Bel ağrısı hastalarında lumbosakral transisyonel vertebra saptanmasında lomber BT ve rutin lomber MRG sekanslarının karşılaştırılması ve MRG incelemelerinde koronal STIR sekansının değeri

Yıl 2025, Cilt: 18 Sayı: 4, 713 - 720, 01.10.2025

Ergin Sağtaş , Hakkı Peker

https://doi.org/10.31362/patd.1653029

Öz

Amaç: Bu çalışmanın amacı, koronal sekans kullanılmadan yapılan rutin lomber MRG incelemelerinde LSTV (lumbosakral transisyonel vertebra) ve alt tiplerinin saptanma oranlarını, bu konuda altın standart yöntem olan lomber BT ile karşılaştırmaktır.
Gereç ve yöntem: Bu retrospektif çalışmada, Şubat 2016 ile Nisan 2024 arasında kliniğe "bel ağrısı" nedeniyle başvuran ve hem lomber MRG hem de BT görüntüleri bulunan 1.560 hasta değerlendirildi. BT'de LSTV varyasyonu olan toplam 105 hasta belirlendi ve bu hastaların MRG görüntüleri, LSTV’nin tespiti, Castellvi sınıflamasına göre alt tip belirlenmesi, foraminal stenoz değerlendirilmesi ve varsa psödoartikülasyon düzeyindeki ödem tespiti için iki gözlemci tarafından bağımsız olarak incelendi.
Bulgular: 1,446 hastanın %9,16'sında LSTV saptanmıştır. Hastaların yaş ortalaması 60 olup, %72,4'ü kadın hastadır. MRG değerlendirmesinde 64 hastada (%61) LSTV saptandı. İki gözlemci arasında LSTV tespiti konusunda yüksek düzeyde uyum gözlenmiştir (κ=0,795, p<0,001); ancak alt tip sınıflandırmasında anlamlı uyumsuzluk bulunmuştur (κ=0,0, p=0,755). BT ve MRI sonuçları karşılaştırıldığında, MRG'nin LSTV tiplerini sınıflandırmadaki doğruluğu oldukça düşük kalmıştır (κ=0,192, p<0,001). Psödoartikulasyon seviyesinde ödem, her iki gözlemci tarafından benzer şekilde tespit edilmiştir (κ=0.9576, p<0,001). BT'de 20 hastada, MRG'de ise 16 hastada foraminal stenoz saptanmış olup gözlemciler arasında yüksek düzeyde uyum gözlenmiştir (κ=0,926, p<0,001).
Sonuç: Rutin MRG protokollerinde disk patolojilerine odaklanılması nedeniyle LSTV sıkça gözden kaçmaktadır. Koronal planda STIR sekansının eklenmesi, LSTV’nin saptanması ve bu düzeydeki inflamasyon ve stenozun erken dönemde fark edilmesi açısından önemlidir.

Anahtar Kelimeler

Lumbosakral transisyonel vertebra , manyetik rezonans görüntüleme , STIR , psödoartikülasyon , bel ağrısı

Comparison of lumbar CT and routine lumbar MRI sequences in detecting lumbosacral transitional vertebrae in patients with low back pain and the value of coronal STIR sequence on MRI

Öz

Purpose: This study aims to compare the detection rates of LSTV (lumbosacral transitional vertebrae) and its subtypes in routine lumbar MRI performed without a coronal sequence with those of lumbar spine CT, which is the gold-standard method in this regard.
Materials and methods: This retrospective study evaluated 1,560 patients who presented with "back pain" between February 2016 and April 2024 and had both lumbar MRI and CT images recorded. A total of 105 patients with LSTV on CT were identified, and two observers independently reviewed the MRI images of these patients for LSTV detection, Castellvi subtype classification, extraforaminal stenosis, and detection of edema at the pseudoarticular level.
Results: LSTV was identified in 9.16% of the 1.446 patients. The mean age of the patients was 60, and 72.4% were female. The MRI evaluation revealed LSTV in 64 patients (61%). A high level of agreement was observed between the observers for LSTV detection (κ=0.795, p<0.001); however, a significant discrepancy appeared in subtype classification (κ=0.0, p=0.755). When comparing CT and MRI results, the accuracy of MRI in classifying LSTV types remained low (κ=0.192, p<0.001). Both observers similarly detected edema at the pseudoarticulation level (κ=0.9576, p<0.001). Extraforaminal stenosis was identified in 20 patients on CT and 16 patients on MRI, with a high degree of agreement between the observers (κ=0.926, p<0.001).
Conclusion: LSTV is often overlooked in routine MRI protocols because the focus is on disc pathology. A coronal STIR sequence is essential for detecting LSTV and identifying inflammation and stenosis at this level.

Anahtar Kelimeler

Lumbosacral transitional vertebra , magnetic resonance imaging , STIR , pseudoarticulation , back pain

Kaynakça

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