Three-dimensional turbo spin-echo sequence versus conventional two-dimensional turbo spin-echo sequences in the evaluation of lumbar intervertebral discs

Year 2018, , 366 - 373, 04.10.2018

Volkan Kızılgöz , Ali Kemal Sivrioğlu , Hasan Aydın , Sunay Sibel Karayol , Can Hakan Yıldırım Utku Menderes

https://doi.org/10.18621/eurj.354357

Abstract

Objective: The aim of this
study was to evaluate the efficacy of a three-dimensional (3D) turbo spin-echo
(TSE) sequence for determining lumbar disc protrusions, and to compare the
findings with those of conventional two-dimensional (2D) TSE sequences and
reveal the interobserver and intermethod agreements of both sequences.

Methods:
A total of 127 discs from 84 patients were evaluated by three
radiologists. Conventional 2D TSE images and 3D TSE images were independently
interpreted with regard to disc pathology and herniation zones and were scored
for the degree of spinal stenosis and lumbar neural foraminal stenosis by the
three reviewers. To evaluate the lumbar discs, areas of protrusion or extrusion
were classified. Interobserver and intermethod reliabilities were calculated
using Krippendorff’s alpha (Kα) test.

Results: Lumbar disc pathology
identification was similar between the 2D TSE and 3D TSE sequences.
Interobserver agreements were better for 3D TSE than 2D TSE in the evaluation
of disc hernias (Kα ratio; 0.965 vs. 0.944), herniation zones (Kα ratio; 0.894
vs. 0.847), and foraminal narrowing (Kα ratio; 0.965 vs. 0.924). Both 2D and 3D
TSE had 100% sensitivity for disc pathologies and spinal stenosis, 81%
sensitivity for herniation zones, and 92.5% sensitivity for foraminal stenosis
in only operated patients.

Conclusions: The 3D TSE sequence was
comparable to conventional magnetic resonance imaging (MRI) sequences in the
evaluation of lumbar disc herniation. This approach can be used in radiology
departments either alone or combined with routine MRI for lumbar disc hernias
as a diagnostic sequence and an approach to overcome problems. 

