Share this content in WeChat
Clinical Article
Quantitative assessment of paraspinal muscle fat infiltration in early stage ankylosing spondylitis patients by using MRI IDEAL sequence
HUANG Ruibin  YANG Hongwu  SU Shuyan  CHEN Liujiang  ZHUANG Ruyao  LIU Yuan 

Cite this article as: Huang RB, Yang HW, Su SY, et al. Quantitative assessment of paraspinal muscle fat infiltration in early stage ankylosing spondylitis patients by using MRI IDEAL sequence[J]. Chin J Magn Reson Imaging, 2022, 13(1): 26-30. DOI:10.12015/issn.1674-8034.2022.01.006.

[Abstract] Objective To evaluate fat infiltration of the multifidus and erector spinal muscles of the lower waist (L3/4, L4/5 levels) of ankylosing spondylitis (AS) patients in early stage, and explore the correlation between them and clinical indicators.Materials and Methods: Using a prospective study, 40 clinically diagnosed AS patients in early stage (AS group) 41 healthy volunteers (control group) matched in age, sex, and body mass index, all subjects were evaluated using iterative decomposition of water and fat with echo asymmetric and leastsquares estimation (IDEAL) sequence examination, the fat fraction values (ƞ) of multifidus and erector muscles at the levels of L3/4 and L4/5 were measured respectively. The clinical indicators such as the course of disease, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS group were collected during the same period. The independent samples t test (or Mann-Whitney U test) was used to compare the quantitative data between the two groups. Spearman correlation was used to evaluate the correlation between ƞ values of multifidus, erector spinae at the levels of L3/4 and L4/5 and clinical indicators.Results The average ƞ values of erector spinae and multifidus muscles at the levels of L3/4 and L4/5 in AS group were higher than those in the control group [(0.28±0.09) vs. (0.24±0.05); (0.32±0.07) vs. (0.26±0.05); (0.31±0.07) vs. (0.28±0.06); (0.36±0.08) vs. (0.30±0.06)], the differences were statistically significant (P<0.05). The average ƞ values of erector spinae and multifidus muscles at the levels of L3/4 and L4/5 in AS group were positively correlated with the course of the disease (P<0.05), but were not significantly correlated with ESR, CRP, and BASDAI scores (P>0.05).Conclusions IDEAL sequence could be used in the quantitative analysis of fat infiltration in lower lumbar paraspinal muscles in early AS patients with good evaluation value for clinical treatment.
[Keywords] spondylitis, ankylosing;paravertebral muscle;fat infiltration;magnetic resonance imaging

HUANG Ruibin   YANG Hongwu   SU Shuyan   CHEN Liujiang   ZHUANG Ruyao*   LIU Yuan  

Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515000, China

Zhuang RY, E-mail:

Conflicts of interest   None.

Received  2021-08-04
Accepted  2021-12-21
DOI: 10.12015/issn.1674-8034.2022.01.006
Cite this article as: Huang RB, Yang HW, Su SY, et al. Quantitative assessment of paraspinal muscle fat infiltration in early stage ankylosing spondylitis patients by using MRI IDEAL sequence[J]. Chin J Magn Reson Imaging, 2022, 13(1): 26-30.DOI:10.12015/issn.1674-8034.2022.01.006

