AG Multimodal Spine Imaging

Contact Details

 A. Gersing, B. SchwaigerBenedikt J. Schwaiger, MD
Alexandra S. Gersing, MD

Department of Diagnostic and Interventional Radiology
Technical University of Munich
Klinikum rechts der Isar
Ismaninger Str. 22, 81675 München

phone: +49 (0) 89 4140 2621

Research Background and Focus

Spinal disorders such as intervertebral disc degeneration, degenerative spondylolisthesis or vertebral fractures caused by osteoporosis or compromised bone strength are amongst the most prevalent musculoskeletal disorders. Resulting back pain and functional impairment such as stiffness are described as the greatest contributor worldwide. With the aging global population, these conditions closely interrelated with age-dependent degeneration will gain even more importance in the near future.

Imaging is a major component of the diagnosis of spinal disorders and also in advancing our knowledge about the underlying mechanisms of pathogenesis. There are multiple well-established imaging modalities available in clinical routine for morphological imaging (i.e., radiography, myelography, CT and MRI), compositional imaging (e.g., dual-energy x-ray absorptiometry (DXA) and quantitative CT (qCT) for bone mineral density (BMD) measurements) and functional imaging (e.g., diffusion-weighted imaging (DWI)). Routine MR imaging provides qualitative information on the hydration of intervertebral discs, yet not on the stability of vertebral bodies. Therefore, newer technologies are currently being developed, such as MR spectroscopy or chemical shift encoding-based water-fat separation for the quantitative assessment of vertebral bone marrow or ancillary BMD measurements, MDCT data and finite-element modeling.

Focus of our workgroup is the optimization of these methods in close cooperation with the other workgroups at our institution and our other cooperation partners, and their application to both in ex-vivo models, validated with biomechanical testing, and in-vivo in patients recruited during clinical routine.

Previous studies have shown the close interaction of vertebral bodies and intervertebral discs as parts of the functional spinal unit; e.g. degenerative changes of the disc significantly influence failure loads of the vertebral bodies. Therefore, multiparametric models encompassing MR- and CT-based quantitative parameters describing both the discs and vertebral bodies are hypothesized to assess degenerative changes and thus integrity of the spine in the most accurate way. To create such models, we will use state-of-the-art methods including deep-learning algorithms and random forest modeling.

Our goal is to create a model based on quantitative parameters describing regional degeneration of the spine to reliably assess the strength of the spinal column and predict the risk for vertebral fractures. In addition, we also believe that optimizing methods and applying them ex-vivo and in-vivo will contribute highly useful information to our understanding on the processes in the degenerative spine, especially regarding the interaction between different structures.

Group Members

Dr. med. Benedikt J. Schwaiger

Dr. med. Alexandra S. Gersing

PD Dr. med. Thomas Baum

PD Dr. med. Jan S. Kirschke


AG Osteoporose

AG Knorpelbildgebung

AG Karampinos

AG Noel

Musculoskeletal and Quantitative Imaging Research, Department of Radiology, University of California, San Francisco (Thomas M. Link, MD, PhD; Professor of Radiology; Chief, Musculoskeletal Radiology),
Url (10.2016):

AG Bildgebung der Wirbelsäule, Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (Jan S. Kirschke (Bauer), MD),
Url (10.2016):,

Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley (Tony M. Keaveny, PhD; Professor of Mechanical Engineering and Bioengineering)

Selected Publications (Pubmed)

Schwaiger BJ, Kopperdahl DL, Nardo L, Facchetti L, Gersing AS, Neumann J, Lee KJ, Keaveny TM, Link TM. Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations. Bone. 2017;101:62-69. doi:10.1016/j.bone.2017.04.008

Mei K, Kopp FK, Bippus R, Kohler T, Schwaiger BJ, Gersing AS, Fehringer A, Sauter A, Munzel D, Pfeiffer F, Rummeny EJ, Kirschke JS, Noel PB, Baum T. Is multidetector CT-based bone mineral density and quantitative bone microstructure assessment at the spine still feasible using ultra-low tube current and sparse sampling? Eur Radiol. 2017. doi:10.1007/s00330-017-4904-y

Karampinos DC, Ruschke S, Dieckmeyer M, Diefenbach M, Franz D, Gersing AS, Krug R, Baum T. Quantitative MRI and spectroscopy of bone marrow. J Magn Reson Imaging. 2017. doi:10.1002/jmri.25769

Karampinos DC, Holwein C, Buchmann S, Baum T, Ruschke S, Gersing AS, Sutter R, Imhoff AB, Rummeny EJ, Jungmann PM. Proton Density Fat-Fraction of Rotator Cuff Muscles Is Associated With Isometric Strength 10 Years After Rotator Cuff Repair: A Quantitative Magnetic Resonance Imaging Study of the Shoulder. Am J Sports Med. 2017:363546517703086. doi:10.1177/0363546517703086

