Imaging Appearance of Magnetic Resonance Myelography In Normal Population: Employing Three-dimensional Sampling Perfection with Application Optimized Contrasts Using Different Flip-angle Evolutions (3D-SPACE) Sequence

摘要

Characterizing the normal distribution of cerebrospinal fluid (CSF) in the spine is crucial for an accurate assessment of CSF leakage and other abnormalities. Magnetic resonance myelography (MRM) is a noninvasive diagnostic method that is commonly used to evaluate the spinal distribution of CSF. Our aim was to evaluate the anatomical distribution of CSF in the spine of healthy individuals, by MRM using the three-dimensional sampling perfection with amplification-optimized contrasts using flip-angle evolutions (3D-SPACE) sequence.Twenty-one healthy volunteers underwent whole-spine MRM imaging using the 3D-SPACE sequence. MRM images were reconstructed with 5-mm axial multiplanar reconstruction (MPR) and maximum intensity projection (MIP) at each spine level. Two radiologists evaluated CSF distribution from the spinal canal in the MPR and MIP images, using 7-point (types A-G) and 3-point (grades 0-3) classification systems, respectively. Inter-reader agreement was calculated with the kappa coefficient (k).Reader I/reader 2 evaluated 46/53, 67/57, 4/6, 0/0, 0/0, 7/5, and 2/5 cervical spine (C-spine)-level MPR images corresponding to types A-G, respectively (k = 0.74). Numbers at the thoracic spine (T-spine) level were 185/186, 41/44, 8/5, 0/0, 0/0, 16/11, and 2/6, respectively (k = 0.69), and at the lumbar spine (L-spine) level were 46/58, 25/23, 9/5, 0/0, 0/0, 19/13, and 6/6, respectively (k = 0.50). Inter-reader agreement for MPR images at the whole-spine level was considered good (k = 0.69). Reader I/reader 2 evaluated 0/0, 13/13, 8/8, and 0/0 MIP images at the C-spine level corresponding to grades 0-3, respectively (k = 0.80). Numbers at the T-spine level were 10/14, 8/5, 3/2, and 0/0, respectively (k = 0.67), and at the L-spine level were 5/2, 10/8, 6/11, and 0/0, respectively (k = 0.26). Inter-reader agreement for MIP images at the whole-spine level was considered good (k = 0.61).In conclusion, T2-weighted MRM with 3D-SPACE sequence imaging can be a useful technique to detect the normal distribution of CSF in the spinal canal. Understanding the normal distribution of CSF in the spinal canal is necessary to achieve an accurate diagnosis of CSF leakage.