title: Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy.
abstract: OBJECTIVE
  To prospectively evaluate the fat content of paraspinal muscles by using proton magnetic resonance (MR) spectroscopy in patients with chronic low back pain (LBP) and in asymptomatic volunteers matched with regard to age, sex, and body mass index.
  
  
  METHODS
  The study was approved by the responsible institutional review board. Informed consent was obtained from each patient and each volunteer. Single-voxel proton MR spectroscopy was used to measure the fat content of the lumbar multifidus and longissimus muscles in 25 patients (13 women, 12 men; mean age, 40.5 years) with chronic LBP and in 25 matched asymptomatic volunteers (13 women, 12 men; mean age, 39.8 years). The fat content was also graded semiquantitatively (grades 0-4). The relationship between fat content and LBP duration, LBP intensity, and self-rated disability was assessed (Pearson correlation).
  
  
  RESULTS
  The mean percentage fat content of the multifidus muscle was 23.6% (95% confidence interval [CI]: 17.5%, 29.7%) in patients with chronic LBP and 14.5% (95% CI: 10.8%, 18.3%) in the volunteers (P = .014). The corresponding values for the longissimus muscle were 29.3% (95% CI: 23.4%, 35.3%) in patients with LBP and 26.0% (95% CI: 21.9%, 30.0%) in the volunteers (P = .66). The semiquantitative grading of the fat content of the multifidus muscle was 0 in 12 (48%) of 25 patients and in 14 (56%) of 25 volunteers, 1 in 11 (44%) patients and in eight (32%) volunteers, and 2 in two (8%) patients and three (12%) volunteers. The semiquantitative grading of the fat content of the longissimus muscle was 0 in nine (36%) of 25 patients and 15 (60%) of 25 volunteers, 1 in 13 (52%) patients and nine (36%) volunteers, and 2 in three (12%) patients and one (4%) volunteer. Neither grade 3 nor grade 4 was assigned to any muscle. The grading differences were not significant between patients and volunteers. No significant correlation was found between fat content and pain intensity, pain duration, or self-rated disability.
  
  
  CONCLUSIONS
  Proton MR spectroscopy demonstrates a significantly higher fat content in the multifidus muscle in patients with chronic LBP than in asymptomatic volunteers. No difference was detected with a semiquantitative grading system.
authors.affiliation: Department of Radiology, Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. mengiardi@yahoo.de
authors.forename: Bernard
authors.initials: B
authors.lastname: Mengiardi
authors.forename: Marius R
authors.initials: MR
authors.lastname: Schmid
authors.forename: Norbert
authors.initials: N
authors.lastname: Boos
authors.forename: Christian W A
authors.initials: CW
authors.lastname: Pfirrmann
authors.forename: Florian
authors.initials: F
authors.lastname: Brunner
authors.forename: Achim
authors.initials: A
authors.lastname: Elfering
authors.forename: Juerg
authors.initials: J
authors.lastname: Hodler
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016658:Psoas Muscles / Q000473:pathology*