Fat quantification of multifidus muscle using T2-weighted Dixon: which measurement methods are best suited for revealing the relationship between fat infiltration and herniated nucleus pulposus

Abstract

Objective To reveal the best-suited method for fat quantification of lumbar multifidus to demonstrate its relationship to herniated nucleus pulposus (HNP) using T2-weighted Dixon. Materials and methods One hundred eight patients who underwent MRI for low back pain were enrolled. Two readers independently analyzed the fat fraction (Ff) using axial two-dimensional (D), coronal 2-D, and coronal 3-D measurement. Pearson's correlation coefficient was calculated between age, body mass index (BMI), and the Ff, and age, sex, BMI, and Ff were compared between 'HNP group' and 'no HNP group'. Multivariate logistic regression analysis was performed to identify factors associated with HNP. Results Coronal 2-D Ff showed the highest correlation with age (r = 0.536, P < 0.001). Coronal 2-D Ff, and coronal 3-D Ff were significantly higher in those with HNP (coronal 2-D: 18.9 +/- 2.9, coronal 3-D: 19.7 +/- 2.6, respectively) than those without HNP (coronal 2-D: 17.2 +/- 3.2, coronal 3-D: 17.4 +/- 3.2, respectively). Ff of all three measurements were significantly higher in those with HNP = 3 levels (axial 2-D: 20.7 +/- 3.0, coronal 2-D: 21.1 +/- 2.7, coronal 3-D: 21.6 +/- 2.5, respectively) than those with HNP <3 levels (axial 2-D: 17.5 +/- 4.3, coronal 2-D: 18.5 +/- 2.7, coronal 3-D: 19.3 +/- 2.5). The BMI was an independent predisposing factor to HNP (P = 0.011). Age and coronal 2-D Ff were significant predictors for multilevel HNP (P = 0.028 and 0.040, respectively). Conclusions The Ff of the multifidus muscle on T2-weighted Dixon was associated with age, sex, and HNP. The coronal 2-D measurement was the best suited for fat quantification in multifidus muscle among three measurement methods.