Association of paraspinal muscle water–fat MRI-based measurements with isometric strength measurements



Chemical shift encoding-based water–fat MRI derived proton density fat fraction (PDFF) of the paraspinal muscles has been emerging as a surrogate marker in subjects with sarcopenia, lower back pain, injuries and neuromuscular disorders. The present study investigates the performance of paraspinal muscle PDFF and cross-sectional area (CSA) in predicting isometric muscle strength.


Twenty-six healthy subjects (57.7% women; age: 30 ± 6 years) underwent 3T axial MRI of the lumbar spine using a six-echo 3D spoiled gradient echo sequence for chemical shift encoding-based water–fat separation. Erector spinae and psoas muscles were segmented bilaterally from L2 level to L5 level to determine CSA and PDFF. Muscle flexion and extension maximum isometric torque values [Nm] at the back were measured with an isokinetic dynamometer.


Significant correlations between CSA and muscle strength measurements were observed for erector spinae muscle CSA (r = 0.40; p = 0.044) and psoas muscle CSA (r = 0.61; p = 0.001) with relative flexion strength. Erector spinae muscle PDFF correlated significantly with relative muscle strength (extension: r = -0.51; p = 0.008; flexion: r = -0.54; p = 0.005). Erector spinae muscle PDFF, but not CSA, remained a statistically significant (p < 0.05) predictor of relative extensor strength in multivariate regression models (R2adj = 0.34; p = 0.002).


PDFF measurements improved the prediction of paraspinal muscle strength beyond CSA. Therefore, chemical shift encoding-based water–fat MRI may be used to detect subtle changes in the paraspinal muscle composition.

Key Points

• We investigated the association of paraspinal muscle fat fraction based on chemical shift encoding-based water–fat MRI with isometric strength measurements in healthy subjects.

• Erector spinae muscle PDFF correlated significantly with relative muscle strength.

• PDFF measurements improved prediction of paraspinal muscle strength beyond CSA.

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Body mass index


Cross-sectional area


Left erector spinae muscles


Right erector spinae muscles


International Physical Activity Questionnaire


Lower back pain


Muscle fat infiltration


Maximum voluntary isometric contraction


Neuromuscular diseases


Proton density fat fraction


Left psoas muscle


Right psoas muscle


Root mean square coefficients of variation


Regions of interest


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This study has received funding by Philips Healthcare, the German Research Foundation (DFG-SFB824/A9) and TUM Faculty of Medicine KKF grant H01.

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Correspondence to Sarah Schlaeger.

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The scientific guarantor of this publication is Thomas Baum, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Philips Healthcare.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Cross-sectional study

• Performed at one institution

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Schlaeger, S., Inhuber, S., Rohrmeier, A. et al. Association of paraspinal muscle water–fat MRI-based measurements with isometric strength measurements. Eur Radiol 29, 599–608 (2019).

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  • Magnetic resonance imaging
  • Paraspinal muscle
  • Muscle strength