Xie Y, Yang KH, LV Q, et al. Practice guideline for patients with ankylosing spondylitis/spondyloarthritis[J]. Chin J Intern Med, 2020, 59(7): 511-518. DOI: 10.3760/cma.j.cn112138-20200505-00448.
Acar Y, Ilcin N, Gurpinar B, et al. Core stability and balance in patients with ankylosing spondylitis[J]. Rheumatol Int, 2019, 39(8): 1389-1396. DOI: 10.1007/s00296-019-04341-5.
Sarac DC, Bayram S, Tore NG, et al. Association of Core Muscle Endurance Times With Balance, Fatigue, Physical Activity Level, and Kyphosis Angle in Patients With Ankylosing Spondylitis[J]. J Clin Rheumatol, 2020. DOI: 10.1097/RHU.0000000000001641.
van der Heijde D, Ramiro S, Landewe R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis[J]. Ann Rheum Dis, 2017, 76(6): 978-991. DOI: 10.1136/annrheumdis-2016-210770.
Resorlu H, Savas Y, Aylanc N, et al. Evaluation of paravertebral muscle atrophy and fatty degeneration in ankylosing spondylitis[J]. Mod Rheumatol, 2017, 27(4): 683-687. DOI: 10.1080/14397595.2016.1245176.
Akgul O, Gulkesen A, Akgol G, et al. MR-defined fat infiltration of the lumbar paravertebral muscles differs between non-radiographic axial spondyloarthritis and established ankylosing spondylitis[J]. Mod Rheumatol, 2013, 23(4): 811-816. DOI: 10.1007/s10165-012-0750-6.
Bok DH, Kim J, Kim TH. Comparison of MRI-defined back muscles volume between patients with ankylosing spondylitis and control patients with chronic back pain: age and spinopelvic alignment matched study[J]. Eur Spine J, 2017, 26(2): 528-537. DOI: 10.1007/s00586-016-4889-2.
Zhang XX, Zhang H, Nan J, et al. Muscle fat measurement by magnetic resonance technology: The progresses in muscle disease[J]. Chin J Magn Reson Imaging, 2019, 10(6): 474-478. DOI: 10.12015/issn.1674-8034.2019.06.017.
Fan QW, Chen QL. Evaluation of Diffusion Weighted Imaging and Dynamic Enhanced Scanning of Sacroiliac Joints in Elderly Patients with Early Ankylosing Spondylitis[J]. Chin J Gerontol, 2019, 39(20): 5041-5044. DOI: 10.3969/j.issn.1005-9202.2019.20.050.
Chinese Society of Rheumatology. Guidelines for the diagnosis and treatment of ankylosing spondylitis[J]. Chin J Rheumatol, 2010, 14(8): 557-559. DOI: 10.3760/cma.j.issn.1007-7480.2010.08.012.
van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria[J]. Arthritis Rheum, 1984, 27(4): 361-368. DOI: 10.1002/art.1780270401.
Lee YH, Hong YS, Park W, et al. Value of multidetector computed tomography for the radiologic grading of sacroiliitis in ankylosing spondylitis[J]. Rheumatol Int, 2013, 33(4): 1005-1011. DOI: 10.1007/s00296-012-2450-0.
Luo H, Wu HY, Chen Y. Application of the combination of DWI and clinical inflammatory index in sacroiliac joint lesion of early AS[J]. China Medical Equipment, 2021, 18(4): 53-57. DOI: 10.3969/J.ISSN.1672-8270.2021.04.013.
Wang CM, Hong WH, Ho HH, et al. Features of trunk muscle weakness in patients with ankylosing spondylitis: A cross-sectional study[J]. Biomed J, 2019, 42(2): 124-130. DOI: 10.1016/
Gordon TP, Sage MR, Bertouch JV, et al. Computed tomography of paraspinal musculature in ankylosing spondylitis[J]. J Rheumatol, 1984, 11(6): 794-797.
Hebert JJ, Kjaer P, Fritz JM, et al. The relationship of lumbar multifidus muscle morphology to previous, current, and future low back pain: a 9-year population-based prospective cohort study[J]. Spine (Phila Pa 1976), 2014, 39(17): 1417-1425. DOI: 10.1097/BRS.0000000000000424.
Crawford RJ, Elliott JM, Volken T. Change in fatty infiltration of lumbar multifidus, erector spinae, and psoas muscles in asymptomatic adults of Asian or Caucasian ethnicities[J]. Eur Spine J, 2017, 26(12): 3059-3067. DOI: 10.1007/s00586-017-5212-6.
White A, Abbott H, Masi AT, et al. Biomechanical properties of low back myofascial tissue in younger adult ankylosing spondylitis patients and matched healthy control subjects[J]. Clin Biomech (Bristol, Avon), 2018, 57: 67-73. DOI: 10.1016/j.clinbiomech.2018.06.006.
Han G, Jiang Y, Zhang B, et al. Imaging Evaluation of Fat Infiltration in Paraspinal Muscles on MRI: A Systematic Review with a Focus on Methodology[J]. Orthop Surg, 2021, 13(4): 1141-1148. DOI: 10.1111/os.12962.
