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J Spinal Disord Tech. 2013 Jul 26. [Epub ahead of print]

Three-Dimensional Isotropic MRI of the Cervical Spine: A Diagnostic Comparison to Conventional MRI.

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  • 1*Yale University School of Medicine, Department of Orthopaedics and Rehabilitation †Yale University School of Medicine, Department of Diagnostic Radiology.



Retrospective diagnostic trial.


To determine the diagnostic performance of three-dimensional turbo spin-echo (3D-TSE) isotropic magnetic resonance imaging (MRI) in the assessment of cervical spine pathology.


MRI is the imaging modality of choice for many cervical spine pathologies. However, axial imaging may be suboptimal if the image plane is oriented differently than the plane of interest, due to lordosis, kyphosis, or deformity. 3D-TSE isotropic MRI is a promising novel technology that bypasses this limitation by enabling dynamic image reformation in any desired orientation.


Forty-eight patients who underwent 3D-TSE and conventional two-dimensional fast spin-echo (2D-FSE) T2-weighted cervical spine MRI at our institution were randomly selected. 3D-TSE and 2D-FSE sequences from each subject were independently evaluated by two orthopaedic spine surgeons and four musculoskeletal radiologists. Images were assessed using specific pilot-tested criteria for stenosis, herniation, and degenerative changes. Inter-method agreement, inter- and intra-rater agreements for 3D-TSE and 2D-FSE, and Fleiss' kappa coefficients were determined.


The overall inter-method agreement was 80.7%. The inter-rater agreement was 75.9% for 3D-TSE and 75.7% for 2D-FSE (P=0.47). The intra-rater agreement was 82.2% for 3D-TSE and 81.5% for 2D-FSE (P=0.71). Fleiss' kappa coefficients were 0.42 for 3D-TSE and 0.43 for 2D-FSE (P=0.62), indicating moderate inter-rater reliability. The inter-method agreement and the 2D-FSE intra-rater agreement were statistically similar (P=0.49).


There is a high degree of agreement between 3D-TSE and 2D-FSE MRI in assessing the cervical spine. The inter-method variability was statistically similar to the intrinsic intra-rater variability of 2D-FSE MRI. This study demonstrates that 3D-TSE yields at least equivalent diagnostic information as conventional 2D-FSE in the cervical spine. In addition, reviewers noted subjective advantages of 3D-TSE image reprocessing, especially when evaluating greater pathology or deformity, with a simplified image acquisition process.

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