Radiologists' evaluation of synthetic cervical spine CT in addition to MR and X-ray imaging for radiculopathy

Visualisation of both soft-tissue and osseous structures is required for optimal cervical spine assessment in patients with cervical radiculopathy. This study investigated whether radiologists considered an MRI-based synthetic CT to be of added value to MRI and X-ray in the assessment of the cervical spine in these patients.

In this exploratory single-centre, retrospective study that was approved by the local institutional review board (NWMO 190716), three radiologists randomly and independently evaluated two sets of images of 24 patients aged 50 years or older that had received an MRI, X-ray and an MRI-based synthetic CT for cervical radiculopathy, using a questionnaire. Prior to this assessment they received instructions on the questionnaire with a separate test set. Image set 1 consisted of MRI and X-ray, and set 2 of MRI and X-ray, complemented by the synthetic CT.

The radiologists reported significantly improved quality of assessment in general and in assessment of cortical delineation, intervertebral joints and neural foramina at C3-4 and C6-7 and presence of posterior lipping, facet arthrosis, bony apposition in the spinal canal when the synthetic CT was presented with MRI and X-ray (median score of 3.8 [IQR 0.2] vs 3.2 [IQR 0.3], p < 0.001). The visibility of trabecular bone was not significantly different between the two sets.

Subjective evaluation by radiologists demonstrated that adding the synthetic cervical spine CT to the MRI and X-ray in patients with cervical radiculopathy could improve the quality of image evaluation and diagnostic confidence, warranting confirmation in larger studies.