Advertisement

European Radiology

, Volume 29, Issue 5, pp 2608–2615 | Cite as

Psoas proximal insertion as a simple and reliable landmark for numbering lumbar vertebrae on MRI of the lumbar spine

  • François RoparsEmail author
  • J. Mesrar
  • J. Ognard
  • S. Querellou
  • J. Rousset
  • M. Garetier
Musculoskeletal
  • 143 Downloads

Abstract

Objective

To evaluate the value of psoas muscle proximal insertion for correct numbering of the lumbar vertebrae in MRI, in particular in case of lumbosacral transitional vertebra (LSTV).

Methods

Two radiologists assessed 477 MRI scans of the lumbar spine with a sagittal localizer sequence on the whole spine for numbering vertebrae caudally from C2. Proximal insertion of the psoas was determined as the most proximal vertebra with psoas over half of its body on coronal T2 STIR sequence. The last lumbar vertebra was named considering both its number and the presence or absence of LSTV according to Castellvi classification. These same parameters were also assessed on 207 PET-CT scans of another cohort including the whole spine.

Results

Proximal insertion of the psoas was L1 in 94.1% of cases: 98.5% in case of modal anatomy, 81.4% in case of LSTV, and 51.7% in case of missing or supernumerary lumbar vertebra without LSTV. There was no statistically significant difference between MRI and CT data. The inter-reader agreement for determination of psoas proximal insertion was excellent (kappa = 0.96).

Conclusion

Proximal insertion of the psoas muscle is a helpful marker for correct numbering of the lumbar vertebrae in MRI and to detect a complete lumbosacral segmentation anomaly.

Key Points

• Proximal insertion of the psoas muscle can be easily identified on a coronal T2 STIR sequence.

• Psoas proximal insertion on the spine almost always designates the first lumbar vertebra and is helpful to accurately number all lumbar vertebrae, especially in case of lumbosacral transitional vertebra.

• Conversely, when psoas muscle does not insert five lumbar bodies above the apparent lumbosacral joint, the probability of variation in the number of lumbar vertebrae is high.

Keywords

Lumbosacral region Lumbar vertebrae Magnetic resonance imaging Psoas muscle 

Abbreviations

HU

Hounsfield units

LSTV

Lumbosacral transitional vertebra

MRI

Magnetic resonance imaging

PACS

Picture archiving and communication system

PET-CT

Positron emission tomography-computed tomography

STIR

Short tau inversion recovery

TE

Echo time

TI

Inversion time

TR

Repetition time

Notes

Acknowledgments

The authors thank Philippe Bruyant for his help with manuscript revision.

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Garetier Marc.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective and retrospective

