Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences

Abstract

Purpose To assess the performance of fat-suppressed fluid-sensitive MRI sequences compared to T1-weighted (T1w) / T2w sequences for the detection of Modic 1 end-plate changes on lumbar spine MRI. Materials and Methods Sagittal T1w, T2w, and fat-suppressed fluid-sensitive MRI images of 100 consecutive patients (consequently 500 vertebral segments; 52 female, mean age 74±7.4 years; 48 male, mean age 71±6.3 years) were retrospectively evaluated. We recorded the presence (yes/no) and extension (i.e., Likert-scale of height, volume, and end-plate extension) of Modic I changes in T1w/T2w sequences and compared the results to fat-suppressed fluid-sensitive sequences (McNemar/Wilcoxon-signed-rank test). Results Fat-suppressed fluid-sensitive sequences revealed significantly more Modic I changes compared to T1w/T2w sequences (156 vs. 93 segments, respectively; p<0.001). The extension of Modic I changes in fat-suppressed fluid-sensitive sequences was significantly larger compared to T1w/T2w sequences (height: 2.53±0.82 vs. 2.27±0.79, volume: 2.35±0.76 vs. 2.1±0.65, end-plate: 2.46±0.76 vs. 2.19±0.81), (p<0.05). Modic I changes that were only visible in fat-suppressed fluid-sensitive sequences but not in T1w/T2w sequences were significantly smaller compared to Modic I changes that were also visible in T1w/T2w sequences (p<0.05). Conclusion In conclusion, fat-suppressed fluid-sensitive MRI sequences revealed significantly more Modic I end-plate changes and demonstrated a greater extent compared to standard T1w/T2w imaging. Key Points When the Modic classification was defined in 1988, T2w sequences were heavily T2-weighted and thus virtually fat-suppressed. Nowadays, the bright fat signal in T2w images masks edema-like changes. The conventional definition of Modic I changes is not fully applicable anymore. Fat-suppressed fluid-sensitive MRI sequences revealed more/greater extent of Modic I changes. Citation Format Finkenstaedt T, Del Grande F, Bolog N etal. Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences. Fortschr Röntgenstr 2018; 190: 152-160.