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Zheng B, Ouyang L, Shi J, Shen X, Lei H. Evaluating lumbar disc degeneration by MRI quantitative metabolic indicators: the perspective of factor analysis. J Orthop Surg Res 2024; 19:281. [PMID: 38711140 DOI: 10.1186/s13018-024-04726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/06/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE This study aimed to investigate an early diagnostic method for lumbar disc degeneration (LDD) and improve its diagnostic accuracy. METHODS Quantitative biomarkers of the lumbar body (LB) and lumbar discs (LDs) were obtained using nuclear magnetic resonance (NMR) detection technology. The diagnostic weights of each biological metabolism indicator were screened using the factor analysis method. RESULTS Through factor analysis, common factors such as the LB fat fraction, fat content, and T2* value of LDs were identified as covariates for the diagnostic model for the evaluation of LDD. This model can optimize the accuracy and reliability of LDD diagnosis. CONCLUSION The application of biomarker quantification methods based on NMR detection technology combined with factor analysis provides an effective means for the early diagnosis of LDD, thereby improving diagnostic accuracy and reliability.
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Affiliation(s)
- Boxin Zheng
- Radiology Department, 909th Hospital (Affiliated Southeast Hospital, Xiamen University), Zhangzhou, China
- School of Mathematics and Statistics, Minnan Normal University, Zhangzhou, China
| | - Lin Ouyang
- Radiology Department, 909th Hospital (Affiliated Southeast Hospital, Xiamen University), Zhangzhou, China
- Institute of Medical Imaging Medical College, Xiamen University, Xiamen, China
| | - Jianhua Shi
- School of Mathematics and Statistics, Minnan Normal University, Zhangzhou, China.
- Fujian Key Laboratory of Granular Computing and Applications, Zhangzhou, China.
| | - Xiaochan Shen
- Radiology Department, 909th Hospital (Affiliated Southeast Hospital, Xiamen University), Zhangzhou, China
- School of Mathematics and Statistics, Minnan Normal University, Zhangzhou, China
| | - Hanbin Lei
- Radiology Department, 909th Hospital (Affiliated Southeast Hospital, Xiamen University), Zhangzhou, China
- School of Mathematics and Statistics, Minnan Normal University, Zhangzhou, China
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Sood A, Mishra GV, Suryadevara M, Parihar P, Khandelwal S, Manuja N, Saboo K, Shelar SS, Ahuja A, Batra N. Role of Apparent Diffusion Coefficient in Evaluating Degeneration of the Intervertebral Disc: A Narrative Review. Cureus 2023; 15:e43340. [PMID: 37700953 PMCID: PMC10493165 DOI: 10.7759/cureus.43340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Degeneration of the lumbar intervertebral disc is the most common cause of lower back pain. It is directly related to daily activities, mechanical stress, and other biological factors. We use imaging modalities to assess the degree of disc degeneration, out of which magnetic resonance imaging (MRI) is the most popular non-invasive modality. It is believed that early changes in disc degeneration are due to the biochemical events in the disc and can be evaluated by sequences in MRI involving the diffusion of water molecules. The apparent diffusion coefficient (ADC) is one such sequence that captures the signals based on the diffusion of water molecules. Ten articles were chosen from PubMed and Google Scholar using the MeSH terms 'lumbar spine degeneration' and 'apparent diffusion coefficient'. This review article has summarized various studies intending to gain a better understanding of the biochemical events leading to the development of disc degeneration. This study has also gathered the role of various sequences in MRI that can quantitatively assess disc degeneration.
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Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Manasa Suryadevara
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Pratap Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Shreya Khandelwal
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Nishtha Manuja
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Keyur Saboo
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sheetal S Shelar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Abhinav Ahuja
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Nitish Batra
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
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3
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Chang EY. Editorial on "Multiparametric MR Investigation of Proteoglycan Diffusivity, T 2 Relaxation, and Concentration in an ex vivo Model of Intervertebral Disc Degeneration". J Magn Reson Imaging 2019; 51:1401-1402. [PMID: 31794103 DOI: 10.1002/jmri.27010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Eric Y Chang
- Research Service, VA San Diego Healthcare System, San Diego, California, USA.,Department of Radiology, University of California, San Diego, California, USA
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4
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Wang M, Tsang A, Tam V, Chan D, Cao P, Wu EX. Multiparametric MR Investigation of Proteoglycan Diffusivity, T
2
Relaxation, and Concentration in an Ex Vivo Model of Intervertebral Disc Degeneration. J Magn Reson Imaging 2019; 51:1390-1400. [DOI: 10.1002/jmri.26979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Min Wang
- College of Biomedical Engineering and Instrument ScienceZhejiang University Hangzhou China
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR China
- Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University Baltimore Maryland USA
| | - Adrian Tsang
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR China
| | - Vivian Tam
- School of Biomedical Sciences, Li Ka Shing Faculty of MedicineThe University of Hong Kong SAR China
| | - Danny Chan
- School of Biomedical Sciences, Li Ka Shing Faculty of MedicineThe University of Hong Kong SAR China
| | - Peng Cao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR China
