Quantitative Evaluation of Cervical Spine Morphometry: Zero Echo Time MRI Versus Multislice CT

For preoperative cervical assessment, both CT and MRI are often required for bony and soft-tissue evaluation, yet CT entails radiation and MRI poorly depicts cortical bone. ZTE offers CT-like contrast in one examination, but whether it correlates with CT for quantitative morphometry remains still uncertain.

To quantify ZTE-CT agreement for cervical osseous morphometry and to compare ZTE with conventional MRI for depicting degenerative osseous features.

Prospective.

38 consecutive surgical patients (21 men, mean age 54.3 ± 11.7 years).

3.0 T MRI; sagittal T1 and T2; 3D ZTE; CT.

Nine categories of cervical morphometric parameters (80 measurements per patient) were assessed using standardized anatomical landmarks; the mean and minimum of all level-specific values were derived per patient for each parameter. Two radiologists independently performed quantitative measurements; three radiologists independently assigned the degenerative osseous feature best depicted on ZTE relative to conventional MRI from four predefined categories.

Intraclass correlation coefficients (ICC) and Bland-Altman analysis for quantitative measurements, and Fleiss' κ for qualitative comparison; post hoc exploratory analyses investigated unanticipated findings. A two-sided p < 0.05 was considered statistically significant.

Interobserver agreement was excellent for all parameters (ICC > 0.98). For mean measurements, ZTE showed good-to-excellent agreement with CT for vertebral body height, disc height, and neuroforaminal dimensions (ICC 0.85-0.94). Minimum measurements showed moderate agreement overall; pedicle dimensions demonstrated low agreement with CT (ICC < 0.60), driven by overestimation of anatomically narrow pedicles. ZTE improved delineation of degenerative osseous features versus conventional MRI in 35 of 38 patients (92.1%; Fleiss' κ = 0.86).

ZTE MRI shows strong agreement with CT for key cervical spine morphometric parameters and improves depiction of degenerative osseous changes compared with conventional MRI. However, CT may remain necessary when precise pedicle evaluation is required for surgical planning.

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Stage 2.