Joseph GB, McCulloch CE, Nevitt MC, Gersing AS, Schwaiger BJ, Kretzschmar M, Heilmeier U, Link TM. Medial femur T2 Z-scores predict the probability of knee structural worsening over 4-8 years: Data from the osteoarthritis initiative. J Magn Reson Imaging. 2017. doi:10.1002/jmri.25662

Guimaraes JB, Facchetti L, Schwaiger BJ, Gersing AS, Majumdar S, Ma BC, Li X, Link TM. Evolution of Intrameniscal Signal-Intensity Alterations Detected on MRI Over 24 Months in Patients With Traumatic Anterior Cruciate Ligament Tear. AJR Am J Roentgenol. 2017;208(2):386-392. doi:10.2214/AJR.16.16625

Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Chanchek N, Guimaraes JB, Mbapte Wamba J, Facchetti L, McCulloch CE, Link TM. Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative. Radiology. 2017:161005. doi:10.1148/radiol.2017161005

Gersing AS, Schwaiger BJ, Heilmeier U, Joseph GB, Facchetti L, Kretzschmar M, Lynch JA, McCulloch CE, Nevitt MC, Steinbach LS, Link TM. Evaluation of Chondrocalcinosis and Associated Knee Joint Degeneration Using MR Imaging: Data from the Osteoarthritis Initiative. Eur Radiol. 2017;27(6):2497-2506. doi:10.1007/s00330-016-4608-8

Foreman SC, Schwaiger BJ, Meyer B, Gersing AS, Zimmer C, Gempt J, Kirschke JS. Computed Tomography and Magnetic Resonance Imaging Parameters Associated with Poor Clinical Outcome in Spondylodiscitis. World Neurosurg. 2017. doi:10.1016/j.wneu.2017.05.102

Foreman SC, Schwaiger BJ, Gempt J, Jungmann PM, Kehl V, Delbridge C, Wantia N, Zimmer C, Kirschke JS. MR and CT Imaging to Optimize CT-Guided Biopsies in Suspected Spondylodiscitis. World Neurosurg. 2017;99:726-734 e727. doi:10.1016/j.wneu.2016.11.017

Facchetti L, Schwaiger BJ, Gersing AS, Guimaraes JB, Nardo L, Majumdar S, Ma BC, Link TM, Li X, Consortium U-PA, Consortium A-A. Cyclops lesions detected by MRI are frequent findings after ACL surgical reconstruction but do not impact clinical outcome over 2 years. Eur Radiol. 2017;27(8):3499-3508. doi:10.1007/s00330-016-4661-3

Chanchek N, Gersing AS, Schwaiger BJ, Nevitt MC, Neumann J, Joseph GB, Lane NE, Zarnowski J, Hofmann FC, Heilmeier U, McCulloch CE, Link TM. Association of diabetes mellitus and biochemical knee cartilage composition assessed by T2 relaxation time measurements: Data from the osteoarthritis initiative. J Magn Reson Imaging. 2017. doi:10.1002/jmri.25766

Schwaiger BJ, Gersing AS, Mbapte Wamba J, Nevitt MC, McCulloch CE, Link TM. Can Signal Abnormalities Detected with MR Imaging in Knee Articular Cartilage Be Used to Predict Development of Morphologic Cartilage Defects? 48-Month Data from the Osteoarthritis Initiative. Radiology. 2016;281(1):158-167. doi:10.1148/radiol.2016152308

Schwaiger BJ, Gersing AS, Baum T, Krestan CR, Kirschke JS. Distinguishing Benign and Malignant Vertebral Fractures Using CT and MRI. Semin Musculoskelet Radiol. 2016;20(4):345-352. doi:10.1055/s-0036-1592433

Schwaiger BJ, Behr M, Gersing AS, Meyer B, Zimmer C, Kirschke JS, Ryang YM, Ringel F. Computed Tomography Findings Associated with Clinical Outcome After Dynamic Posterior Stabilization of the Lumbar Spine. World Neurosurg. 2016;93:306-314. doi:10.1016/j.wneu.2016.06.048

Gersing AS, Solka M, Joseph GB, Schwaiger BJ, Heilmeier U, Feuerriegel G, Nevitt MC, McCulloch CE, Link TM. Progression of cartilage degeneration and clinical symptoms in obese and overweight individuals is dependent on the amount of weight loss: 48-month data from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 2016;24(7):1126-1134. doi:10.1016/j.joca.2016.01.984

Waldt S, Gersing A, Brugel M. Measurements and classifications in spine imaging. Semin Musculoskelet Radiol. 2014;18(3):219-227. doi:10.1055/s-0034-1375565

Schwaiger BJ, Gersing AS, Baum T, Noel PB, Zimmer C, Bauer JS. Bone mineral density values derived from routine lumbar spine multidetector row CT predict osteoporotic vertebral fractures and screw loosening. AJNR Am J Neuroradiol. 2014;35(8):1628-1633. doi:10.3174/ajnr.A3893