• Observational

• Performed at one institution

References

  1. 1.
    Malanga GA, Cooke PM (2004) Segmental anomaly leading to wrong level disc surgery in cauda equina syndrome. Pain Physician 7:107–110Google Scholar
  2. 2.
    Konin GP, Walz DM (2010) Lumbosacral transitional vertebrae: classification, imaging findings, and clinical relevance. AJNR Am J Neuroradiol 31:1778–1786CrossRefGoogle Scholar
  3. 3.
    Paik NC, Lim CS, Jang HS (2013) Numeric and morphological verification of lumbosacral segments in 8280 consecutive patients. Spine (Phila Pa 1976) 38:E573–E578CrossRefGoogle Scholar
  4. 4.
    Castellvi AE, Goldstein LA, Chan DP (1984) Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine (Phila Pa 1976) 9:493–495CrossRefGoogle Scholar
  5. 5.
    Apazidis A, Ricart PA, Diefenbach CM, Spivak JM (2011) The prevalence of transitional vertebrae in the lumbar spine. Spine J 11:858–862CrossRefGoogle Scholar
  6. 6.
    Hughes RJ, Saifuddin A (2004) Imaging of lumbosacral transitional vertebrae. Clin Radiol 59:984–991CrossRefGoogle Scholar
  7. 7.
    Paik NC, Lim CS, Jang HS (2012) Numbering of vertebrae on MRI using a PACS cross-referencing tool. Acta Radiol 53:785–789CrossRefGoogle Scholar
  8. 8.
    Akbar JJ, Weiss KL, Saafir MA, Weiss JL (2010) Rapid MRI detection of vertebral numeric variation. AJR Am J Roentgenol 195:465–466CrossRefGoogle Scholar
  9. 9.
    Lee CH, Seo BK, Choi YC et al (2005) Using MRI to evaluate anatomic significance of aortic bifurcation, right renal artery, and conus medullaris when locating lumbar vertebral segments. AJR Am J Roentgenol 182:1295–1300CrossRefGoogle Scholar
  10. 10.
    Tokgoz N, Ucar M, Erdogan AB, Kilic K, Ozcan C (2014) Are spinal or paraspinal anatomic markers helpful for vertebral numbering and diagnosing lumbosacral transitional vertebrae? Korean J Radiol 15:258–266CrossRefGoogle Scholar
  11. 11.
    Farshad-Amacker NA, Aichmair A, Herzog RJ, Farshad M (2015) Merits of different anatomical landmarks for correct numbering of the lumbar vertebrae in lumbosacral transitional anomalies. Eur Spine J 24:600–608CrossRefGoogle Scholar
  12. 12.
    Carrino JA, Campbell PD Jr, Lin DC et al (2011) Effect of spinal segment variants on numbering vertebral levels at lumbar MR imaging. Radiology 259:196–202Google Scholar
  13. 13.
    Nakajima A, Usui A, Hosokai Y et al (2014) The prevalence of morphological changes in the thoracolumbar spine on whole-spine computed tomographic images. Insights Imaging 5:77–83CrossRefGoogle Scholar
  14. 14.
    Farshad-Amacker NA, Lurie B, Herzog RJ, Farshad M (2014) Is the iliolumbar ligament a reliable identifier of the L5 vertebra in lumbosacral transitional anomalies? Eur Radiol 24:2623–2630CrossRefGoogle Scholar
  15. 15.
    O’Driscoll CM, Irwin A, Saifuddin A (1996) Variations in morphology of the lumbosacral junction on sagittal MRI: correlation with plain radiography. Skeletal Radiol 25:225–230CrossRefGoogle Scholar
  16. 16.
    Wigh RE (1980) The thoracolumbar and lumbosacral transitional junctions. Spine (Phila Pa 1976) 5:215–222CrossRefGoogle Scholar
  17. 17.
    Kershenovich A, Macias OM, Syed F, Davenport C, Moore GJ, Lock JH (2016) Conus medullaris level in vertebral columns with lumbosacral transitional vertebra. Neurosurgery 78:62–70CrossRefGoogle Scholar
  18. 18.
    Lee CH, Seo BK, Choi YC et al (2004) Using MRI to evaluate anatomic significance of aortic bifurcation, right renal artery, and conus medullaris when locating lumbar vertebral segments. AJR Am J Roentgenol 182:1295–1300CrossRefGoogle Scholar
  19. 19.
    Lee CH, Park CM, Kim KA et al (2007) Identification and prediction of transitional vertebrae on imaging studies: anatomical significance of paraspinal structures. Clin Anat 20:905–914CrossRefGoogle Scholar
  20. 20.
    Hanson EH, Mishra RK, Chang DS et al (2010) Sagittal whole-spine magnetic resonance imaging in 750 consecutive outpatients: accurate determination of the number of lumbar vertebral bodies: clinical article. J Neurosurg Spine 12:47–55CrossRefGoogle Scholar
  21. 21.
    Farshad-Amacker NA, Lurie B, Herzog RJ, Farshad M (2014) Interreader and intermodality reliability of standard anteroposterior radiograph and magnetic resonance imaging in detection and classification of lumbosacral transitional vertebra. Spine J 14:1470–1475CrossRefGoogle Scholar
  22. 22.
    Hsieh CY, Vanderford JD, Moreau SR, Prong T (2000) Lumbosacral transitional segments: classification, prevalence, and effect on disk height. J Manipulative Physiol Ther 23:483–489CrossRefGoogle Scholar
  23. 23.
    Tertti MO, Salminen JJ, Paajanen HE, Terho PH, Kormano MJ (1991) Low-back pain and disk degeneration in children: a case-control MR imaging study. Radiology 180:503–507CrossRefGoogle Scholar
  24. 24.
    Gray H (1918) Anatomy of the human body. Lea and Febiger, PhiladelphiaCrossRefGoogle Scholar
  25. 25.
    Le Double AF (1897) Treaty about variations of the human muscular system [in French]. Schleicher Frères, ParisGoogle Scholar
  26. 26.
    Laporte C, Albert JD, Duvauferrier R, Bertaud V, Gouillou M, Guillin R (2014) MRI investigation of radiating pain in the lower limbs: value of an additional sequence dedicated to the lumbosacral plexus and pelvic girdle. AJR Am J Roentgenol 203:1280–1285CrossRefGoogle Scholar
  27. 27.
    Tureli D, Ekinci G, Baltacioglu F (2014) Is any landmark reliable in vertebral enumeration? A study of 3.0-Tesla lumbar MRI comparing skeletal, neural, and vascular markers. Clin Imaging 38:792–796CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RadiologyMilitary Teaching Hospital Clermont-TonnerreBrest Cedex 9France
  2. 2.Department of RadiologyUniversity Hospital La Cavale BlancheBrestFrance
  3. 3.Department of Nuclear MedicineUniversity Hospital MorvanBrestFrance

Personalised recommendations