Wang Y, Zha YF, Xing D. Quantitative MRI study of the relationship between fat content in lumbar paravertebral muscles and disc degeneration[J]. Chin J Magn Reson Imaging, 2018, 9(11): 819-824. DOI: 10.12015/issn.1674-8034.2018.11.004.
Sherlock SP, Zhang Y, Binks M, et al. Quantitative muscle MRI biomarkers in Duchenne muscular dystrophy: cross-sectional correlations with age and functional tests[J]. Biomark Med, 2021, 15(10): 761-773. DOI: 10.2217/bmm-2020-0801.
Yin L, Xie ZY, Xu HY, et al. T2 Mapping and Fat Quantification of Thigh Muscles in Children with Duchenne Muscular Dystrophy[J]. Curr Med Sci, 2019, 39(1): 138-145. DOI: 10.1007/s11596-019-2012-8.
Wang YJ, Zhou SC, Zhu TT. Objective measurement of minimal fat in normal multifidus muscle using T2-mapping and chemical shift imaging IDEAL[J]. Radiol Prac, 2019, 34(2): 188-192. DOI: 10.13609/j.cnki.1000-0313.2019.02.015.
Ozturk EC, Yagci I. The structural, functional and electrophysiological assessment of paraspinal musculature of patients with ankylosing spondylitis and non-radiographic axial spondyloarthropathy[J]. Rheumatol Int, 2021, 41(3): 595-603. DOI: 10.1007/s00296-020-04781-4.
Aranda-Valera IC, Garrido-Castro JL, Martinez-Galisteo A, et al. Patients with Axial Spondyloarthritis Show an Altered Flexion/Relaxation Phenomenon[J]. Diagnostics (Basel), 2021, 11(5). DOI: 10.3390/diagnostics11050810.
Otto LAM, Froeling M, van Eijk RPA, et al. Quantification of disease progression in spinal muscular atrophy with muscle MRI-a pilot study[J]. NMR Biomed. 2021, 34(4): e4473. DOI: 10.1002/nbm.4473.
Zhang Y, Xu H, Hu X, et al. Histopathological changes in supraspinous ligaments, ligamentum flava and paraspinal muscle tissues of patients with ankylosing spondylitis[J]. Int J Rheum Dis, 2016, 19(4): 420-429. DOI: 10.1111/1756-185X.12305.
Ibáñez VS, Visman IM, van Denderen C, et al. Muscle wasting in male TNF-alpha blocker naive ankylosing spondylitis patients: a comparison of gender differences in body composition[J]. Rheumatology (Oxford), 2017, 56(9): 1566-1572. DOI: 10.1093/rheumatology/kex187.
Yurdakul OV, Ince OE, Bagcier F, et al. Evaluating the strength of spinal and proximal girdle muscles in patients with axial spondyloarthritis: Correlation with activity, disability, and functionality[J]. Int J Rheum Dis, 2021, 24(5): 701-710. DOI: 10.1111/1756-185X.14102.
Kim SC, Lee YG, Park SB, et al. Muscle Mass, Strength, Mobility, Quality of Life, and Disease Severity in Ankylosing Spondylitis Patients: A Preliminary Study[J]. Ann Rehabil Med, 2017, 41(6): 990-997. DOI: 10.5535/arm.2017.41.6.990.
Öztürk ZA, Kul S, Türkbeyler İH, et al. Is increased neutrophil lymphocyte ratio remarking the inflammation in sarcopenia?[J]. Exp Gerontol, 2018, 110: 223-229. DOI: 10.1016/j.exger.2018.06.013.
El Maghraoui A, Ebo'o FB, Sadni S, et al. Is there a relation between pre-sarcopenia, sarcopenia, cachexia and osteoporosis in patients with ankylosing spondylitis?[J]. BMC Musculoskelet Disord, 2016, 17: 268. DOI: 10.1186/s12891-016-1155-z.
Cruz-Jentoft AJ, Romero-Yuste S, Chamizo CE, et al. Sarcopenia, immune-mediated rheumatic diseases, and nutritional interventions[J]. Aging Clin Exp Res, 2021. DOI: 10.1007/s40520-021-01800-7.
Wang M, Fu W, Meng L, et al. SWE and SMI ultrasound techniques for monitoring needling treatment of ankylosing spondylitis: study protocol for a single-blinded randomized controlled trial[J]. Trials, 2021, 22(1): 385. DOI: 10.1186/s13063-021-05344-z.
Molwitz I, Leiderer M, Mcdonough R, et al. Skeletal muscle fat quantification by dual-energy computed tomography in comparison with 3T MR imaging[J]. Eur Radiol, 2021, 31(10): 7529-7539. DOI: 10.1007/s00330-021-07820-1.
Ran J, Yin C, Liu C, et al. The Diagnostic Value of MR IVIM and T2 Mapping in Differentiating Autoimmune Myositis From Muscular Dystrophy[J]. Acad Radiol, 2021, 28(6): e182-e188. DOI: 10.1016/j.acra.2020.04.022.

PREV A preliminary study on the efficacy of tumor necrosis factor alpha antagonists in the treatment of axial spondyloarthropathy by T1-mapping technique
NEXT Preliminary study of CMR tissue feature tracking technology on left ventricular function in patients with hypertrophic cardiomyopathy with ejection fraction preservation

Tel & Fax: +8610-67113815    E-mail: