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Quantitative correlation of lumbar foraminal stenosis with local morphological metrics

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Abstract

Purpose

Clinical evaluation of lumbar foraminal stenosis typically includes qualitative assessments of perineural epidural fat content around the spinal nerve root and evaluation of nerve root impingement. The present study investigates the use of several morphological MRI-derived metrics as quantitative predictors of foraminal stenosis grade.

Methods

62 adult patients that underwent lumbar spine MRI evaluation over a 1-month duration in 2018 were included in the analysis. Radiological gradings of stenosis were captured from the existing clinical electronic medical record. Clinical gradings were recorded using a 0–5 scale: 0 = no stenosis, 1 = mild stenosis, 2 = mild-moderate stenosis, 3 = moderate stenosis, 4 = moderate-severe stenosis, 5 = severe stenosis. Quantitative measures of perineural epidural fat volume, nerve root cross-sectional area, and lumbar pedicle length were derived from T1 weighted sagittal spine MRI on each side of all lumbar levels. Spearman correlations of each measured metric at each level were then computed against the stenosis gradings.

Results

A total of 347 volumetric segmentation and radiological foraminal stenosis grade sets were derived from the 62-subject study cohort. Statistical analysis revealed significant correlations (p < 0.001) between the volume of perineural fat and stenosis grades for all lumbar vertebral levels.

Conclusion

The results of the study have demonstrated that segmented volumes of perineural fat predict the severity of clinically scored foraminal stenosis. This finding motivates further development of automated perineural fat segmentation methods, which could offer a quantitative imaging biometric that yields more reproducible diagnosis, assessment, and tracking of foraminal stenosis.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Code availability

Not Applicable.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Radiology, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA

    Vimal S. Gunasekaran, Dustin Hejdak, Benjamin Meyer, Andrew Klein & Kevin Koch

Authors
  1. Vimal S. Gunasekaran
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  2. Dustin Hejdak
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  3. Benjamin Meyer
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  4. Andrew Klein
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  5. Kevin Koch
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by VG, DH and KK. The first draft of the manuscript was written by VG and KK and all other authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vimal S. Gunasekaran.

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Conflict of interest

The authors declare that they have no conflict of interest.

Consent to participate

The study was performed through a retrospective clinical data review protocol approved by the local Institutional Review Board under a waiver of consent. All data collected within the study was extracted from the clinical record and there was no study-oriented interaction with any study subjects. A waiver from the local IRB can be provided if requested.

Ethical approval

Ethical approval was waived by the local Ethics Committee of the Medical College of Wisconsin in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Gunasekaran, V.S., Hejdak, D., Meyer, B. et al. Quantitative correlation of lumbar foraminal stenosis with local morphological metrics. Eur Spine J 30, 3319–3323 (2021). https://doi.org/10.1007/s00586-021-06944-8

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  • DOI: https://doi.org/10.1007/s00586-021-06944-8

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