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



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).


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.


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).


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.


Lumbosacral region Lumbar vertebrae Magnetic resonance imaging Psoas muscle 



Hounsfield units


Lumbosacral transitional vertebra


Magnetic resonance imaging


Picture archiving and communication system


Positron emission tomography-computed tomography


Short tau inversion recovery


Echo time


Inversion time


Repetition time



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


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

Compliance with ethical standards


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.


• Prospective and retrospective

• Observational

• Performed at one institution


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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

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