| | - Ed X. Wu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR China
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5
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Luo TD, Marquez-Lara A, Zabarsky ZK, Vines JB, Mowry KC, Jinnah AH, Ma X, Berwick BW, Willey JS, Li Z, Smith TL, O'Gara TJ. A percutaneous, minimally invasive annulus fibrosus needle puncture model of intervertebral disc degeneration in rabbits. J Orthop Surg (Hong Kong) 2019; 26:2309499018792715. [PMID: 30114959 DOI: 10.1177/2309499018792715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Various animal models have been proposed to mimic the pathophysiologic process of intervertebral disc degeneration, a leading cause of back pain. The purpose of this study is to describe a minimally invasive technique via percutaneous needle puncture of the annulus fibrosus in New Zealand white rabbits. METHODS Under fluoroscopic guidance, an 18-gauge spinal needle was inserted 2 cm lateral to the midline spinous process. The needle was slowly advanced at approximately 45° angle until it was adjacent to the L5/L6 disc space. Lateral and anteroposterior views were used to verify correct needle position before advancing into the nucleus pulposus. The rabbits underwent weekly X-rays for 4 weeks to assess disc height index. MRI T2 relaxation was evaluated at week four to assess morphological changes. Discs were histologically graded on a 12-point scale to assess degeneration and compared to discs obtained from uninjured rabbits. RESULTS There were no complications associated with the percutaneous needle puncture procedure. All animals survived the duration of the experiment. Four weeks after injury, the disc height had progressively narrowed to approximately 50% of baseline. MRI assessment at the 4-week time point demonstrated a mean T2 relaxation time at the L5/L6 level that was 20.9% of the T2 relaxation time at the uninjured L4/L5 disc level ( p < 0.001). Histological analysis demonstrated lamellar disorganization of the annulus and decreased cellularity and proteoglycan content within the injured nucleus compared to uninjured control discs. CONCLUSION The present study demonstrated a reliable technique of inducing an annular tear via a percutaneous needle puncture. Compared to open surgical approaches, the percutaneous model produces similar progressive disc degeneration while minimizing harm to the animal subjects. CLINICAL RELEVANCE The present study establishes a technique for the introduction of novel therapeutic agents to treat disc degeneration that may translate to future clinical trials.
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Affiliation(s)
- T David Luo
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alejandro Marquez-Lara
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Zachary K Zabarsky
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeremy B Vines
- 2 Organogenesis Surgical and Sports Medicine, Birmingham, AL, USA
| | - Katie C Mowry
- 2 Organogenesis Surgical and Sports Medicine, Birmingham, AL, USA
| | - Alexander H Jinnah
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Xue Ma
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Benjamin W Berwick
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jeffrey S Willey
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,3 Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Zhongyu Li
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas L Smith
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Tadhg J O'Gara
- 1 Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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6
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Gornet MG, Peacock J, Claude J, Schranck FW, Copay AG, Eastlack RK, Benz R, Olshen A, Lotz JC. Magnetic resonance spectroscopy (MRS) can identify painful lumbar discs and may facilitate improved clinical outcomes of lumbar surgeries for discogenic pain. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:674-687. [PMID: 30610465 DOI: 10.1007/s00586-018-05873-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/13/2018] [Accepted: 12/25/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The goal of this study was to refine clinical MRS to optimize performance and then determine whether MRS-derived biomarkers reliably identify painful discs, quantify degeneration severity, and forecast surgical outcomes for chronic low back pain (CLBP) patients. METHODS We performed an observational diagnostic development and accuracy study. Six hundred and twenty-three (623) discs in 139 patients were scanned using MRS, with 275 discs also receiving provocative discography (PD). MRS data were used to quantify spectral features related to disc structure (collagen and proteoglycan) and acidity (lactate, alanine, propionate). Ratios of acidity to structure were used to calculate pain potential. MRS-SCOREs were compared to PD and Pfirrmann grade. Clinical utility was judged by evaluating surgical success for 75 of the subjects who underwent lumbar surgery. RESULTS Two hundred and six (206) discs had both a successful MRS and independent pain diagnosis. When comparing to PD, MRS had a total accuracy of 85%, sensitivity of 82%, and specificity of 88%. These increased to 93%, 91%, and 93% respectively, in non-herniated discs. The MRS structure measures differed significantly between Pfirrmann grades, except grade I versus grade II. When all MRS positive discs were treated, surgical success was 97% versus 57% when the treated level was MRS negative, or 54% when the non-treated adjacent level was MRS positive. CONCLUSION MRS correlates with PD and may support improved surgical outcomes for CLBP patients. Noninvasive MRS is a potentially valuable approach to clarifying pain mechanisms and designing CLBP therapies that are customized to the patient. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | | | | | | | | | | | - Ryan Benz
- SoCal Bioinformatics, Inc, Glendale, CA, USA
| | - Adam Olshen
- University of California at San Francisco, San Francisco, CA, USA
| | - Jeffrey C Lotz
- University of California at San Francisco, San Francisco, CA, USA.
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7
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Molecular pain markers correlate with pH-sensitive MRI signal in a pig model of disc degeneration. Sci Rep 2018; 8:17363. [PMID: 30478330 PMCID: PMC6255799 DOI: 10.1038/s41598-018-34582-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 10/01/2018] [Indexed: 12/28/2022] Open
Abstract
Intervertebral disc (IVD) degeneration is a leading cause of chronic low back pain that affects millions of people every year. Yet identification of the specific IVD causing this pain is based on qualitative visual interpretation rather than objective findings. One possible approach to diagnosing pain-associated IVD could be to identify acidic IVDs, as decreased pH within an IVD has been postulated to mediate discogenic pain. We hypothesized that quantitative chemical exchange saturation transfer (qCEST) MRI could detect pH changes in IVDs, and thence be used to diagnose pathologically painful IVDs objectively and noninvasively. To test this hypothesis, a surgical model of IVD degeneration in Yucatan minipigs was used. Direct measurement of pH inside the degenerated IVDs revealed a significant drop in pH after degeneration, which correlated with a significant increase in the qCEST signal. Gene analysis of harvested degenerated IVDs revealed significant upregulation of pain-, nerve- and inflammatory-related markers after IVD degeneration. A strong positive correlation was observed between the expression of pain markers and the increase in the qCEST signal. Collectively, these findings suggest that this approach might be used to identify which IVD is causing low back pain, thereby providing valuable guidance for pain and surgical management.
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8
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Zhang YL, Li B, Zhou ZH. A cross-sectional study: serum CCL3/MIP-1α levels may reflect lumbar intervertebral disk degeneration in Han Chinese people. J Pain Res 2018; 11:497-503. [PMID: 29551909 PMCID: PMC5842780 DOI: 10.2147/jpr.s152349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background The macrophage inflammatory protein-1α (MIP-1α), also named chemokine cytokine ligand 3 (CCL3), has been detected in nucleus pulposus and increased following cytokine stimulation. Objective The current study was performed to explore the relationship between serum CCL3/MIP-1α levels with lumbar intervertebral disk degeneration (IDD). Patients and methods A total of 132 disk degeneration patients confirmed by magnetic resonance imaging and 126 healthy controls were enrolled in the current study. Radiological evaluation of the IDD was conducted using a 3.0-T magnetic resonance imaging scanner for entire lumbar vertebra region. Degeneration of intervertebral disk was assessed by Schneiderman criteria. Serum CCL3/MIP-1α levels were investigated using a sandwich enzyme-linked immunosorbent assay. The Visual Analog Scale scores and Oswestry Disability Index index were recorded for clinical severity. Results Elevated concentrations of CCL3 in serum were found in IDD patients compared with asymptomatic volunteers. The case group included 49 IDD patients with grade 1, 42 with grade 2, and 41 with grade 3. Grade 3 and 2 had significantly higher CCL3 concentrations in serum compared with those with grade 1. The serum CCL3 levels were positively related to the degree of disk degeneration. In addition, the serum CCL3 levels also demonstrated a significant correlation with the clinical severity determined by Visual Analog Scale scores and Oswestry Disability Index index. Conclusion Serum CCL3 may serve as a biomarker of IDD.
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Affiliation(s)
- Yi-Li Zhang
- School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.,School of Health Services Management, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Bei Li
- School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.,School of Health Services Management, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Zeng-Huan Zhou
- School of Public Health, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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9
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Chen B, Huang SG, Ju L, Li M, Nie FF, Zhang Y, Zhang YH, Chen X, Gao F. Effect of microRNA-21 on the proliferation of human degenerated nucleus pulposus by targeting programmed cell death 4. ACTA ACUST UNITED AC 2017; 49:S0100-879X2016000600602. [PMID: 27240294 PMCID: PMC4897996 DOI: 10.1590/1414-431x20155020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/16/2015] [Indexed: 12/28/2022]
Abstract
This study aims to explore the effect of microRNA-21 (miR-21) on the proliferation of
human degenerated nucleus pulposus (NP) by targeting programmed cell death 4 (PDCD4)
tumor suppressor. NP tissues were collected from 20 intervertebral disc degeneration
(IDD) patients, and from 5 patients with traumatic spine fracture. MiR-21 expressions
were tested. NP cells from IDD patients were collected and divided into blank control
group, negative control group (transfected with miR-21 negative sequences), miR-21
inhibitor group (transfected with miR-21 inhibitors), miR-21 mimics group
(transfected with miR-21 mimics) and PDCD4 siRNA group (transfected with PDCD4
siRNAs). Cell growth was estimated by Cell Counting Kit-8; PDCD4, MMP-2,MMP-9 mRNA
expressions were evaluated by qRT-PCR; PDCD4, c-Jun and p-c-Jun expressions were
tested using western blot. In IDD patients, the expressions of miR-21 and PDCD4 mRNA
were respectively elevated and decreased (both P<0.05). The miR-21 expressions
were positively correlated with Pfirrmann grades, but negatively correlated with
PDCD4 mRNA (both P<0.001). In miR-21 inhibitor group, cell growth, MMP-2 and MMP-9
mRNA expressions, and p-c-Jun protein expressions were significantly lower, while
PDCD4 mRNA and protein expressions were higher than the other groups (all P<0.05).
These expressions in the PDCD4 siRNA and miR-21 mimics groups was inverted compared
to that in the miR-21 inhibitor group (all P<0.05). MiR-21 could promote the
proliferation of human degenerated NP cells by targeting PDCD4, increasing
phosphorylation of c-Jun protein, and activating AP-1-dependent transcription of
MMPs, indicating that miR-21 may be a crucial biomarker in the pathogenesis of
IDD.
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Affiliation(s)
- B Chen
- Department of Orthopedics, Linyi Second People's Hospital, Linyi, China
| | - S G Huang
- Department of Orthopedics, Linyi Second People's Hospital, Linyi, China
| | - L Ju
- Department of Orthopedics, Linyi Second People's Hospital, Linyi, China
| | - M Li
- Department of Orthopedics, Linyi Second People's Hospital, Linyi, China
| | - F F Nie
- Department of Orthopedics, Linyi Second People's Hospital, Linyi, China
| | - Y Zhang
- Department of General Surgery, Affiliated Hospital of Taishan Medical University, Taian, China
| | - Y H Zhang
- Department of Orthopedics, Linyi Second People's Hospital, Linyi, China
| | - X Chen
- Department of Orthopedics, Linyi Second People's Hospital, Linyi, China
| | - F Gao
- Department of Orthopedics, Linyi Second People's Hospital, Linyi, China
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Hansen BB, Hansen P, Carrino JA, Fournier G, Rasti Z, Boesen M. Imaging in mechanical back pain: Anything new? Best Pract Res Clin Rheumatol 2016; 30:766-785. [DOI: 10.1016/j.berh.2016.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/21/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
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Rivers WE, Rimmalapudi V, Heit JJ. Progress in Advanced Imaging Techniques for the Lumbar Spine. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Reith W, Bodea S, Kettner M, Mühl-Benninghausen R, Simgen A. [Degenerative and age-related alterations of the spine]. Radiologe 2015; 54:1069-77. [PMID: 25398568 DOI: 10.1007/s00117-014-2730-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Degenerative alterations of the spine occur in an individual-specific manner with increasing age. This is not only dependent on external factors, such as hard physical labor over many years but can also be genetically influenced as demonstrated in recent studies. The spinal cord is well-protected within the spinal canal but can be impaired by degenerative alterations of the intervertebral discs and functional spinal segments. Depositions or narrowing of nerve structures can cause lasting pain or focal neurological deficits, such as paralysis or sensitivity disorders. These complaints can slowly develop over years, e.g. by a gradually increasing bony narrowing of the spinal canal (spinal canal stenosis) or can occur suddenly, e.g. an acute herniated disc. However, low back pain is much more common and occurs in approximately 80 % of people sometime during their lifetime. It is necessary to recognize the normal age-related anatomical alterations in magnetic resonance imaging (MRI), particularly for intervertebral discs in order to interpret these correctly. Knowledge of the spectrum of the various age-related degenerative processes which can occur in intervertebral discs and vertebral bodies is necessary to be able to differentiate them from pathological alterations. This is important because therapy decisions are often made as a direct result of MRI.
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Affiliation(s)
- W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, 66424, Homburg/Saar, Deutschland,
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13
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Koyama K, Nakazato K, Hiranuma K. Etiology and nature of intervertebral disc degeneration and its correlation with low back pain. THE JOURNAL OF PHYSICAL FITNESS AND SPORTS MEDICINE 2015. [DOI: 10.7600/jpfsm.4.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Koji Koyama
- Department of Judotherapy, Tokyo Ariake University of Medical and Health Sciences
| | - Koichi Nakazato
- Graduate School of Health and Sport Sciences, Nippon Sport Science University
| | - Kenji Hiranuma
- Graduate School of Health and Sport Sciences, Nippon Sport Science University
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14
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Rodrigues LMR, Yoshino CV, Costa AB. Lumbar alterations in magnetic resonance: correlation between Modic and Pfirrmann classifications. COLUNA/COLUMNA 2014. [DOI: 10.1590/s1808-18512014130300263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To evaluate the relationship of sex and age with Modic and Pfirrmann classifications and verify the relationship between the two classifications in the group of patients studied. METHODS: 300 magnetic resonance scans (MRI) of the lumbar segment of the patients were evaluated; each lumbar segment (L1-L2, L2-L3, L3-L4, L4-L5 and L5-S1) was assessed according to Modic and Pfirrmann classifications. RESULTS: The type III of Pfirrmann was the most prevalent, whereas Modic was absent on most levels analyzed. The Modic signal was present mainly in the lower levels (L4-L5 and L5-S1) and in females. CONCLUSION: There is a strong correlation between the changes of the endplate and intervertebral discs, evidenced by changes in MRI. The relationship between Pfirrmann and Modic classifications is statistically higher the greater the disc degeneration.
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15
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Wang AM, Cao P, Yee A, Chan D, Wu EX. Detection of extracellular matrix degradation in intervertebral disc degeneration by diffusion magnetic resonance spectroscopy. Magn Reson Med 2014; 73:1703-12. [PMID: 24817583 DOI: 10.1002/mrm.25289] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/16/2014] [Accepted: 04/22/2014] [Indexed: 01/07/2023]
Abstract
PURPOSE To investigate whether diffusion magnetic resonance spectroscopy (MRS) can detect the extracellular matrix (ECM) degradation during intervertebral disc degeneration (IVDD) by the increased mobility of ECM macromolecules such as proteoglycans and collagens. METHODS Fresh bovine intervertebral discs were injected with papain solution to induce ECM degradation. The apparent diffusion coefficients (ADCs), T2 values, and contents of ECM macromolecules and water resonances were measured longitudinally in the nucleus pulposus. RESULTS The macromolecule ADCs increased drastically at day 1 after papain injection, and continued increasing for 5 days. In contrast, the proteoglycan content exhibited a small and slow decrease after injection while the macromolecule T2 values, water T2, ADC, and content showed slight increase or no change. The protein gel electrophoresis analysis confirmed the gradually increased ECM fragmentation in accordance with the observed macromolecule ADC increases. CONCLUSION Diffusion MRS provides a new method to characterize the ECM degradation processes directly and sensitively. Macromolecule ADCs offer a potentially more sensitive and earlier marker for ECM degradation than the proteoglycan content and T2, and water MR properties during early IVDD. Such diffusion approach offers the possibility to directly monitor ECM integrity and degradation processes in vivo at molecular and microstructural levels in both preclinical and clinical settings.
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Affiliation(s)
- Anna M Wang
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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16
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Liu Q, Tawackoli W, Pelled G, Fan Z, Jin N, Natsuaki Y, Bi X, Gart A, Bae H, Gazit D, Li D. Detection of low back pain using pH level-dependent imaging of the intervertebral disc using the ratio of R1ρ dispersion and -OH chemical exchange saturation transfer (RROC). Magn Reson Med 2014; 73:1196-205. [PMID: 24700573 DOI: 10.1002/mrm.25186] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 11/08/2022]
Abstract
PURPOSE Low pH is associated with intervertebral disc (IVD)-generated low back pain (LBP). The purpose of this work was to develop an in vivo pH level-dependent magnetic resonance imaging (MRI) method for detecting discogenic LBP, without using exogenous contrast agents. METHODS The ratio of R1ρ dispersion and chemical exchange saturation transfer (CEST) (RROC) was used for pH-level dependent imaging of the IVD while eliminating the effect of labile proton concentration. The technique was validated by numerical simulations and studies on phantoms and ex vivo porcine spines. Four male (ages 42.8 ± 18.3) and two female patients (ages 55.5 ± 2.1) with LBP and scheduled for discography were examined with the method on a 3.0 Tesla MR scanner. RROC measurements were compared with discography outcomes using paired t-test. RESULTS Simulation and phantom results indicated RROC is a concentration independent and pH level-dependent technique. Porcine spine study results found higher RROC value was related to lower pH level. Painful discs based on discography had significant higher RROC values than those with negative diagnosis (P < 0.05). CONCLUSION RROC imaging is a promising pH level dependent MRI technique that has the potential to be a noninvasive imaging tool to detect painful IVDs in vivo.
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Affiliation(s)
- Qi Liu
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Biomedical Engineering, Northwestern University, Chicago, Illinois, USA
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A statistical model for intervertebral disc degeneration: determination of the optimal T2 cut-off values. Clin Neuroradiol 2013; 24:355-63. [PMID: 24218066 DOI: 10.1007/s00062-013-0266-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the possibility of quantitative classification in intervertebral disc degeneration using spin-spin relaxation time (T2) cut-off values with regard to morphological classifications. METHODS Lumbar magnetic resonance (MR) imaging was performed on 21 subjects (a total of 104 lumbar disks). The T2 relaxation time was measured in the nucleus pulposus using a sagittal multi-echo spin-echo sequence. The morphological classification of disc degeneration was assessed independently by three experienced neuroradiologists according to the Pfirrmann and Schneiderman classifications. Receiver operating characteristic analysis was performed among grades to determine T2 cut-off values in each classification. Intra- and interobserver differences were calculated using kappa statistics. RESULTS Moderate overall interobserver agreement was found between observers in both the Pfirrmann and Schneiderman classification schemes (kappa 0.46 and 0.51), while intraobserver reliability was substantial to almost perfect. The interobserver reliability was only fair in Pfirrmann grades III and IV (kappa 0.33 and 0.36), but the T2 cut-off values still indicated a significant difference between grades (p<0.05). CONCLUSIONS Interobserver agreement of MR evaluation in patients with intervertebral disc degeneration was only fair to moderate on the classification of more severe disc degeneration in the Pfirrmann and Schneiderman schemes. Based on our results, quantitative T2 cut-off values seem to be a more reliable method to define the degree of disc degeneration, which may help staging intervertebral disc degeneration (IVDD) even if the interobserver reliability is low.
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Brayda-Bruno M, Tibiletti M, Ito K, Fairbank J, Galbusera F, Zerbi A, Roberts S, Wachtel E, Merkher Y, Sivan SS. Advances in the diagnosis of degenerated lumbar discs and their possible clinical application. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23 Suppl 3:S315-23. [PMID: 23978994 DOI: 10.1007/s00586-013-2960-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/27/2013] [Accepted: 08/06/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE One possible source of chronic low back pain is a degenerated intervertebral disc. In this review, various diagnostic methods for the assessment of the presence of degenerative changes are described. These include clinical MRI, a number of novel MRI techniques and nuclear magnetic resonance spectroscopy. METHODS Non-systematic literature review. RESULTS Clinical MRI is the most commonly employed technique to determine the general "health status" of the intervertebral disc. Novel MRI techniques, such as quantitative MRI, T1ρ MRI, sodium MRI and nuclear magnetic resonance spectroscopy, are more sensitive in quantifying the biochemical changes of disc degeneration, as measured by alteration in collagen structure, as well as water and proteoglycan loss. As potential future diagnostic alternatives, miniature sensors are currently being developed to measure parameters associated with the disc degeneration cascade, such as intradiscal pressure and PG concentration. However, none of the methods listed above show sufficient specificity to identify a degenerated disc as the actual source of the pain. Provocative discography is the only test aimed at a direct diagnosis of discogenic pain, but it has a high false positive rate and there is some evidence of long-term adverse effects. Imaging techniques have also been tested for this purpose, but their validity has not been confirmed and they do appear to be problematic. CONCLUSIONS A reliable diagnostic tool that could help a clinician to determine if a disc is the source of the pain in patients with chronic LBP is still not available. New MRI techniques are under investigation that could result in a significant improvement over current methods, particularly as they can allow monitoring, not only of morphological but also of biochemical changes.
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Costa AB, Mattar T, Appolonio PR, Yoshino C, Yonezaki AM, Rodrigues LMR. Associação entre tropismo facetário e doença degenerativa de disco lombar. COLUNA/COLUMNA 2013. [DOI: 10.1590/s1808-18512013000200008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Documentar a presença de degeneração de disco e tropismo facetário em pacientes portadores de dor lombar crônica e sua distribuição por sexo e faixa etária. Avaliar também a associação de tropismo facetário e degeneração discal lombar além de avaliar a orientação das facetas de acordo com sexo e faixa etária. MÉTODOS: Estudo retrospectivo de imagens de ressonância magnética obtidas em 288 pacientes (N = 288; 118 homens e 170 mulheres) com média de idade de 53,33 anos, portadores de dor lombar crônica. As imagens foram avaliadas por dois médicos assistentes especialistas em cirurgia da coluna para avaliar e quantificar a orientação das facetas, o tropismo facetário e o grau de degeneração discal dos níveis L3-L4, L4-L5 e L5-S1. Foi analisada a associação entre tropismo facetário e doença degenerativa discal, além de associação com sexo e idade. RESULTADOS: Observa-se que 85,8% dos discos apresentam classificação de Pfirrmann superior ou igual ao Tipo III. Com relação ao grau de degeneração discal, não houve diferença entre os sexos e aumentou com o aumento da faixa etária. Com relação ao grau de tropismo, não difere entre os níveis avaliados e o sexo, aumenta de acordo com a elevação da faixa etária. Houve aumento do grau do degeneração discal com o aumento do grau de tropismo facetário. CONCLUSÃO: A maioria dos discos intervertebrais analisados de pacientes com dor lombar crônica encontram-se degenerados e grau de degeneração aumenta com a idade. O grau de tropismo facetário aumenta com a idade e se relaciona com o grau de degeneração discal.
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Gervais J, Périé D, Parent S, Labelle H, Aubin CE. MRI signal distribution within the intervertebral disc as a biomarker of adolescent idiopathic scoliosis and spondylolisthesis. BMC Musculoskelet Disord 2012. [PMID: 23206365 PMCID: PMC3551775 DOI: 10.1186/1471-2474-13-239] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Early stages of scoliosis and spondylolisthesis entail changes in the intervertebral disc (IVD) structure and biochemistry. The current clinical use of MR T2-weighted images is limited to visual inspection. Our hypothesis is that the distribution of the MRI signal intensity within the IVD in T2-weighted images depends on the spinal pathology and on its severity. Therefore, this study aims to develop the AMRSID (analysis of MR signal intensity distribution) method to analyze the 3D distribution of the MR signal intensity within the IVD and to evaluate their sensitivity to scoliosis and spondylolisthesis and their severities. Methods This study was realized on 79 adolescents who underwent a MRI acquisition (sagittal T2-weighted images) before their orthopedic or surgical treatment. Five groups were considered: low severity scoliosis (Cobb angle ≤50°), high severity scoliosis (Cobb angles >50°), low severity spondylolisthesis (Meyerding grades I and II), high severity spondylolisthesis (Meyerding grades III, IV and V) and control. The distribution of the MRI signal intensity within the IVD was analyzed using the descriptive statistics of histograms normalized by either cerebrospinal fluid or bone signal intensity, weighted centers and volume ratios. Differences between pathology and severity groups were assessed using one- and two-way ANOVAs. Results There were significant (p < 0.05) variations of indices between scoliosis, spondylolithesis and control groups and between low and high severity groups. The cerebrospinal fluid normalization was able to detect differences between healthy and pathologic IVDs whereas the bone normalization, which reflects both bone and IVD health, detected more differences between the severities of these pathologies. Conclusions This study proves for the first time that changes in the intervertebral disc, non visible to the naked eye on sagittal T2-weighted MR images of the spine, can be detected from specific indices describing the distribution of the MR signal intensity. Moreover, these indices are able to discriminate between scoliosis and spondylolisthesis and their severities, and provide essential information on the composition and structure of the discs whatever the pathology considered. The AMRSID method may have the potential to complement the current diagnostic tools available in clinics to improve the diagnostic with earlier biomarkers, the prognosis of evolution and the treatment options of scoliosis and spondylolisthesis.
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Affiliation(s)
- Julien Gervais
- Department of Mechanical Engineering, Ecole Polytechnique, Montreal, Canada.
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Eskola PJ, Lemmelä S, Kjaer P, Solovieva S, Männikkö M, Tommerup N, Lind-Thomsen A, Husgafvel-Pursiainen K, Cheung KMC, Chan D, Samartzis D, Karppinen J. Genetic association studies in lumbar disc degeneration: a systematic review. PLoS One 2012. [PMID: 23185509 PMCID: PMC3503778 DOI: 10.1371/journal.pone.0049995] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective Low back pain is associated with lumbar disc degeneration, which is mainly due to genetic predisposition. The objective of this study was to perform a systematic review to evaluate genetic association studies in lumbar disc degeneration as defined on magnetic resonance imaging (MRI) in humans. Methods A systematic literature search was conducted in MEDLINE, MEDLINE In-Process, SCOPUS, ISI Web of Science, The Genetic Association Database and The Human Genome Epidemiology Network for information published between 1990–2011 addressing genes and lumbar disc degeneration. Two investigators independently identified studies to determine inclusion, after which they performed data extraction and analysis. The level of cumulative genetic association evidence was analyzed according to The HuGENet Working Group guidelines. Results Fifty-two studies were included for review. Forty-eight studies reported at least one positive association between a genetic marker and lumbar disc degeneration. The phenotype definition of lumbar disc degeneration was highly variable between the studies and replications were inconsistent. Most of the associations presented with a weak level of evidence. The level of evidence was moderate for ASPN (D-repeat), COL11A1 (rs1676486), GDF5 (rs143383), SKT (rs16924573), THBS2 (rs9406328) and MMP9 (rs17576). Conclusions Based on this first extensive systematic review on the topic, the credibility of reported genetic associations is mostly weak. Clear definition of lumbar disc degeneration phenotypes and large population-based cohorts are needed. An international consortium is needed to standardize genetic association studies in relation to disc degeneration.
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Affiliation(s)
- Pasi J Eskola
- Oulu Center for Cell - Matrix Research, Biocenter and Department of Medical Biochemistry and Molecular Biology, University of Oulu, Oulu, Finland
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Conventional and ultrashort time-to-echo magnetic resonance imaging of articular cartilage, meniscus, and intervertebral disk. Top Magn Reson Imaging 2012; 21:275-89. [PMID: 22129641 DOI: 10.1097/rmr.0b013e31823ccebc] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Magnetic resonance imaging (MRI) examination of musculoskeletal tissues is being performed routinely for diagnoses of injury and diseases. Although conventional MRI using spin echo sequences has been effective, a number of important musculoskeletal soft tissues remain "magnetic resonance-invisible" because of their intrinsically short T2 values resulting in a rapid signal decay. This makes visualization and quantitative characterization difficult. With the advent and refinement of ultrashort time-to-echo (UTE) MRI techniques, it is now possible to directly visualize and quantitatively characterize these tissues. This review explores the anatomy, conventional MRI, and UTE MRI of articular cartilage, meniscus of the knee, and intervertebral disks and provides a survey of magnetic resonance studies used to better understand tissue structure, composition, and function, as well as subtle changes in diseases.
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In vivo intervertebral disc characterization using magnetic resonance spectroscopy and T1ρ imaging: association with discography and Oswestry Disability Index and Short Form-36 Health Survey. Spine (Phila Pa 1976) 2012; 37:214-21. [PMID: 21697767 PMCID: PMC3633556 DOI: 10.1097/brs.0b013e3182294a63] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vivo study of intervertebral disc degeneration by using quantitative magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). OBJECTIVE To quantify water and proteoglycan (PG) content in the intervertebral disc by using in vivo MRS and to evaluate the relationship between MRS-quantified water/PG content, T1ρ, Pfirrmann score, clinical self-assessment, and discography. SUMMARY OF BACKGROUND DATA Previous in vitro studies have investigated the relationship between MRS-quantified water/PG content and degenerative grade by using cadaveric intervertebral discs. T1ρ has been shown to relate to Pfirrmann grade and clinical self-assessment. However, the associations between MRS-quantified water/PG content, MRI-based T1ρ, self-assessment of health status, and clinical response to discography have not been studied in vivo. METHODS MRS and MRI were performed in 26 patients (70 discs) with symptomatic intervertebral degenerative disc (IVDD) and 23 controls (41 discs). Patients underwent evaluation of intervertebral discs with provocative discography. All subjects completed the Short Form-36 Health Survey and Oswestry Disability Index questionnaires. RESULTS The water/PG peak area ratio was significantly elevated in (a) patients (compared with controls) and in (b) discs with positive discography (compared with negative discography). Magnetic resonance (MR) T1ρ exhibited similar trends. A significant association was found between T1ρ and normalized PG content (R = 0.61, P < 0.05) but not between T1ρ and normalized water content (R = 0.24, P > 0.05). The water/PG peak area ratio, normalized water, normalized PG, and Pfirrmann grade were significantly associated with patient self-assessment of disability and physical composite score, while disc height was not. CONCLUSION This study demonstrated a relationship between in vivo MRS spectroscopy (water content and PG content), imaging parameters (T1ρ and Pfirrmann grade), discography results, and clinical self-assessment, suggesting that MRS-quantified water, PG, and MR T1ρ relaxation time may potentially serve as biomarkers of symptomatic IVDD.
