J Korean Soc Spine Surg.  2012 Sep;19(3):90-96. 10.4184/jkss.2012.19.3.90.

Incidentally Detected Concurrent Lower Thoracic Lesions in Extended Lumbar Spine MRI

• Chung JY
• Yim JH
• Seo HY
• Kim HS
• Kim DY

• KMID: 1435585
• DOI: http://doi.org/10.4184/jkss.2012.19.3.90

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To evaluate the prevalence and associated factors of the concurrent lower thoracic lesions in patients who have a lumbar spine disease, using the extended lumbar MRI. SUMMARY OF LITERATURE REVIEW: There are no studies regarding the concurrent thoracic lesions with lumbar disease.
MATERIALS AND METHODS
All the patients, who had visited the out-patient department (OPD) of orthopaedic surgery in our hospital and underwent lumbar spine MRI, were studied during 1 year. Totally, 750 patients were included. The extended lumbar spine MRI contained additional extended T2-weighted sagittal images that cover the lower thoracic vertebrae with 35 centimeters long. We analyzed the highest observable level, characteristics of detected thoracic lesions. Those lesions were classified according to the severity of compression of the spinal cord and investigation for associated factors of patients. Also, the times for additional tests were measured.
RESULTS
Additional tests were able to observe up to the 7th thoracic vertebrae. In 257 cases (34.3%), the lower thoracic lesions were detected and increased with aging (p<0.001). A total of 48 patients (6%) had the lesion compressing the spinal cord and 28 patients needed further evaluation for the lower thoracic lesion. Further, 2 cases were treated surgically for lower thoracic lesions. Scanning extra time for additional test were 3 minutes.
CONCLUSIONS
The prevalence of lower thoracic lesions accompanied with the lumbar disease was 34% in this study. Therefore, additional extended lumbar spine MRI is needed to check possible concurrent lesions in the lower thoracic spine.

Keyword

Thoracic spine; Concurrent lesion; MRI

MeSH Terms

Aging
Humans
Outpatients
Prevalence
Retrospective Studies
Spinal Cord
Spine
Thoracic Vertebrae

Figure

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  Fig. 1. Grades of the severity of lower thoracic lesion(white arrow). (A) Grade 0: No compressive lesion. (B) Grade 1: The herniated thoracic intervertebral disc compressed the thecal sac but there is no cord contact. (C) Grade 3: The herniated thoracic intervertebral disc and hypertrophic ligamentum flavum compress the spinal cord.

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  Fig. 2. The rate of concurrent thoracic lesion is increased with aging(p<0.001).

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  Fig. 3. The lower thoracic spine lesion(white arrow) detected in extended lumbar spine MRI, T2 sagittal images. (A) Hypertrophic ligamentum flavum involving T11/12 in a 72-year-old man. (B) Osteoporotic fracture at T7 and T12 in a 68-year-old woman. (C) Disc herniation at T10/11 in a 81 year-old woman. (D) Metastatic tumor lesion at T9 in a 56-year old man.

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