Real-time dynamic 3-T MRI assessment of spine kinematics: a feasibility study utilizing three different fast pulse sequences

Abstract

Background Half-Fourier acquisition single-shot turbo spin-echo (HASTE), continuous radial gradient-echo (GRE), and True FISP allow real-time dynamic assessment of the spine. Purpose To evaluate the feasibility of adding dynamic sequences to routine spine magnetic resonance imaging (MRI) for assessment of spondylolisthesis. Material and Methods Retrospective review was performed of patients referred for dynamic MRI of the cervical or lumbar spine between January 2017 and 2018 who had flexion-extension radiographs within two months of MRI. Exclusion criteria were: incomplete imaging; spinal hardware; and inability to tolerate dynamic examination. Blinded, independent review by two board-certified musculoskeletal radiologists was performed to assess for spondylolisthesis (>3 mm translation); consensus review of dynamic radiographs served as the gold standard. Cervical spinal cord effacement was assessed. Inter-reader agreement and radiographic concordance was calculated for each sequence. Results Twenty-one patients were included (8 men, 13 women; mean age 47.9 ± 16.5 years). Five had MRI of the cervical spine and 16 had MRI of the lumbar spine. Mean acquisition time was 18.4 ± 1.7 min with dynamic sequences in the range of 58–77 s. HASTE and True FISP had the highest inter-reader reproducibility (κ = 0.88). Reproducibility was better for the lumbar spine (κ = 0.94) than the cervical spine (κ = 0.28). Sensitivity of sequences for spondylolisthesis was in the range of 68.8%–78.6%. All three sequences had high accuracy levels: ≥90.5% averaged across the cervical and lumbar spine. Cervical cord effacement was observed during dynamic MRI in two cases (100% agreement). Conclusion Real-time dynamic MRI sequences added to spine MRI protocols provide reliable and accurate assessment of cervical and lumbar spine spondylolisthesis during flexion and extension.

Clinical feasibility of 2D dynamic sagittal HASTE flexion-extension imaging of the cervical spine for the assessment of spondylolisthesis and cervical cord impingement

“…Our dynamic images also had lower quality compared to the routine sequences although they were mainly diagnostic for the purpose of assessing listhesis or cord impingement in the cervical spine. In our experience, the 2D HASTE sequence produces better image quality when subjectively compared to other MRI techniques, including TrueFISP [8]. It may be that three very short sagittal sequences in maximum flexion, neutral, maximum extension may provide the same information with better resolution as compared to the CINE 2D HASTE, however one advantage of the dynamic sequence described herin is that the patient does not have to hold a given position, rather simply flex and extend as the sequence is acquired in real-time.…”

“…2D HASTE represents one of the oldest, most established and widely available sequences yet appears robust in the context of dynamic spine imaging. Indeed, the HASTE technique has been described in a range of dynamic clinical applications, yet with surprisingly little published with respect to kinematic imaging of the spine [8,13].…”

“…The HASTE sequence has demonstrated utility in a wide variety of clinical contexts: dynamic evaluation of temporomandibular disorders [4], phonation [5], dynamic bowel motility [6] and pelvic floor dysfunction [7]. The HASTE sequence has also recently been applied to the spine in comparison to TrueFISP and Gradient Recalled Echo sequence with radial K space sampling, specifically to assess for lumbar and cervical spondylolisthesis as well as for dynamic effacement of the cervical cord [8].…”

Comparison of prenatal ultrasonography and fetal MRI in diagnosing neural tube defects: A prospective observational study

“…In our study, ultrasonography showed a significantly higher diagnostic accordance rate for spina bifida, which could be attributed to its sensitivity to bones with strong high-echo signals. Although the true FISP sequence of fetal MRI could well image the spine, 17 the vertebrae with low signals seem indistinct among surrounding tissues. Interestingly, we encountered two cases of bony malformations during the study enrolment process.…”

Editorial Commentary: Real-Time Dynamic Magnetic Resonance Imaging of the Patellofemoral Joint: Ready for Prime Time?

“…The clinical utility of dynamic MRI in the musculoskeletal system is wide-ranging, from patellofemoral kinematics [1][2][3] to imaging of the hip in femoroacetabular impingement 4 and also dynamic spine imaging. 5,6 Especially when combined with thorough clinical evaluation, confirmation of abnormal joint kinematics by real-time MRI may be of considerable value in supporting therapeutic measures such as surgery or physical therapy. The video format of dynamic MRI is also ideal for advancing patient-centered care, improving patient literacy on their condition, and offering a potential catalyst for shared decision-making between surgeons and their patients.…”