title: Differentiation of Osteophytes and Disc Herniations in Spinal Radiculopathy Using Susceptibility-Weighted Magnetic Resonance Imaging.
abstract: The aim of this study was to evaluate the diagnostic performance of susceptibility-weighted magnetic resonance imaging (SW-MRI) for the differentiation of osteophytes and disc herniations of the spine compared with that of conventional spine MR sequences and radiography.
  
  
  
  This study was approved by the local ethics review board; written consent was obtained from all subjects. Eighty-one patients with suspected radiculopathy of the spine were included prospectively. Radiography, T1/T2, and SW-MRI of the cervical/lumbar spine were performed. As reference standard, 93 osteophytes (n = 48 patients) were identified on radiographs in combination with conventional T1/T2 images. One hundred fourteen posterior disc herniations (n = 60 patients) were identified on T1/T2 in combination with radiography excluding osteophytes. For this study, 2 observers independently assessed the presence of osteophytes and disc herniations on T1/T2 and SW-MRI, with radiographs excluded from the analysis. In a subgroup of patients (n = 19), additional computed tomography images were evaluated. Sensitivity, specificity, and interobserver agreement were calculated.
  
  
  
  Most osteophytes (n = 92 of 93) and disc herniations (n = 113 of 114) could be identified and differentiated on SW-MRI magnitude/phase images, if radiographs were excluded from analysis. Susceptibility-weighted magnetic resonance imaging achieved a sensitivity of 98.9% and specificity of 99.1% for the identification of osteophytes. Conventional T1/T2 spine MR sequences achieved a sensitivity and specificity of 68.6% and 86.5%, respectively, if radiographs were excluded from analysis. Regarding the size of osteophytes, SW-MRI showed a strong correlation with computed tomography (R = 0.96) and radiography (R = 0.95). In addition, SW-MRI achieved a higher interobserver agreement compared with conventional MR.
  
  
  
  Susceptibility-weighted magnetic resonance imaging enables the reliable differentiation of osteophytes and disc herniations in patients with spinal radiculopathy with a higher sensitivity and specificity compared with conventional T1/T2 MR sequences.
authors.affiliation: From the Departments of *Radiology, and †Neuroradiology, Charité-University Medicine Berlin, Berlin; and ‡Spine Department, Orthopedic University Hospital Friedrichsheim, Frankfurt am Main, Germany.
authors.forename: Yvonne Yi-Na
authors.initials: YY
authors.lastname: Bender
authors.forename: Gerd
authors.initials: G
authors.lastname: Diederichs
authors.forename: Thula Cannon
authors.initials: TC
authors.lastname: Walter
authors.forename: Moritz
authors.initials: M
authors.lastname: Wagner
authors.forename: Thomas
authors.initials: T
authors.lastname: Liebig
authors.forename: Marcus
authors.initials: M
authors.lastname: Rickert
authors.forename: Kay-Geert
authors.initials: KG
authors.lastname: Hermann
authors.forename: Bernd
authors.initials: B
authors.lastname: Hamm
authors.forename: Marcus Richard
authors.initials: MR
authors.lastname: Makowski
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000000981:diagnostic imaging*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D054850:Osteophyte / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011843:Radiculopathy / Q000150:complications*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity