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Published in: BMC Musculoskeletal Disorders 1/2022

Open Access 01-12-2022 | Research

Comparison of region-of-interest delineation methods for diffusion tensor imaging in patients with cervical spondylotic radiculopathy

Authors: Penghuan Wu, Chengyan Huang, Benchao Shi, Anmin Jin

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

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Abstract

Background

Diffusion tensor imaging is a promising technique for determining the responsible lesion of cervical radiculopathy, but the selection and delineation of the region of interest (ROI) affect the results. This study explored the impact of different ROI sketching methods on the repeatability and consistency of DTI measurement values in patients with cervical spondylotic radiculopathy (CSR).

Methods

This retrospective study included CSR patients who underwent DTI imaging. The images were analyzed independently by two radiologists. Four delineation methods were used: freehand method, maximum roundness, quadrilateral method, and multi-point averaging method. They re-examined the images 6 weeks later. The intra-class correlation coefficient (ICC) was used to investigate the consistency between the two measurements and the reproducibility between two radiologists.

Results

Forty-two CSR patients were included in this study. The distribution of the compressed nerve roots was five C4, eight C5, sixteen C6, eleven C7, and two C8. No differences were found among the four methods in fractional anisotropy (FA) or apparent diffusion coefficient (ADC), irrespective of radiologists (all P>0.05). Similar results were observed between the first and second measurements (all P>0.05), but some significant differences were observed for radiologist 2 for the four-small rounds method (P=0.033). The freehand and single largest circle methods were the two methods with the highest ICC between the two measurements and the two radiologists (all ICC >0.90).

Conclusion

The freehand and single largest circle methods were the most consistent methods for delineating DTI ROI in patients with CSR.
Literature
1.
go back to reference Childress MA, Becker BA. Nonoperative Management of Cervical Radiculopathy. Am Fam Physician. 2016;93:746–54.PubMed Childress MA, Becker BA. Nonoperative Management of Cervical Radiculopathy. Am Fam Physician. 2016;93:746–54.PubMed
2.
go back to reference Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11:64–72.CrossRef Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11:64–72.CrossRef
3.
go back to reference Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Pain P: 4. Cervical radicular pain. Pain Pract. 2010;10:1–17.CrossRef Van Zundert J, Huntoon M, Patijn J, Lataster A, Mekhail N, van Kleef M. Pain P: 4. Cervical radicular pain. Pain Pract. 2010;10:1–17.CrossRef
4.
go back to reference Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005;353:392–9.CrossRef Carette S, Fehlings MG. Clinical practice. Cervical radiculopathy. N Engl J Med. 2005;353:392–9.CrossRef
5.
go back to reference Ruan D, He Q, Ding Y, Hou L, Li J, Luk KD. Intervertebral disc transplantation in the treatment of degenerative spine disease: a preliminary study. Lancet. 2007;369:993–9.CrossRef Ruan D, He Q, Ding Y, Hou L, Li J, Luk KD. Intervertebral disc transplantation in the treatment of degenerative spine disease: a preliminary study. Lancet. 2007;369:993–9.CrossRef
6.
go back to reference Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72:1178–84.CrossRef Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72:1178–84.CrossRef
7.
go back to reference Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976). 2003(28):52–62. Wainner RS, Fritz JM, Irrgang JJ, Boninger ML, Delitto A, Allison S. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine (Phila Pa 1976). 2003(28):52–62.
8.
go back to reference Landman BA, Bogovic JA, Wan H, El Zahraa ESF, Bazin PL, Prince JL. Resolution of crossing fibers with constrained compressed sensing using diffusion tensor MRI. Neuroimage. 2012;59:2175–86.CrossRef Landman BA, Bogovic JA, Wan H, El Zahraa ESF, Bazin PL, Prince JL. Resolution of crossing fibers with constrained compressed sensing using diffusion tensor MRI. Neuroimage. 2012;59:2175–86.CrossRef
9.
go back to reference Chuanting L, Qingzheng W, Wenfeng X, Yiyi H, Bin Z. 3.0T MRI tractography of lumbar nerve roots in disc herniation. Acta Radiol. 2014;55:969–75.CrossRef Chuanting L, Qingzheng W, Wenfeng X, Yiyi H, Bin Z. 3.0T MRI tractography of lumbar nerve roots in disc herniation. Acta Radiol. 2014;55:969–75.CrossRef
10.
go back to reference Murtz P, Kaschner M, Lakghomi A, Gieseke J, Willinek WA, Schild HH, et al. Diffusion-weighted MR neurography of the brachial and lumbosacral plexus: 3.0 T versus 1.5 T imaging. Eur J Radiol. 2015;84:696–702.CrossRef Murtz P, Kaschner M, Lakghomi A, Gieseke J, Willinek WA, Schild HH, et al. Diffusion-weighted MR neurography of the brachial and lumbosacral plexus: 3.0 T versus 1.5 T imaging. Eur J Radiol. 2015;84:696–702.CrossRef
11.
go back to reference Gutmann L. Pearls and pitfalls in the use of electromyography and nerve conduction studies. Semin Neurol. 2003;23:77–82.CrossRef Gutmann L. Pearls and pitfalls in the use of electromyography and nerve conduction studies. Semin Neurol. 2003;23:77–82.CrossRef
12.
go back to reference Fitzgerald RT, Bartynski WS, Collins HR. Vertebral artery position in the setting of cervical degenerative disease: implications for selective cervical transforaminal epidural injections. Interv Neuroradiol. 2013;19:425–31.CrossRef Fitzgerald RT, Bartynski WS, Collins HR. Vertebral artery position in the setting of cervical degenerative disease: implications for selective cervical transforaminal epidural injections. Interv Neuroradiol. 2013;19:425–31.CrossRef
13.
go back to reference Crombe A, Alberti N, Hiba B, Uettwiller M, Dousset V, Tourdias T. Cervical Spinal Cord DTI Is Improved by Reduced FOV with Specific Balance between the Number of Diffusion Gradient Directions and Averages. AJNR Am J Neuroradiol. 2016;37:2163–70.CrossRef Crombe A, Alberti N, Hiba B, Uettwiller M, Dousset V, Tourdias T. Cervical Spinal Cord DTI Is Improved by Reduced FOV with Specific Balance between the Number of Diffusion Gradient Directions and Averages. AJNR Am J Neuroradiol. 2016;37:2163–70.CrossRef
14.
go back to reference Lawrence KE, Nabulsi L, Santhalingam V, Abaryan Z, Villalon-Reina JE, Nir TM, et al. Age and sex effects on advanced white matter microstructure measures in 15,628 older adults: A UK biobank study. Brain Imaging Behav. 2021;15:2813–23.CrossRef Lawrence KE, Nabulsi L, Santhalingam V, Abaryan Z, Villalon-Reina JE, Nir TM, et al. Age and sex effects on advanced white matter microstructure measures in 15,628 older adults: A UK biobank study. Brain Imaging Behav. 2021;15:2813–23.CrossRef
15.
go back to reference Turna O, Turna IF. Quantitative assessment of cervical spinal cord by diffusion tensor tractography in 3.0 T. Radiol Med. 2021;126:83–8.CrossRef Turna O, Turna IF. Quantitative assessment of cervical spinal cord by diffusion tensor tractography in 3.0 T. Radiol Med. 2021;126:83–8.CrossRef
16.
go back to reference Martin Noguerol T, Barousse R, Socolovsky M, Luna A. Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg. 2017;7:398–421.CrossRef Martin Noguerol T, Barousse R, Socolovsky M, Luna A. Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg. 2017;7:398–421.CrossRef
17.
go back to reference Basser PJ, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B. 1996;111:209–19.CrossRef Basser PJ, Pierpaoli C. Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B. 1996;111:209–19.CrossRef
18.
go back to reference Bernabeu A, Lopez-Celada S, Alfaro A, Mas JJ, Sanchez-Gonzalez J. Is diffusion tensor imaging useful in the assessment of the sciatic nerve and its pathologies? Our clinical experience. Br J Radiol. 2016;89:20150728.CrossRef Bernabeu A, Lopez-Celada S, Alfaro A, Mas JJ, Sanchez-Gonzalez J. Is diffusion tensor imaging useful in the assessment of the sciatic nerve and its pathologies? Our clinical experience. Br J Radiol. 2016;89:20150728.CrossRef
19.
go back to reference Mori S, van Zijl PC. Fiber tracking: principles and strategies - a technical review. NMR Biomed. 2002;15:468–80.CrossRef Mori S, van Zijl PC. Fiber tracking: principles and strategies - a technical review. NMR Biomed. 2002;15:468–80.CrossRef
20.
go back to reference Chen YY, Lin XF, Zhang F, Zhang X, Hu HJ, Wang DY, et al. Diffusion tensor imaging of symptomatic nerve roots in patients with cervical disc herniation. Acad Radiol. 2014;21:338–44.CrossRef Chen YY, Lin XF, Zhang F, Zhang X, Hu HJ, Wang DY, et al. Diffusion tensor imaging of symptomatic nerve roots in patients with cervical disc herniation. Acad Radiol. 2014;21:338–44.CrossRef
21.
go back to reference Lambregts DM, Beets GL, Maas M, Curvo-Semedo L, Kessels AG, Thywissen T, et al. Tumour ADC measurements in rectal cancer: effect of ROI methods on ADC values and interobserver variability. Eur Radiol. 2011;21:2567–74.CrossRef Lambregts DM, Beets GL, Maas M, Curvo-Semedo L, Kessels AG, Thywissen T, et al. Tumour ADC measurements in rectal cancer: effect of ROI methods on ADC values and interobserver variability. Eur Radiol. 2011;21:2567–74.CrossRef
22.
go back to reference Ma X, Han X, Jiang W, Wang J, Zhang Z, Li G, et al. A Follow-up Study of Postoperative DCM Patients Using Diffusion MRI with DTI and NODDI. Spine (Phila Pa 1976). 2018;43:E898–904.CrossRef Ma X, Han X, Jiang W, Wang J, Zhang Z, Li G, et al. A Follow-up Study of Postoperative DCM Patients Using Diffusion MRI with DTI and NODDI. Spine (Phila Pa 1976). 2018;43:E898–904.CrossRef
23.
go back to reference Han X, Suo S, Sun Y, Zu J, Qu J, Zhou Y, et al. Apparent diffusion coefficient measurement in glioma: Influence of region-of-interest determination methods on apparent diffusion coefficient values, interobserver variability, time efficiency, and diagnostic ability. J Magn Reson Imaging. 2017;45:722–30.CrossRef Han X, Suo S, Sun Y, Zu J, Qu J, Zhou Y, et al. Apparent diffusion coefficient measurement in glioma: Influence of region-of-interest determination methods on apparent diffusion coefficient values, interobserver variability, time efficiency, and diagnostic ability. J Magn Reson Imaging. 2017;45:722–30.CrossRef
24.
go back to reference Nogueira L, Brandao S, Matos E, Nunes RG, Ferreira HA, Loureiro J, et al. Region of interest demarcation for quantification of the apparent diffusion coefficient in breast lesions and its interobserver variability. Diagn Interv Radiol. 2015;21:123–7.CrossRef Nogueira L, Brandao S, Matos E, Nunes RG, Ferreira HA, Loureiro J, et al. Region of interest demarcation for quantification of the apparent diffusion coefficient in breast lesions and its interobserver variability. Diagn Interv Radiol. 2015;21:123–7.CrossRef
25.
go back to reference Zhu F, Liu Y, Zeng L, Wang Y, Kong X, Yao S, et al. Evaluating the Severity and Prognosis of Acute Traumatic Cervical Spinal Cord Injury: A Novel Classification Using Diffusion Tensor Imaging and Diffusion Tensor Tractography. Spine (Phila Pa 1976). 2021;46:687–94.CrossRef Zhu F, Liu Y, Zeng L, Wang Y, Kong X, Yao S, et al. Evaluating the Severity and Prognosis of Acute Traumatic Cervical Spinal Cord Injury: A Novel Classification Using Diffusion Tensor Imaging and Diffusion Tensor Tractography. Spine (Phila Pa 1976). 2021;46:687–94.CrossRef
26.
go back to reference Hakulinen U, Brander A, Ilvesmaki T, Helminen M, Ohman J, Luoto TM, et al. Reliability of the freehand region-of-interest method in quantitative cerebral diffusion tensor imaging. BMC Med Imaging. 2021;21:144.CrossRef Hakulinen U, Brander A, Ilvesmaki T, Helminen M, Ohman J, Luoto TM, et al. Reliability of the freehand region-of-interest method in quantitative cerebral diffusion tensor imaging. BMC Med Imaging. 2021;21:144.CrossRef
27.
go back to reference Inoue C, Fujii S, Kaneda S, Fukunaga T, Kaminou T, Kigawa J, et al. Apparent diffusion coefficient (ADC) measurement in endometrial carcinoma: effect of region of interest methods on ADC values. J Magn Reson Imaging. 2014;40:157–61.CrossRef Inoue C, Fujii S, Kaneda S, Fukunaga T, Kaminou T, Kigawa J, et al. Apparent diffusion coefficient (ADC) measurement in endometrial carcinoma: effect of region of interest methods on ADC values. J Magn Reson Imaging. 2014;40:157–61.CrossRef
28.
go back to reference Wu W, Yang Z, Zhang T, Ru N, Zhang F, Wu B, et al. Microstructural Changes in Compressed Cervical Spinal Cord Are Consistent With Clinical Symptoms and Symptom Duration. Spine (Phila Pa). 1976;2020(45):E999–E1005. Wu W, Yang Z, Zhang T, Ru N, Zhang F, Wu B, et al. Microstructural Changes in Compressed Cervical Spinal Cord Are Consistent With Clinical Symptoms and Symptom Duration. Spine (Phila Pa). 1976;2020(45):E999–E1005.
29.
go back to reference Wang K, Chen Z, Zhang F, Song Q, Hou C, Tang Y, et al. Evaluation of DTI Parameter Ratios and Diffusion Tensor Tractography Grading in the Diagnosis and Prognosis Prediction of Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976). 2017;42:E202–10.CrossRef Wang K, Chen Z, Zhang F, Song Q, Hou C, Tang Y, et al. Evaluation of DTI Parameter Ratios and Diffusion Tensor Tractography Grading in the Diagnosis and Prognosis Prediction of Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976). 2017;42:E202–10.CrossRef
30.
go back to reference Liang KN, Feng PY, Feng XR, Cheng H. Diffusion Tensor Imaging and Fiber Tractography Reveal Significant Microstructural Changes of Cervical Nerve Roots in Patients with Cervical Spondylotic Radiculopathy. World Neurosurg. 2019;126:e57–64.CrossRef Liang KN, Feng PY, Feng XR, Cheng H. Diffusion Tensor Imaging and Fiber Tractography Reveal Significant Microstructural Changes of Cervical Nerve Roots in Patients with Cervical Spondylotic Radiculopathy. World Neurosurg. 2019;126:e57–64.CrossRef
31.
go back to reference Ma C, Guo X, Liu L, Zhan Q, Li J, Zhu C, et al. Effect of region of interest size on ADC measurements in pancreatic adenocarcinoma. Cancer Imaging. 2017;17:13.CrossRef Ma C, Guo X, Liu L, Zhan Q, Li J, Zhu C, et al. Effect of region of interest size on ADC measurements in pancreatic adenocarcinoma. Cancer Imaging. 2017;17:13.CrossRef
32.
go back to reference Jafari-Khouzani K, Paynabar K, Hajighasemi F, Rosen B. Effect of Region of Interest Size on the Repeatability of Quantitative Brain Imaging Biomarkers. IEEE Trans Biomed Eng. 2019;66:864–72.CrossRef Jafari-Khouzani K, Paynabar K, Hajighasemi F, Rosen B. Effect of Region of Interest Size on the Repeatability of Quantitative Brain Imaging Biomarkers. IEEE Trans Biomed Eng. 2019;66:864–72.CrossRef
33.
go back to reference Sun Y, Xiao Q, Hu F, Fu C, Jia H, Yan X, et al. Diffusion kurtosis imaging in the characterisation of rectal cancer: utilizing the most repeatable region-of-interest strategy for diffusion parameters on a 3T scanner. Eur Radiol. 2018;28:5211–20.CrossRef Sun Y, Xiao Q, Hu F, Fu C, Jia H, Yan X, et al. Diffusion kurtosis imaging in the characterisation of rectal cancer: utilizing the most repeatable region-of-interest strategy for diffusion parameters on a 3T scanner. Eur Radiol. 2018;28:5211–20.CrossRef
Metadata
Title
Comparison of region-of-interest delineation methods for diffusion tensor imaging in patients with cervical spondylotic radiculopathy
Authors
Penghuan Wu
Chengyan Huang
Benchao Shi
Anmin Jin
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-022-05639-5

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