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Fidai AB, Kim B, Lintz M, Kirnaz S, Gadjradj P, Boadi BI, Koga M, Hussain I, Härtl R, Bonassar LJ. Flexible support material maintains disc height and supports the formation of hydrated tissue engineered intervertebral discs in vivo. JOR Spine 2024; 7:e1363. [PMID: 39104832 PMCID: PMC11299905 DOI: 10.1002/jsp2.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/19/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
Background Mechanical augmentation upon implantation is essential for the long-term success of tissue-engineered intervertebral discs (TE-IVDs). Previous studies utilized stiffer materials to fabricate TE-IVD support structures. However, these materials undergo various failure modes in the mechanically challenging IVD microenvironment. FlexiFil (FPLA) is an elastomeric 3D printing filament that is amenable to the fabrication of support structures. However, no present study has evaluated the efficacy of a flexible support material to preserve disc height and support the formation of hydrated tissues in a large animal model. Methods We leveraged results from our previously developed FE model of the minipig spine to design and test TE-IVD support cages comprised of FPLA and PLA. Specifically, we performed indentation to assess implant mechanical response and scanning electron microscopy to visualize microscale damage. We then implanted FPLA and PLA support cages for 6 weeks in the minipig cervical spine and monitored disc height via weekly x-rays. TE-IVDs cultured in FPLA were also implanted for 6 weeks with weekly x-rays and terminal T2 MRIs to quantify tissue hydration at study endpoint. Results Results demonstrated that FPLA cages withstood nearly twice the deformation of PLA without detrimental changes in mechanical performance and minimal damage. In vivo, FPLA cages and stably implanted TE-IVDs restored native disc height and supported the formation of hydrated tissues in the minipig spine. Displaced TE-IVDs yielded disc heights that were superior to PLA or discectomy-treated levels. Conclusions FPLA holds great promise as a flexible and bioresorbable material for enhancing the long-term success of TE-IVD implants.
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Affiliation(s)
- Alikhan B. Fidai
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
| | - Byumsu Kim
- Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaNew YorkUSA
| | - Marianne Lintz
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medical CollegeNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Pravesh Gadjradj
- Department of Neurological Surgery, Weill Cornell Medical CollegeNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Blake I. Boadi
- Department of Neurological Surgery, Weill Cornell Medical CollegeNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Maho Koga
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical CollegeNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical CollegeNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Lawrence J. Bonassar
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew YorkUSA
- Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaNew YorkUSA
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Abel F, Altorfer FCS, Rohatgi V, Gibbs W, Chazen JL. Imaging of Discogenic and Vertebrogenic Pain. Radiol Clin North Am 2024; 62:217-228. [PMID: 38272616 DOI: 10.1016/j.rcl.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Chronic low back pain is a major source of pain and disability globally involving multifactorial causes. Historically, intervertebral disc degeneration and disruption have been associated as primary back pain triggers of the anterior column, termed "discogenic pain." Recently, the vertebral endplates have been identified as another possible pain trigger of the anterior column. This "endplate-driven" model, defined "vertebrogenic pain," is often interconnected with disc degeneration. Diagnosis of vertebrogenic and discogenic pain relies on imaging techniques that isolate pain generators and exclude comorbid conditions. Traditional methods, like radiographs and discography, are augmented by more sensitive methods, including SPECT, CT, and MRI. Morphologic MRI is pivotal in revealing indicators of vertebrogenic (eg, Modic endplate changes) and discogenic pain (eg, disc degeneration and annular fissures). More advanced methods, like ultra-short-echo time imaging, and quantitative MRI further amplify MRI's accuracy in the detection of painful endplate and disc pathology. This review explores the pathophysiology of vertebrogenic and discogenic pain as well as the impact of different imaging modalities in the diagnosis of low back pain. We hope this information can help identify patients who may benefit from personalized clinical treatment and image-guided therapies.
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Affiliation(s)
- Frederik Abel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, NY 10021, USA
| | - Franziska C S Altorfer
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, NY 10021, USA; Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
| | - Varun Rohatgi
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, NY 10065, USA
| | - Wende Gibbs
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA
| | - Joseph Levi Chazen
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, NY 10021, USA.
