Interdisciplinary Neurosurgery (Mar 2022)
Comparison of Pfirrmann classification and objective T2 signal intensity of cervical disc-cisterna magna ratio measurements in cervical intervertebral disc degeneration
Abstract
Objective: This study aimed to determine the relation of the intervertebral disc signal intensity to cisterna magna [1] signal intensity ratio to the morphological changes in the cervical intervertebral discs (CID) on a T2-weighted image performed on a 3.0-Tesla (3 T) magnetic resonance imaging (MRI), and its relationships to the age, disc space heights, gender, and Pfirrmann grades. Materials and Methods: One hundred fifty patients were enrolled. Sagittal T2-weighted images were performed on 3.0-Tesla (MRI) on the cases included in the study. All intervertebral disc heights (anterior, middle, posterior), signal intensities, and cisterna magna signal intensities between C2-T1 were measured by two different researchers. Based on the resulting data, Pfirrmann scores were divided into three groups, and a cut-off value was determined between grades by using their mean and median values. Results: When the data was examined, it was found that the CID-cisterna magna (CM) signal intensity ratio values were significantly statistically different in all (C2 → T1) levels according to the grades (p < 0.05); as the Pfirrmann classification goes from low to high at each intervertebral disc level (Grade 1&2 → Grade 4&5), CID-CM signal intensity ratio values statistically significantly decreased. The ROC curve obtained for each level and the area under the curve (AUC) were calculated and found to be statistically significant. Conclusion: The Pfirrmann grading system is not a reliable evaluation method for CID degeneration grading because the height of the cervical disc varies significantly according to the measurement area and level. It is thought that further research can lead to more objective classification based on widely used T2-weighted MRI intensity measurement.
