Objective: To quantitatively evaluate the multifidi (MF) degeneration by using multi-echo 3.0 T magnetic resonance (MR) chemical shift-encoding water-fat imaging (Dixon) sequence in patients with degenerative scoliosis (DS) and contrast with those in non-DS volunteers. Methods: Sixty subjects who underwent 3.0 T MR lumbar examination using Dixon sequence from July 2018 to June 2020 in our hospital were included in this study

with thirty DS patients (DS group) and thirty non-DS volunteers (control group). The fat infiltration (FI) and cross sectional area (CSA) at the MF on levels L4 through L5 (L4/5) of all subjects were measured by two radiologists using the double-blind method to compare consistency. The mean percentage of FI (FI%)

relative CSA (RCSA)

functional CSA (FCSA)

asymmetry ratio of area (AAA) and asymmetry ratio of fat infiltration index (AAFI) of bilateral MF at L4/5 were calculated

and the differences were compared between DS and control groups. The statistical significance of Oswestry disability index (ODI)

sum of visual analogue scale scores (VAS) at lumbar and legs and Roland-Morris disability questionnaire (RMD) scores between DS patients and control volunteers were also compared. Receiver operating characteristic (ROC) curve of FI%

AAFI

ODI

RMD and VAS were calculated. Results: Interobserver agreement of FI%and CSA was excellent between the two radiologists (ICC>0.9). The FI%

RCSA

FCSA and AAFI of bilateral MF were statistically significant (P<0.05). ODI

VAS and RMD obtained from DS group showed a significantly higher scores than those from control group. Areas of FI%

AAFI

ODI

RMD and VAS under the ROC curve were respectively 0.818

0.754

0.984

0.947 and 0.933.Conclusion: The FI%and AAFI of bilateral MF at L4/5 level calculated by multi-echo Dixon image will reflect the worse pain and quality of life of DS patients

which has good consistency with clinical factors

with a valuable diagnostic efficacy to identify non-DS volunteers.