Keywords

Magnetic resonance imaging, spin echo imaging, intervertebral disc, spine

References

• [1] Blizzard DJ, Haims AH, Lischuk AW, Arunakul R, Hustedt JW, Grauer JN, et al. 3D-FSE isotropic MRI of the lumber spine novel application of an existing technology. J Spinal Disord Tech 2015;28:152-7.
• [2] Tins B, Cassar-Pullicino V, Haddaway M, Nachtrab U. Three-dimensional sampling perfection with application-optimised contrasts using a different flip angleevolutions sequence for routine imaging of the spine: preliminary experience. Br J Radiol 2012;85:e480-9.
• [3] Mahmutyazicioglu K, Ozdemir H, Savranlar A, Ozer T, Erdem O, Erdem Z, et al. Comparison of three-dimensional gradient echo, turbo spin echo and steady-state gradient echo sequences in axial MRI examination of the cervical spine. Tani Girisim Radyol 2003;9:432-8.
• [4] Baskaran V, Pereles FS, Russell EJ, Georganos SA, Shaibani A, Spero KA, et al. Myelographic MR imaging of the cervical spine with a 3D true fast imaging with steady-state precession technique: initial experience. Radiology 2003;227:585-92.
• [5] Meindl T, Wirth S, Weckbach S, Dietrich O, Reiser M, Schoenberg SO. Magnetic resonance imaging of the cervical spine: comparison of 2D T2-weighted turbo spin echo, 2D T2*weighted gradient recalled echo and 3D T2-weighted variable flip-angle turbo spin echo sequences. Eur Radiol 2009;19:713-21.
• [6] Held P, Fründ R, Seitz J, Nitz W, Haffke T, Hees H. Comparison of 2-D turbo spin echo and 3-D gradient echo sequences for the detection of the trigeminal nerve and branches anatomy. Eur J Radiol 2001;37:18-25.
• [7] Ramlı N, Cooper A, Jaspan T. High resolution CISS imaging of the spine. Br J Radiol 2001;74:862-73.
• [8] Murakami N, Matsushima T, Kuba H, Ikezaki K, Morioka T, Mihara F, et al. Combining steady-state constructive interference and diffusion-weighted magnetic resonance imaging in the surgical treatment of epidermoid tumours. Neurosurg Rev 1999;22:159-62.
• [9] Yousry I, Camelio S, Schmid UD, Horsfield MA, Wiesmann M, Brückmann H, et al. Visualization of cranial nerves 1-12: Value of 3D CISS and T2W FSE sequences. Eur Radiol 2000;10:1061-7.
• [10] Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994;331:69-73.
• [11] Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, et al. A practical MRI grading system for lumbar foraminal stenosis. Am J Roentgenol 2010;194:1095-8.
• [12] Aydin H, Kızılgöz V, Hekimoğlu B. Compared with the conventional MR imaging, do the constructive interference steady state sequence and diffusion weighted imaging aid in the diagnosis of lumbar disc hernias? Eurasian J Med. 2011;43:152-61.
• [13] Kijowski R, Davis KW, Woods MA, Lindstrom MJ, De Smet AA, Gold GE, et al. Knee joint: comprehensiveassessment with 3D isotropic resolution fast spin-echo MR imaging-diagnostic performance compared with that of conventionalMR imaging at 3.0T. Radiology 2009;252:486-95.
• [14] Busse RF, Brau AC, Vu A, Michelich CR, Bayram E, Kijowski R, et al. Effects of refocusing flip angle modulation and view ordering in 3D fast spin echo. Magn Reson Med 2008;60:640-9.
• [15] Yoon YC, Kim SS, Chung HW, Choe BK, Ahn JH. Diagnostic efficacy in kneeMRI comparing conventional technique and multiplanar reconstructionwith one-millimeter FSE PDW images. Acta Radiol 2007;48:869-74.
• [16] Busse RF, Hariharan H, Vu A, Brittain JH. Fast spin echo sequences withvery long echo trains: design of variable refocusing flip angleschedules and generation of clinical T-2 contrast. Magn Reson Med 2006;55:1030-7.
• [17] Kwon JW, Yoon YC, Choi SH. Three-dimensional isotropicT2-weighted cervical MRI at 3T: Comparison with two-dimensionalT2-weighted sequences. Clin Radiol 2012;67:106-13.
• [18] Meindl T, Wirth S, Weckbach S, Dietrich O, Reiser M, Schoenberg SO. Magnetic resonance imagingof the cervical spine: comparison of 2D T2-weighted turbo spinecho, 2D T2*weighted gradient-recalled echo and 3D T2-weightedvariable flip-angle turbo spin echo sequences. Eur Radiol 2009;19:713-21.
• [19] Grenier N, Gréselle JF,Douws C. MR imaging of foraminal and extraforaminal lumbar disk herniations. J Comput Assist Tomogr 1990;14:243-9.
• [20] Epstein NC, Epstein JA, Carras R, Hyman RA. Far lateral lumbar disc herniations and associated structural abnormalities: an evaluation in 60 patients of the comparative value of CT, MRI, and myelo-CT in diagnosis and management. Spine 1990;15:534-49.
• [21] Lejeune JP, Hladky JP, Cotton A, Vinchon M, Christiaens JL. Foraminal lumbar disc herniation: experience with 83 patients. Spine 1994;10:1905-8.
• [22] Lee S, Jee WH, Jung JY, Lee SY, Ryu KS, Ha KY. MRI of the lumbar spine: comparison of 3D isotropic turbo spin-echo SPACE sequence versus conventional 2D sequences at 3.0 T. Acta Radiol.2015;56:174-81.