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MRI-Based Lesion Quality Score Assessing Ossification Of The Posterior Longitudinal Ligament Of The Cervical Spine – Cervical Disc Replacement

This study aimed to develop an MRI-based score to accurately identify cervical ossification of the posterior longitudinal ligament (OPLL) lesions and establish its diagnostic value. The retrospective cohort study included 35 patients with OPLL undergoing surgery and 99 patients with soft disc herniation for comparison. The T1 and T2 lesion quality (LQ) scores were calculated using unenhanced MRI scans, with ROC analysis showing high accuracy in predicting OPLL presence. The study found a correlation between T1 LQ scores and CT-based Hounsfield unit values for identifying OPLL lesions, suggesting the potential of MRI in diagnosing OPLL. Additional studies are needed to further validate the findings

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : the highest rated spinal clinic in UK

Published article

CONCLUSIONS: This study found a correlation between the MRI-based T1 LQ scores and CT-based HU value for identifying OPLL lesions. Additional studies will be needed to validate that the T1 LQ score from the unenhanced MRI scan can identify cervical OPLL.

Cervical Disc Arthroplasty Surgery Expert. Best Spinal Surgeon UK
Abstract Background context: No method currently exists for MRI-based determination of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine using objective criteria. Purpose: The purpose of this study was to develop an MRI-based score to determine whether a lesion represents a cervical OPLL lesion and to establish the objective diagnostic value. Study,

Abstract

Background context: No method currently exists for MRI-based determination of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine using objective criteria.

Purpose: The purpose of this study was to develop an MRI-based score to determine whether a lesion represents a cervical OPLL lesion and to establish the objective diagnostic value.

Study design: Retrospective cohort in a single medical institution PATIENT SAMPLE: Thirty-five patients undergoing surgery for OPLL (Group A) and 99 patients undergoing cervical disc arthroplasty for soft disc herniation (Group B) between 2011 and 2020 were retrospectively included. All OPLL lesions on unenhanced MRI scan were correlated with a corresponding CT scan. Demographics were comparable between the two groups.

Outcome measures (physiologic measures): Using unenhanced magnetic resonance imaging (MRI), the T1- and T2- lesion quality (LQ) scores were calculated. Receiver operating characteristic (ROC) analysis was performed to calculate the area-under-the-curve (AUC) of both LQ scores as a predictor of the presence of OPLL. Computed tomography- (CT-) based Hounsfield unit (HU) values of OPLL lesions were obtained and compared with both LQ scores. The LQ scores for MRI scanners from different manufacturers were compared using Student’s t test to confirm the validity of the LQ score by scanner type.

Methods: The regions of interest for signal intensity (SI) were defined as the darkest site of the lesion and the cerebrospinal fluid (CSF) at the cerebellomedullary cistern. The T1 and T2 LQ scores were measured as the ratio of the SI at the darkest site of the lesion divided by the SI of the CSF.

Results: The T1 and T2 LQ scores in Group A were significantly lower than those in Group B (p < 0.001). ROC analysis determined that T1 and T2 LQ scores of 0.46 and 0.07, respectively, could distinguish the presence of OPLL with an accuracy of 0.93 and 0.89, respectively (p <0.001). When the T1 LQ score of the lesion is <0.46, a diagnosis of OPLL may be suspected with 100% sensitivity and 92.3% specificity. The HU of the lesion had a moderate negative correlation with the T1 LQ score (r = -0.665, p < 0.0001). Both LQ scores were unaffected by manufacturer type.

Conclusions: This study found a correlation between the MRI-based T1 LQ scores and CT-based HU value for identifying OPLL lesions. Additional studies will be needed to validate that the T1 LQ score from the unenhanced MRI scan can identify cervical OPLL.

Keywords: Hounsfield Units; MRI scan; computed tomography; lesion quality score; ossification of the posterior longitudinal ligament; receiver operating characteristic analysis; retrospective cohort study.

The London Spine Unit : the highest rated spinal clinic in UK

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MRI-based lesion quality score assessing ossification of the posterior longitudinal ligament of the cervical spine

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Abstract Background context: No method currently exists for MRI-based determination of ossification of the posterior longitudinal ligament (OPLL) of the cervical spine using objective criteria. Purpose: The purpose of this study was to develop an MRI-based score to determine whether a lesion represents a cervical OPLL lesion and to establish the objective diagnostic value. Study

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