Evaluation of the Reproducibility of MR Elastography Measurements of the Lumbar Back Muscles.

ABSTRACT

BACKGROUND: MR elastography (MRE) may provide quantitative imaging biomarkers of lumbar back muscles (LBMs), complementing MRI in spinal diseases by assessing muscle mechanical properties. However, reproducibility analyses for MRE of LBM are lacking. PURPOSE: To assess technical failure, within-day and inter-day reproducibility, robustness with the excitation source positioning, and inter-observer agreement of MRE of muscles. STUDY TYPE Prospective. SUBJECTS: Seventeen healthy subjects (mean age 28 ± 4 years; 11 females). FIELD STRENGTH/SEQUENCE 1.5 T, gradient-echo MRE, T1-weighted turbo spin echo. ASSESSMENT The pneumatic driver was centered at L3 level. Four MRE were performed during two visits, 2-4 weeks apart, each consisting of two MRE with less than 10 minutes inter-scan interval. At Visit 1, after the first MRE, the coil and driver were removed, then reinstalled. The MRE was repeated. At Visit 2, following the first MRE, only the driver was moved down 5 cm. The MRE was repeated. Two radiologists segmented the multifidus and erector spinae muscles. STATISTICAL TESTS Paired t-test, analysis of variance, intraclass correlation coefficients (ICCs). P-values <0.05 were considered statistically significant. RESULTS: Mean stiffness of LBM ranged from 1.44 to 1.60 kPa. Mean technical failure rate was 2.5%. Inter-observer agreement was excellent (ICC ranging from 0.82 [0.64-0.96] to 0.99 [0.98-0.99] in the multifidus, and from 0.85 [0.69-0.92] to 0.99 [0.97-0.99] in the erector spinae muscles). Within-day reproducibility was fair in the multifidus (ICC 0.53 [0.47-0.77]) and good in the erector spinae muscles (ICC 0.74 [0.48-0.88]). Reproducibility after moving the driver was excellent in both multifidus (ICC 0.85 [0.69-0.93]) and erector spinae muscles (ICC 0.84 [0.67-0.92]). Inter-day reproducibility was excellent in the multifidus (ICC 0.76 [0.48-0.89]) and poor in the erector spinae muscles (ICC 0.23 [-0.61 to 0.63]). DATA CONCLUSION: MRE of LBM provides measurements of stiffness with fair to excellent reproducibility and excellent inter-observer agreement. However, inter-day reproducibility in the multifidus muscles indicated that the herein used MRE protocol may not be optimal for this muscle. EVIDENCE LEVEL 2 TECHNICAL EFFICACY Stage 1.