Magnetic resonance imaging evaluation of age and level dependence of multifidus fatty infiltration in normal Indian healthy volunteers

Authors

  • Harshitha Kamatham Department of Radiodiagnosis, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka, India http://orcid.org/0000-0001-6445-4413
  • Venkatesh Kadiri Department of Orthopaedics, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka, India http://orcid.org/0000-0002-0194-1924
  • Gautam Muthu Department of Radiodiagnosis, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka, India
  • Swaroop Bysani Department of Radiodiagnosis, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20223297

Keywords:

Multifidus, Fatty infiltration, Lumbar spine, Multifidus fatty infiltration

Abstract

Background: Multifidus is one of the main stabilizers of lumbar spine. Fatty infiltration of multifidus varies with the age, sex, side and level of spine studied. The present study aims at the evaluation and comparison of the trends of multifidus fatty infiltration in normal population at various levels in both genders, side and different decade groups in healthy individual volunteers.

Methods: Twenty-five normal healthy volunteers equally distributed across different age groups (3rd-7th decades) formed the healthy study group. In step 1, normal population magnetic resonance (MR) images are collected and evaluated individually. In step 2, fatty infiltration of all people ascending in age was calculated at each lumbar level and on either side. In step 3, normal population were divided into decades and fatty infiltration at each decade and segment wise comparison was done. In step 4, statistical analysis of significance was done between the groups. All the T2 MR images were measured using Image j 1.50i software. Exclusion criteria included no proper visualization of paraspinal musculature in the T2 MR images. Associated conditions affecting the degeneration (other lytic lesions/vertebral fractures-healed or unhealed). Other etiology included disc prolapse, listhesis, infections, tumors, and trauma. For each MRI scan, at least 3 cuts for each segment were obtained in which the central cut will be selected for measurement.

Results: In study population, at all age groups the multifidus fatty infiltration (MFI) at all given levels upper lumbar levels (L1-2, L2-3) showed less fatty infiltration than lower levels. With increasing age there is increase in MFI in all levels. On either side, as the age increases fat % increases and in individual people as the segment going caudal the fat % increases. At each segment left side has more fat % than right side and overall fat % increase from L1 to S1 levels. As decades increases fat % increases in each individual segment, and also fat % increases from cephalad to caudal. There is a rapid increase in fat % transition from 4th to 5th decade. Overall fat % increase is seen from L1 to S1 in each decade. Females L1-2 to L3-4 does not show significant fat % increase. There are more fat % in females than males in lower lumbar levels, but the body mass index (BMI), daily activities may be a confounding factor.

Conclusions: Lumbar paravertebral muscle fat content increases with aging, in healthy volunteers 3nd to 7th decade of age. Women, low lumbar levels, left side the multifidus muscle are most affected.

Author Biographies

Harshitha Kamatham, Department of Radiodiagnosis, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka, India

MD radiodiagnosis

Venkatesh Kadiri, Department of Orthopaedics, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka, India

MS ORTHOPAEDICS

Gautam Muthu, Department of Radiodiagnosis, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka, India

MD radiodiagnosis

Swaroop Bysani, Department of Radiodiagnosis, Raja Rajeswari Medical College and Hospital, Bangalore, Karnataka, India

MD radiodiagnosis

References

Akagi R, Takai Y, Kato E, Wakahara T, Ohta M, Kanehisa H, et al. Development of an equation to predict muscle volume of elbow flexors for men and women with a wide range of age. Eur J Appl Physiol. 2010;108:689-94.

Samagh SP, Kramer EJ, Melkus G, Laron D, Bodendorfer B, Natsuhara K, et al. MRI quantification of fatty infiltration and muscle atrophy in a mouse model of rotator cuff tears. J Orthop Res. 2013;31:421-6.

Elliott JM, Flynn TW, Al-Najjar A, Press J, Nguyen B, Noteboom JT, et al. The pearls and pitfalls of magnetic resonance imaging for the spine. J Orthop Sports Phys Ther. 2011;41:848-60.

Elliott JM, O’Leary S, Sterling M, Hendrikz O, Pedler A, Jull G, et al. Magnetic resonance imaging findings of fatty infiltrate in the cervical flexors in chronic whiplash. Spine. 2010;35:948-54.

Fischer MA, Nanz D, Shimakawa A, Schirmer T, Guggenberger R, Chhabra A, et al. Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology. 2013;266:555-63.

Reeder SB, Hu HH, Sirlin CB. Proton density fat-fraction: a standardized MR-based biomarker of tissue fat concentration. J Magn Reson Imaging. 2012;36:1011-4.

Elliott J, Pedler A, Kenardy J, Galloway G, Jull G, Sterling M. The temporal development of fatty infiltrates in the neck muscles following whiplash injury: an association with pain and posttraumatic stress. PLoS One. 2011;6:e21194.

Fischer MA, Pfirrmann CW, Espinosa N, Raptis D , Buck F. Dixon-based MRI for assessment of muscle-fat content in phantoms, healthy volunteers and patients with achillodynia: comparison to visual assessment of calf muscle quality. Eur Radiol. 2014;24:1366-75.

