Paraspinal Muscle in Chronic Low Back Pain: Comparison Between Standard Parameters and Chemical Shift Encoding-Based Water-Fat MRI

J Magn Reson Imaging. 2022 Nov;56(5):1600-1608. doi: 10.1002/jmri.28145. Epub 2022 Mar 14.


Background: Paraspinal musculature (PSM) is increasingly recognized as a contributor to low back pain (LBP), but with conventional MRI sequences, assessment is limited. Chemical shift encoding-based water-fat MRI (CSE-MRI) enables the measurement of PSM fat fraction (FF), which may assist investigations of chronic LBP.

Purpose: To investigate associations between PSM parameters from conventional MRI and CSE-MRI and between PSM parameters and pain.

Study type: Prospective, cross-sectional.

Population: Eighty-four adults with chronic LBP (44.6 ± 13.4 years; 48 males).

Field strength/sequence: 3-T, T1-weighted fast spin-echo and iterative decomposition of water and fat with echo asymmetry and least squares estimation sequences.

Assessment: T1-weighted images for Goutallier classification (GC), muscle volume, lumbar indentation value, and muscle-fat index, CSE-MRI for FF extraction (L1/2-L5/S1). Pain was self-reported using a visual analogue scale (VAS). Intra- and/or interreader agreement was assessed for MRI-derived parameters.

Statistical tests: Mixed-effects and linear regression models to 1) assess relationships between PSM parameters (entire cohort and subgroup with GC grades 0 and 1; statistical significance α = 0.0025) and 2) evaluate associations of PSM parameters with pain (α = 0.05). Intraclass correlation coefficients (ICCs) for intra- and/or interreader agreement.

Results: The FF showed excellent intra- and interreader agreement (ICC range: 0.97-0.99) and was significantly associated with GC at all spinal levels. Subgroup analysis suggested that early/subtle changes in PSM are detectable with FF but not with GC, given the absence of significant associations between FF and GC (P-value range: 0.036 at L5/S1 to 0.784 at L2/L3). Averaged over all spinal levels, FF and GC were significantly associated with VAS scores.

Data conclusion: In the absence of FF, GC may be the best surrogate for PSM quality. Given the ability of CSE-MRI to detect muscle alterations at early stages of PSM degeneration, this technique may have potential for further investigations of the role of PSM in chronic LBP.

Level of evidence: 2 TECHNICAL EFFICACY STAGE: 2.

Keywords: Goutallier classification; chemical shift; fat fraction; low back pain; paraspinal musculature.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Humans
  • Low Back Pain* / diagnostic imaging
  • Lumbar Vertebrae
  • Magnetic Resonance Imaging / methods
  • Male
  • Paraspinal Muscles* / diagnostic imaging
  • Paraspinal Muscles* / physiology
  • Prospective Studies
  • Water


  • Water