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Majumdar S, Link TM, Steinbach LS, Hu S, Kurhanewicz J. Diagnostic tools and imaging methods in intervertebral disk degeneration. Orthop Clin North Am 2011; 42:501-11, viii. [PMID: 21944587 DOI: 10.1016/j.ocl.2011.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Low back pain has a negative impact on the economy and society. Intervertebral disk degeneration is linked to the occurrence of low back pain. MRI provides three-dimensional morphologic and biochemical information regarding the status of the disk. This article reviews new and evolving MRI disk-imaging techniques, including grading, relaxation-time measurements, diffusion, and contrast perfusion. In addition, high-resolution magic-angle spinning methods to correlate in vitro disk degeneration (with pain, etc) and in vivo spectroscopic results are discussed. With the potential for morphologic and biochemical characterization of the intervertebral disk, MRI shows promise as a tool to quantitatively assess disk health.
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Affiliation(s)
- Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, USA.
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Niu G, Yang J, Wang R, Dang S, Wu EX, Guo Y. MR imaging assessment of lumbar intervertebral disk degeneration and age-related changes: apparent diffusion coefficient versus T2 quantitation. AJNR Am J Neuroradiol 2011; 32:1617-23. [PMID: 21799044 DOI: 10.3174/ajnr.a2556] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE T2 and ADC mappings are 2 quantitative MR imaging tools for assessing IVDD. This study aimed to compare these 2 measures in detecting IVDD and its age-related changes. MATERIALS AND METHODS Thirty-seven asymptomatic volunteers and 28 patients with back pain or sciatica were examined, and their lumbar disk T2 and ADC maps were quantified via sagittal imaging protocols at 1.5T. For all participants, the Pfirrmann system was used by 2 radiologists for grading disks. T2 and ADC values in the inner portion of disks were measured, and their variances in different grades were analyzed by 1-way ANOVA testing. The ability of T2 and ADC measures to differentiate IVDD grades was compared on the basis of their ROC curves. For asymptomatic subjects, the correlations between age and the 2 MR imaging measures were assessed by the Pearson correlation test. RESULTS Both T2 and ADC values were found to decrease with the increasing Pfirrmann grades except T2 in grade V. Significant T2 differences were seen among grades I-IV, but not between grades IV and V. There were no significant ADC differences among grades I-III. Moreover, the areas under the ROC curves differed significantly (0.95 and 0.67 for T2 and ADC, respectively). Linear regression analysis revealed that T2 yielded more significant correlation with age (r = -0.77) than ADC did (r = -0.37). CONCLUSIONS T2 quantitation provides a more sensitive and robust approach for detecting and characterizing the early stage of IVDD and age-related disk changes.
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Affiliation(s)
- G Niu
- Department of Diagnostic Radiology, First Hospital of Medical School, Xi’an Jiaotong University, Xi’an, China
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Leite MS, Luciano RP, Martins DE, Wajchenberg M, Puertas EB. Correlação entre as classificações de Pfirrmann e Modic na degeneração do disco intervertebral lombar. COLUNA/COLUMNA 2010. [DOI: 10.1590/s1808-18512010000400010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: correlacionar as alterações encontradas nas ressonâncias magnéticas lombares quanto às classificações de Pfirrmann e Modic. MÉTODOS: foram selecionadas 54 ressonâncias lombossacras de pacientes ambulatoriais (23 homens e 31 mulheres) que já se encontravam em investigação por sua comorbidade. Foram classificados 264 discos intervertebrais (L1 a S1) quanto ao grau de degeneração segundo Pfirrmann. A presença de alterações de sinal de corpo vertebral foi registrada quanto à classificação de Modic. Foi aplicado teste χ2, adotando níveis de significância inferiores a 0,05 (a=5%). RESULTADOS: a média de idade pesquisada foi de 48,4 anos (26 a 77 anos). Observou-se maior prevalência de Pfirrmann tipo IV (31,1%). Em 88,3% da amostra o sinal de Modic estava ausente, assim como Modic 3; 60% das alterações Modic 2 foram relacionadas ao Pfirrmann tipo V, e 36,4% das alterações Modic 1 foram igualmente distribuídas entre Pfirrmann tipo IV e V. Encontrou-se associação estatisticamente significante entre as alterações de Modic e de Pfirrmann (p<0,001). CONCLUSÃO: houve uma clara associação entre as classificações estudadas ao se comparar os estágios mais avançados de Pfirrmann (IV e V) com Modic tipo 1 e 2.
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Prantner V, Isaksson H, Närväinen J, Lammentausta E, Nissi MJ, Avela J, Gröhn OHJ, Jurvelin JS. NMR relaxation times of trabecular bone—reproducibility, relationships to tissue structure and effects of sample freezing. Phys Med Biol 2010; 55:7363-75. [DOI: 10.1088/0031-9155/55/23/012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Stelzeneder D, Trattnig S. Biochemische MR-Bildgebung der Bandscheibe und Facettengelenke der Wirbelsäule. Radiologe 2010; 50:1115-9. [DOI: 10.1007/s00117-010-2033-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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