Can cervical spine axial GRE imaging replace FSE T2 axial imaging in the evaluation of central canal stenosis?

Abstract Background Many hospitals perform both axial fast spin-echo T2-weighted image (FSE T2WI) and axial gradient recalled echo T2-weighted (GRE) imaging. Purpose This study was performed to compare inter-reader agreement of cervical central spinal stenosis (CCSS) grading with the use of axial GRE imaging and axial FSE T2WI. We also compared the correlations between each radiologic grade and clinical manifestations. Methods A total of 143 patients (M: F = 71:72; mean age, 52 years) who underwent magnetic resonance imaging of the cervical spine at our hospital were included. Two radiologists evaluated the degree of CCSS from the level of C2–3 to the level of C6–7 using axial GRE imaging, axial FSE T2WI, axial GRE imaging with sagittal T2WI, and axial FSE T2WI with sagittal T2WI. Kappa statistics were used to analyze the inter-reader agreement. Results The existence of substantial agreement between GRE axial and FSE T2 axial images was reported by both readers (0.657 ≤ κ ≤ 0.665), who also reported almost-perfect agreement between GRE axial + T2 sagittal and T2 axial + T2 sagittal imaging (0.958 ≤ κ ≤ 0.979). The GRE axial, GRE axial + T2 sagittal, and T2 axial + T2 sagittal images showed superior correlation (moderate) compared to that of T2 axial images only (weak) in revealing the correlation between Kang grade and clinical manifestation. Conclusion The agreement of CCSS grading with axial GRE imaging and axial FSE T2WI findings was substantial. Using axial GRE images led to a superior correlation between magnetic resonance sequence and clinical manifestations relative to using axial FSE T2WI.