title: Reliability of quantifying the spatial distribution of fatty infiltration in lumbar paravertebral muscles using a new segmentation method for T1-weighted MRI.
abstract: To our knowledge, there are no methods allowing for quantification of the spatial distribution of lumbar paravertebral muscle fatty infiltration (FI) in the transverse plane. There is an increasing emphasis on muscle tissues as modifiable factors in lumbar spine health. Population datasets based on conventional T1-weighted (T1-W) magnetic resonance imaging (MRI) represent a valuable resource for examining all spinal tissues, and methods with reliability are needed. The aim of our study was to determine the reliability of a novel method quantifying lumbar paravertebral muscle fat content based on conventional T1-W MRI.
  
  
  
  Axial 3-Tesla T1W MRIs from ten adult subjects (3W, 7M; mean age 52.8 ± SD 7.2 years) were randomly selected from the large prospective cross-sectional Hong Kong Population-based Disc Degeneration Cohort study examining lumbar spine degeneration. The selected sample included subjects with mixed imaging-determined disc degeneration and low back pain history. Two raters with MRI lumbar paravertebral muscle analysis experience (R1 > 250 h and R2 > 1000 h) repeat-measured the image-set a week apart. Multifidus and erector spinae (spinalis, longissimus and iliocostalis) were manually outlined together on a single-slice from the inferior vertebral end-plates of L1 to L5 using a semi-automated, quartile-defining (Q1-4 (medial to lateral) and Qmean) MatLab-based programme. Bland-Altman plots and intra-class correlation coefficients (ICC) with 95 % confidence intervals (CI) describe intra- and inter-rater reliability according to lumbar level, quartile, and side, and combined level and quartile.
  
  
  
  There was good intra- (ICC = 0.88; CI: 0.87-0.90) and inter-rater agreement (ICC = 0.82; CI: 0.80-0.84). Intra-rater values for Qmean (ICC; CI) were higher at L5 (0.89; 0.79-0.94) than L1 (0.61; 0.37-0.78). Higher intra-rater values for L1-5 were shown at Q1 (0.93; 0.91-0.95) than Q3 (0.83; 0.78-0.87) or Q4 (0.81; 0.76-0.85), and on the right (0.91; 0.90-0.93) than left (0.85; 0.83-0.88). Similar observations were made for inter-rater values in terms of lumbar level and quartile, with no differences between sides shown.
  
  
  
  In our study of ten cases we demonstrate a reliable method to quantify the spatial distribution of fat content in lumbar paravertebral muscles based on T1W MRI. Understanding the geography of fat content in these muscles may offer additional insight in determining and improving spinal health. The clinical relevance and application of this method require testing across various populations to build on the early feasibility established in this study.
authors.affiliation: Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland.
authors.forename: Áine Ni
authors.initials: ÁN
authors.lastname: Mhuiris
authors.affiliation: Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Volken
authors.affiliation: Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland.|Feinberg School of Medicine, Northwestern University, Chicago, USA.|School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
authors.forename: James M
authors.initials: JM
authors.lastname: Elliott
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, USA.|McCormick School of Engineering, Northwestern University, Evanston, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Hoggarth
authors.affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfalum, Hong Kong, SAR China.
authors.forename: Dino
authors.initials: D
authors.lastname: Samartzis
authors.affiliation: Centre for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, Postfach, CH-8401, Winterthur, Switzerland. rebecca.crawford@zhaw.ch.|Faculty of Health Professions, Curtin University, Perth, Australia. rebecca.crawford@zhaw.ch.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Crawford
mesh_terms: D050154:Adiposity; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging*; D017116:Low Back Pain / Q000000981:diagnostic imaging*; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064170:Paraspinal Muscles / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Fatty infiltration; Lumbar spine; Paravertebral muscle; Reliability; T1-weighted MRI