Ultrasound imaging measures of vertebral bony landmark distances are weakly to moderately correlated with intervertebral disc height as assessed by MRI

Ulrike H Mitchell; A Wayne Johnson; Lauren Adams; Tayva Sonnefeld; Patrick J Owen

doi:10.1136/bmjsem-2021-001292

Ultrasound imaging measures of vertebral bony landmark distances are weakly to moderately correlated with intervertebral disc height as assessed by MRI

BMJ Open Sport Exerc Med. 2022 Mar 25;8(1):e001292. doi: 10.1136/bmjsem-2021-001292. eCollection 2022.

Authors

Ulrike H Mitchell¹, A Wayne Johnson¹, Lauren Adams¹, Tayva Sonnefeld¹, Patrick J Owen²

Affiliations

¹ Exercises Sciences, Brigham Young University, Provo, Utah, USA.
² Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia.

Abstract

Objectives: To assess the validity and reliability of ultrasound-derived interbony landmark distances as a proxy for MRI-derived intervertebral disc (IVD) height.

Methods: This is a cross-sectional criterion validity study. Twelve college-aged participants without current low back pain completed both MRI and ultrasound imaging of the lumbar spine in a prone position. Single-segment and multisegment distances between the spinous and mammillary processes at the lumbar segments (L2/L3, L3/L4, L4/L5) were measured twice using ultrasound and analysed digitally. Sagittal slices of the lumbar spine were taken via T1-weighted MRI and IVD height, and the overall distance between IVDs L2/L3 and L4/L5 was imaged once and measured twice.

Results: There was moderate correlation between multilevel-based measurements (overall distance between L2 and L5, r=0.677, p=0.016) and the average across three levels (r=0.596, p=0.041) when using the spinous processes as bony landmarks. Single-segment measures were not significantly correlated (all: p>0.092). Accuracy and precision were better for the overall MRI-derived distance between the three IVDs from L2 and L5 MRI and the distance measured between the spinous processes L2-L5. There was excellent reliability within multiple measurements at each location, with intraclass correlation coefficient, ICC_(3,1), ranging from 0.93 to 0.99 (95% CI 0.82 to 0.99) for ultrasound and from 0.98 to 0.99 (95% CI 0.92 to 0.99) for MRI.

Conclusion: Findings do not support the use of ultrasound imaging for estimating single-segment IVD height, yet it may be used to measure the change in distance over time with a certain degree of precision based on its excellent reliability.

Keywords: Reliability; Spine; Validity.