROUND: Magnetic Resonance Imaging (MRI) is commonly used to assess the health of the lumbar spine and supporting structures. Studies have suggested that fatty infiltration of the posterior lumbar muscles is important in predicting responses to treatment for low back pain. However, methodological differences exist in defining the region of interest (ROI) of a muscle, which limits the ability to compare data between studies. The purpose of this study was to determine reliability and systematic differences within and between two commonly utilized methodologies for ROI definitions of lumbar paraspinal muscle. METHODS: T2-weighted MRIs of the mid-L4 vertebrae from 37 patients with low back pain who were scheduled for lumbar spine surgery were included from a hospital database. Fatty infiltration for these patients ranged from low to high, based on Kjaer criteria. Two methods were used to define ROI: 1) segmentation of the multifidus and erector spinae based on fascial planes including epimuscular fat, and 2) segmentation of the multifidus and erector spinae based on visible muscle boundaries, which did not include epimuscular fat. Total cross sectional area (tCSA), fat signal fraction (FSF), muscle cross sectional area, and fat cross sectional area were measured. Degree of agreement between raters for each parameter was assessed using intra-class correlation coefficients (ICC) and area fraction of overlapping voxels. RESULTS: Excellent inter-rater agreement (ICC > 0.75) was observed for all measures for both methods. There was no significant difference between area fraction overlap of ROIs between methods. Method 1 demonstrated a greater tCSA for both the erector spinae (14–15%, p < 0.001) and multifidus (4%, p < 0.016) but a greater FSF only for the erector spinae (11–13%, p < 0.001). CONCLUSION: The two methods of defining lumbar spine muscle ROIs demonstrated excellent inter-rater reliability, although significant differences exist as method 1 showed larger CSA and FSF values compared to method 2. The results of this study confirm the validity of using either method to measure lumbar paraspinal musculature, and that method should be selected based on the primary outcome variables of interest. BioMed Central 2018-05-07 /pmc/articles/PMC5938809/ /pubmed/29734942 http://dx.doi.org/10.1186/s12891-018-2059-x Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Berry, David B.
Padwal, Jennifer
Johnson, Seth
Parra, Callan L.
Ward, Samuel R.
Shahidi, Bahar
Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine
title Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine
title_full Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine
title_fullStr Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine
title_full_unstemmed Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine
title_short Methodological considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine
title_sort methodological considerations in region of interest definitions for paraspinal muscles in axial mris of the lumbar spine
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938809/
https://www.ncbi.nlm.nih.gov/pubmed/29734942
http://dx.doi.org/10.1186/s12891-018-2059-x
work_keys_str_mv AT berrydavidb methodologicalconsiderationsinregionofinterestdefinitionsforparaspinalmusclesinaxialmrisofthelumbarspine
AT padwaljennifer methodologicalconsiderationsinregionofinterestdefinitionsforparaspinalmusclesinaxialmrisofthelumbarspine
AT johnsonseth methodologicalconsiderationsinregionofinterestdefinitionsforparaspinalmusclesinaxialmrisofthelumbarspine
AT parracallanl methodologicalconsiderationsinregionofinterestdefinitionsforparaspinalmusclesinaxialmrisofthelumbarspine
AT wardsamuelr methodologicalconsiderationsinregionofinterestdefinitionsforparaspinalmusclesinaxialmrisofthelumbarspine
AT shahidibahar methodologicalconsiderationsinregionofinterestdefinitionsforparaspinalmusclesinaxialmrisofthelumbarspine