Usefulness of Magnetic Resonance Texture Analysis for Differentiation between Recurrent Disc Herniation and Postoperative Epidural Fibrosis

Although magnetic resonance (MR) with contrast-enhancement has been used as standard imaging tool for distinguishing recurrent disc herniation from postoperative epidural fibrosis, it is relatively invasive and vulnerable to contrast material-related complication. Also, the differentiation between recurrent disc herniation and postoperative epidural fibrosis on non-enhanced MR is not always clear. Until now, no study has evaluated the diagnostic usefulness of MR texture analysis (MRTA) for differentiation between recurrent disc herniation from postoperative epidural fibrosis. Therefore, the purpose of this study is to evaluate the usefulness of MRTA for differentiation between recurrent disc herniation from postoperative epidural fibrosis. Regarding mean, skewness, MPP, and entropy, values on all sequences were significantly lower in recurrent disc herniation than those in postoperative epidural fibrosis (p<0.001). The best performing MRTA parameters were MPP on T2WI (AUC, 0.81; 95 % CI, 0.72-0.90) and on T1WI (AUC, 0.80; 95 % CI, 0.70- 0.88). There were excellent interobserver agreements for all measurements (ICC, 0.838–0.905).