Quantitative imaging in medicine and surgery · 2026
Quantitative MRI assessment of paraspinal muscles and the psoas: associations with low back pain.
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Ozenbas Cemre, Ozturk Cemal Arman, Altinok Tayfun
Аннотация
BACKGROUND: Low back pain (LBP) is a leading cause of disability worldwide, yet the contribution of paraspinal muscle fat infiltration remains uncertain. This study aimed to quantitatively assess paraspinal muscle fat fraction using the Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation for Imaging Quantification (IDEAL-IQ) sequence in patients with LBP and to explore its relationships with pain severity, disability, and demographic factors such as age, sex, and body mass index (BMI).
METHODS: This retrospective cross-sectional study included 124 patients (64 males, 60 females; mean age, 38.3±12.6 years). Fat fraction values of the multifidus, erector spinae, and psoas muscles were measured bilaterally at L1-L2 through L4-L5 levels using IDEAL-IQ. Pain and disability were assessed with the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Correlation and multiple regression analyses were conducted to determine associations, adjusting for age, sex, and BMI. Interobserver agreement between two radiologists was evaluated using the intraclass correlation coefficient (ICC).
RESULTS: Women demonstrated consistently higher muscle fat fractions than men across all lumbar levels. In females, multifidus fat fraction ranged from 10.1% to 10.5% (vs. 5.3-5.7% in males), erector spinae ranged from 8.8% to 12.1% (vs. 5.0-7.1% in males), and psoas ranged from 5.4% to 5.7% (vs. 4.1-5.0% in males). These differences were statistically significant for all lumbar levels except psoas at L2-L3 and L4-L5. BMI showed a positive correlation with fat fraction across all lumbar levels (r=0.29-0.50, all P<0.001). VAS scores were positively correlated with multifidus (r=0.44-0.54), erector spinae (r=0.41-0.56), and psoas (r=0.35-0.42) fat fractions (all P<0.001). Similarly, ODI scores demonstrated significant positive correlations with multifidus (r=0.44-0.54), erector spinae (r=0.42-0.56), and psoas (r=0.42-0.52) fat fractions at every lumbar level (all P<0.001). Regression analysis confirmed fat fraction as an independent predictor of both VAS and ODI (adjusted R2=0.22-0.32, P<0.001). Interobserver agreement was excellent (ICC =0.92-0.98).
CONCLUSIONS: Quantitative assessment of paraspinal muscles and the psoas muscle fat fraction using IDEAL-IQ revealed significant associations with pain severity and disability, independent of demographic factors. If validated by larger prospective studies, incorporating IDEAL-IQ sequences into routine lumbar magnetic resonance imaging (MRI) protocols and reporting paraspinal muscle fat fraction may contribute to a more comprehensive and quantitative evaluation of patients with LBP.
METHODS: This retrospective cross-sectional study included 124 patients (64 males, 60 females; mean age, 38.3±12.6 years). Fat fraction values of the multifidus, erector spinae, and psoas muscles were measured bilaterally at L1-L2 through L4-L5 levels using IDEAL-IQ. Pain and disability were assessed with the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Correlation and multiple regression analyses were conducted to determine associations, adjusting for age, sex, and BMI. Interobserver agreement between two radiologists was evaluated using the intraclass correlation coefficient (ICC).
RESULTS: Women demonstrated consistently higher muscle fat fractions than men across all lumbar levels. In females, multifidus fat fraction ranged from 10.1% to 10.5% (vs. 5.3-5.7% in males), erector spinae ranged from 8.8% to 12.1% (vs. 5.0-7.1% in males), and psoas ranged from 5.4% to 5.7% (vs. 4.1-5.0% in males). These differences were statistically significant for all lumbar levels except psoas at L2-L3 and L4-L5. BMI showed a positive correlation with fat fraction across all lumbar levels (r=0.29-0.50, all P<0.001). VAS scores were positively correlated with multifidus (r=0.44-0.54), erector spinae (r=0.41-0.56), and psoas (r=0.35-0.42) fat fractions (all P<0.001). Similarly, ODI scores demonstrated significant positive correlations with multifidus (r=0.44-0.54), erector spinae (r=0.42-0.56), and psoas (r=0.42-0.52) fat fractions at every lumbar level (all P<0.001). Regression analysis confirmed fat fraction as an independent predictor of both VAS and ODI (adjusted R2=0.22-0.32, P<0.001). Interobserver agreement was excellent (ICC =0.92-0.98).
CONCLUSIONS: Quantitative assessment of paraspinal muscles and the psoas muscle fat fraction using IDEAL-IQ revealed significant associations with pain severity and disability, independent of demographic factors. If validated by larger prospective studies, incorporating IDEAL-IQ sequences into routine lumbar magnetic resonance imaging (MRI) protocols and reporting paraspinal muscle fat fraction may contribute to a more comprehensive and quantitative evaluation of patients with LBP.