Smith AC, Parrish TB, Abbott R, Hoggarth M, Mendoza K, Yu Fen Chen. Muscle-fat MRI: 1.5 Tesla and 3.0 Tesla versus histology. Muscle Nerve. 2014;50:170-6.

Dixon WT. Simple proton spectroscopic imaging. Radiology. 1984;153:189-94.

Ma J. Dixon techniques for water and fat imaging. J Magn Reson Imaging. 2008;28:543-58.

Elliott JM, Walton DM, Rademaker A, Todd B Parrish. Quantification of cervical spine muscle fat: a comparison between T1-weighted and multiecho gradient echo imaging using a variable projection algorithm (VARPRO). BMC Med Imag. 2013;13:30.

Paalanne N, Niinimaki J, Karppinen J, Taimela S, Mutanen P, Takatalo J, et al. Assessment of association between low back pain and paraspinal muscle atrophy using opposed-phase magnetic resonance imaging: a population-based study among young adults. Spine. 2011;36:1961-8.

Elliott JM, Courtney DM, Rademaker A, Pinto D, Sterling M, Parrish T. The rapid and progressive degeneration of the cervical multifidus in whiplash: a MRI study of fatty infiltration. Spine (Phila Pa 1976). 2015;40:E694-700.

Gaeta M, Scribano E, Mileto A, Rodolico C, Toscano A, Settineri N, et al. Muscle fat fraction in neuromuscular disorders: dual-echo dual-flip-angle spoiled gradient-recalled MR imaging technique for quantification—a feasibility study. Radiology. 2011;259:487-94.

Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Cuyper HJD. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J. 2000;9:266-72.

Fortin M, Videman T, Gibbons LE, Battié MC. Paraspinal muscle morphology and composition: a 15-yr longitudinal magnetic resonance imaging study. Med Sci Sports Exerc. 2014;46:893-901.

Fortin M, Yuan Y, Battie´ MC. Factors associated with paraspinal muscle asymmetry in size and composition in a general population sample of men. Phys Ther. 2013;93:1540-50.

Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2008;13:43-9.

Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol. 2011;84:709-13.

Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P , O'Sullivan R, et al. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J. 2015;15:1593-601.

Hodges P, Holm AK, Hansson T, Holm S. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine. 2006;31:2926-33.

Farshad M, Gerber C, Farshad-Amacker NA, Dietrich TJ, Laufer-Molnar V, Min K. Asymmetry of the multifidus muscle in lumbar radicular nerve compression. Skeletal Radiol. 2014;43:49-53.

Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5:2.

Mengiardi B, Schmid MR, Boos N, Pfirrmann CWA, Brunner F, Elfering A, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240:786-92.

Parkkola R, Ryto¨koski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine. 1993;18:830-6.

Barker KL, Shamley DR, Jackson D. Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain: the relationship to pain and disability. Spine. 2004;29:E515-9.

Meakin JR, Fulford J, Seymour R, Welsman JR, Knapp KM. The relationship between sagittal curvature and extensor muscle volume in the lumbar spine. J Anat. 2013;222:608-14.

Valentin S, Licka T, Elliott J. Age and side-related morphometric MRI evaluation of trunk muscles in people without back pain. Man Ther. 2015;20:90-5.

Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36:811-6.

D’Hooge R, Cagnie B, Crombez G, Vanderstraeten G, Dolphens M, Danneels L. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther. 2012;17:584-8.

Been E, Kalichman L. Lumbar lordosis. Spine J. 2014;14:87-97.

Tong HC, Haig AJ, Yamakawa KS, Miner JA. Paraspinal electromyography: age correlated normative values in asymptomatic subjects. Spine. 2005;30:E499-502.

Haig AJ, London Z, Sandella DE. Symmetry of paraspinal muscle denervation in clinical lumbar spinal stenosis: support for a hypothesis of posterior primary ramus stretching? Muscle Nerve. 2013;48:198-203.

Yarjanian JA, Fetzer A, Yamakawa KS, Tong HC, Smuck M, Haig A. Correlation of paraspinal atrophy and denervation in back pain and spinal stenosis relative to asymptomatic controls. PMR. 2013;5:39-44.

Abbott R, Pedler A, Sterling M, Hides J, Murphey T, Hoggarth M, et al. The geography of fatty infiltrates within the cervical multifidus and semispinalis cervicis in individuals with chronic whiplash-associated disorders. J Orthop Sports Phys Ther. 2015;45:281-8.

Doherty TJ. Invited review: aging and sarcopenia. J Appl Physiol. 2003;95:1717-27.

Downloads

Published

2022-12-30

How to Cite

Kamatham, H., Kadiri, V., Muthu, G., & Bysani, S. (2022). Magnetic resonance imaging evaluation of age and level dependence of multifidus fatty infiltration in normal Indian healthy volunteers. International Journal of Research in Medical Sciences, 11(1), 94–100. https://doi.org/10.18203/2320-6012.ijrms20223297

Issue

Section

Original Research Articles