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Background <p>Computed tomography (CT) is favored for diagnosing lumbar spondylolysis owing to its high resolution, rapid scanning, and cost-effectiveness. Nonetheless, the high levels of radiation exposure associated with it limit its use, especially in younger populations. To mitigate these concerns, deep learning models that use magnetic resonance imaging (MRI) to produce synthetic CT images have been developed. These synthetic images, which avoid radiation risks, mimic true CT imaging capabilities and can be generated during routine MRI procedures that provide excellent soft tissue contrast. However, the application of synthetic CT in diagnosing lumbar spondylolysis remains underexplored. In this case series, we evaluated the potential utility of synthetic CT as an imaging tool for assessing lumbar arch deformities.</p> Presentation of cases <p>Case 1 involved a 60-year-old woman with a 3&#xa0;year history of persistent low back pain, who reported discomfort in her legs and lower back. Symptoms worsened after weight-bearing activities and pressure on the fifth lumbar vertebra. Imaging, including MRI, conventional CT, and synthetic CT, revealed a bilateral fifth lumbar spondylolysis with 1° anterior slipping of the fifth lumbar vertebra. Synthetic CT highlighted a cortical discontinuity of the pars interarticularis. Case 2 featured a 29-year-old woman with occasional lower back pain and normal radiographic findings. Synthetic CT demonstrated higher sensitivity but less sharpness in depicting the fracture line than conventional CT. Case 3 involved a 27-year-old man with progressive lower back pain and leg discomfort. Both conventional and synthetic CT accurately diagnosed a left isthmus fracture, demonstrating the potential of synthetic CT for precise diagnosis without radiation risks in young patients.</p> Conclusions <p>These findings have significant implications for clinical practice, as they substantiate the feasibility and clinical utility of synthetic CT as an innovative imaging modality for individuals with lumbar spondylolysis. This method offers a non-radiation alternative to CT for evaluating lumbar spondylolysis, particularly in younger individuals.</p>

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Radiation-free diagnosis of lumbar spondylolysis: case series evaluating MRI-based synthetic CT efficacy

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年11月18日

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  • Gan Cao,
  • Jichao Zhu,
  • Anyu Yin,
  • Shanghuang Xie,
  • Xiaolin Yang,
  • Helin Liu,
  • Feiyuan Zhang,
  • Ling Luo,
  • Zhaotong Li,
  • Jun Xia

摘要

Background

Computed tomography (CT) is favored for diagnosing lumbar spondylolysis owing to its high resolution, rapid scanning, and cost-effectiveness. Nonetheless, the high levels of radiation exposure associated with it limit its use, especially in younger populations. To mitigate these concerns, deep learning models that use magnetic resonance imaging (MRI) to produce synthetic CT images have been developed. These synthetic images, which avoid radiation risks, mimic true CT imaging capabilities and can be generated during routine MRI procedures that provide excellent soft tissue contrast. However, the application of synthetic CT in diagnosing lumbar spondylolysis remains underexplored. In this case series, we evaluated the potential utility of synthetic CT as an imaging tool for assessing lumbar arch deformities.

Presentation of cases

Case 1 involved a 60-year-old woman with a 3 year history of persistent low back pain, who reported discomfort in her legs and lower back. Symptoms worsened after weight-bearing activities and pressure on the fifth lumbar vertebra. Imaging, including MRI, conventional CT, and synthetic CT, revealed a bilateral fifth lumbar spondylolysis with 1° anterior slipping of the fifth lumbar vertebra. Synthetic CT highlighted a cortical discontinuity of the pars interarticularis. Case 2 featured a 29-year-old woman with occasional lower back pain and normal radiographic findings. Synthetic CT demonstrated higher sensitivity but less sharpness in depicting the fracture line than conventional CT. Case 3 involved a 27-year-old man with progressive lower back pain and leg discomfort. Both conventional and synthetic CT accurately diagnosed a left isthmus fracture, demonstrating the potential of synthetic CT for precise diagnosis without radiation risks in young patients.

Conclusions

These findings have significant implications for clinical practice, as they substantiate the feasibility and clinical utility of synthetic CT as an innovative imaging modality for individuals with lumbar spondylolysis. This method offers a non-radiation alternative to CT for evaluating lumbar spondylolysis, particularly in younger individuals.