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Rofo 2018; 190(02): 152-160
DOI: 10.1055/s-0043-118130
Musculoskeletal System
© Georg Thieme Verlag KG Stuttgart · New York

Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences

Modic-Typ-1-Endplattenveränderungen: Detektionsrate mittels fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen
Tim Finkenstaedt
1   Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Filippo Del Grande
2   Institute of Diagnostic and Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
,
Nicolae Bolog
3   Phoenix Diagnostic Clinic, Bucharest, Romania
,
Nils Ulrich
4   Department of Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
,
Sina Tok
4   Department of Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
,
Orpheus Kolokythas
5   Institute for Radiology and Nuclear Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
,
Johann Steurer
6   Horten Center for patient oriented research and knowledge transfer, University Hospital Zurich, Zurich, Switzerland
,
Gustav Andreisek
1   Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Sebastian Winklhofer
1   Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
7   Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
on behalf of the LSOS Study Group › Author Affiliations
Further Information

Publication History

06 April 2017

25 July 2017

Publication Date:
27 November 2017 (online)

Also available at
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Abstract

Purpose To assess the performance of fat-suppressed fluid-sensitive MRI sequences compared to T1-weighted (T1w) / T2w sequences for the detection of Modic 1 end-plate changes on lumbar spine MRI.

Materials and Methods Sagittal T1w, T2w, and fat-suppressed fluid-sensitive MRI images of 100 consecutive patients (consequently 500 vertebral segments; 52 female, mean age 74 ± 7.4 years; 48 male, mean age 71 ± 6.3 years) were retrospectively evaluated. We recorded the presence (yes/no) and extension (i. e., Likert-scale of height, volume, and end-plate extension) of Modic I changes in T1w/T2w sequences and compared the results to fat-suppressed fluid-sensitive sequences (McNemar/Wilcoxon-signed-rank test).

Results Fat-suppressed fluid-sensitive sequences revealed significantly more Modic I changes compared to T1w/T2w sequences (156 vs. 93 segments, respectively; p < 0.001). The extension of Modic I changes in fat-suppressed fluid-sensitive sequences was significantly larger compared to T1w/T2w sequences (height: 2.53 ± 0.82 vs. 2.27 ± 0.79, volume: 2.35 ± 0.76 vs. 2.1 ± 0.65, end-plate: 2.46 ± 0.76 vs. 2.19 ± 0.81), (p < 0.05). Modic I changes that were only visible in fat-suppressed fluid-sensitive sequences but not in T1w/T2w sequences were significantly smaller compared to Modic I changes that were also visible in T1w/T2w sequences (p < 0.05).

Conclusion In conclusion, fat-suppressed fluid-sensitive MRI sequences revealed significantly more Modic I end-plate changes and demonstrated a greater extent compared to standard T1w/T2w imaging.

Key Points 

  • When the Modic classification was defined in 1988, T2w sequences were heavily T2-weighted and thus virtually fat-suppressed.

  • Nowadays, the bright fat signal in T2w images masks edema-like changes.

  • The conventional definition of Modic I changes is not fully applicable anymore.

  • Fat-suppressed fluid-sensitive MRI sequences revealed more/greater extent of Modic I changes.

Citation Format

  • Finkenstaedt T, Del Grande F, Bolog N et al. Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences. Fortschr Röntgenstr 2018; 190: 152 – 160

Zusammenfassung

Ziel Ziel der Studie ist es, die Detektionsrate von Modic-Typ-1-Endplattenveränderungen mittels fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen gegenüber Standard T1- und T2-gewichteten Sequenzen an der Lendenwirbelsäule zu vergleichen.

Material und Methoden Sagittale T1, T2 und fettgesättigte, flüssigkeitssensitive MRT-Sequenzen von 100 Patienten (gesamt 500 Wirbelsegmente; 52 weiblich, Durchschnittsalter 74 ± 7,4 Jahre; 48 männlich, Durchschnittsalter 71 ± 6,3 Jahre) wurden retrospektiv untersucht. Das Vorhandensein (ja/nein) und die Ausdehnung (Likert-skalierte Höhen-, Volumen- und anteroposteriore Endplattenausdehnung) von Modic-1-Veränderungen auf T1/T2 gegenüber fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen wurden analysiert (McNemar/Wilcoxon-signed-rank test).

Ergebnisse Mittels fettgesättigter, flüssigkeitssensitiver MRT-Sequenzen konnten signifikant mehr Modic-1-Veränderungen detektiert werden als mittels T1-/T2-Sequenzen (156 vs. 93 Segmente; p < 0,001). Die Ausdehnung von Modic-1-Veränderungen auf fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen war signifikant größer gegenüber T1-/T2-Sequenzen (Höhe: 2,53 ± 0,82 vs. 2,27 ± 0,79, Volumen: 2,35 ± 0,76 vs. 2,1 ± 0,65, Endplattenausdehnung: 2,46 ± 0,76 vs. 2,19 ± 0,81), (p < 0,05). Modic-1-Veränderungen, die nur auf fettgesättigten, flüssigkeitssensitiven Sequenzen, aber nicht auf T1-/T2-Sequenzen detektiert werden konnten, waren signifikant kleiner im Vergleich zu Modic-1-Veränderungen, die auch auf T1-/T2-Sequenzen sichtbar waren (p < 0,05).

Schlussfolgerung Fettgesättigte, flüssigkeitssensitive Sequenzen haben nicht nur signifikant häufiger Modic-1-Veränderungen, sondern auch eine größere Ausdehnung ebendieser gegenüber Standard T1-/T2-Sequenzen nachweisen können.

Kernaussagen:

  • Als die Modic-Klassifikation 1988 definiert wurde, waren T2-Sequenzen technisch bedingt nahezu fettgesättigt

  • Fettsignal aktueller T2-Sequenzen ist deutlich heller, wodurch zusätzliches Knochenmarksödem maskiert werden kann

  • Die ursprüngliche Definition von Modic-1-Veränderungen ist daher heutzutage nicht mehr zutreffend

  • Fettgesättigte, flüssigkeitssensitive Sequenzen haben häufiger/größere Ausdehnung von Modic-1-Veränderungen gegenüber T1-/T2-Sequenzen nachweisen können

Key words

modic - magnetic resonance imaging - spinal canal - bone diseases - sensitivity and specificity
 

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