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Ma Y, Carl M, Tang Q, Moazamian D, Athertya JS, Jang H, Bukata SV, Chung CB, Chang EY, Du J. Whole knee joint mapping using a phase modulated UTE adiabatic T 1ρ (PM-UTE-AdiabT 1ρ ) sequence. Magn Reson Med 2024; 91:896-910. [PMID: 37755319 PMCID: PMC10843531 DOI: 10.1002/mrm.29871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To develop a 3D phase modulated UTE adiabatic T1ρ (PM-UTE-AdiabT1ρ ) sequence for whole knee joint mapping on a clinical 3 T scanner. METHODS This new sequence includes six major features: (1) a magnetization reset module, (2) a train of adiabatic full passage pulses for spin locking, (3) a phase modulation scheme (i.e., RF cycling pair), (4) a fat saturation module, (5) a variable flip angle scheme, and (6) a 3D UTE Cones sequence for data acquisition. A simple exponential fitting was used for T1ρ quantification. Phantom studies were performed to investigate PM-UTE-AdiabT1ρ 's sensitivity to compositional changes and reproducibility as well as its correlation with continuous wave-T1ρ measurement. The PM-UTE-AdiabT1ρ technique was then applied to five ex vivo and five in vivo normal knees to measure T1ρ values of femoral cartilage, meniscus, posterior cruciate ligament, anterior cruciate ligament, patellar tendon, and muscle. RESULTS The phantom study demonstrated PM-UTE-AdiabT1ρ 's high sensitivity to compositional changes, its high reproducibility, and its strong linear correlation with continuous wave-T1ρ measurement. The ex vivo and in vivo knee studies demonstrated average T1ρ values of 105.6 ± 8.4 and 77.9 ± 3.9 ms for the femoral cartilage, 39.2 ± 5.1 and 30.1 ± 2.2 ms for the meniscus, 51.6 ± 5.3 and 29.2 ± 2.4 ms for the posterior cruciate ligament, 79.0 ± 9.3 and 52.0 ± 3.1 ms for the anterior cruciate ligament, 19.8 ± 4.5 and 17.0 ± 1.8 ms for the patellar tendon, and 91.1 ± 8.8 and 57.6 ± 2.8 ms for the muscle, respectively. CONCLUSION The 3D PM-UTE-AdiabT1ρ sequence allows volumetric T1ρ assessment for both short and long T2 tissues in the knee joint on a clinical 3 T scanner.
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Affiliation(s)
- Yajun Ma
- Department of Radiology, University of California San Diego, CA, USA
| | | | - Qingbo Tang
- Department of Radiology, University of California San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, CA, USA
| | - Dina Moazamian
- Department of Radiology, University of California San Diego, CA, USA
| | - Jiyo S Athertya
- Department of Radiology, University of California San Diego, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, CA, USA
| | - Susan V Bukata
- Department of Orthopaedic Surgery, University of California San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, CA, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, CA, USA
- Department of Bioengineering, University of California San Diego, CA, USA
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4
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Han H, Zhao X, Ma H, Zhang Y, Lei B. Multifunctional injectable hydrogels with controlled delivery of bioactive factors for efficient repair of intervertebral disc degeneration. Heliyon 2023; 9:e21867. [PMID: 38027562 PMCID: PMC10665751 DOI: 10.1016/j.heliyon.2023.e21867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/07/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Millions of people worldwide suffer from intervertebral disc degeneration (IVDD), which imposes a significant socioeconomic burden on society. There is an urgent clinical demand for more effective treatments for IVDD because conventional treatments can only alleviate the symptoms rather than preventing the progression of IVDD. Hydrogels, a class of elastic biomaterials with good biocompatibility, are promising candidates for intervertebral disc repair and regeneration. In recent years, various hydrogels have been investigated in vitro and in vivo for the repair of intervertebral discs, some of which are ready for clinical testing. This review summarizes the latest findings and developments in using bioactive factors-released bioactive injectable hydrogels for the repair and regeneration of intervertebral discs. It focuses on the analysis and summary of the use of multifunctional injectable hydrogels to delivery bioactive factors (cells, exosomes, growth factors, genes, drugs) for disc regeneration, providing guidance for future study. Finally, we discussed and analyzed the optimal timing for the application of controlled-release hydrogels in the treatment of IVDD to meet the high standards required for intervertebral disc regeneration and precision medicine.
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Affiliation(s)
- Hao Han
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xiaoming Zhao
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Hongyun Ma
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yingang Zhang
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Bo Lei
- Department of Orthopaedics of the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, China
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, 710000, China
- Fronter Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, 710000, China
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5
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Russo F, Ambrosio L, Giannarelli E, Vorini F, Mallio CA, Quattrocchi CC, Vadalà G, Papalia R, Denaro V. Innovative quantitative magnetic resonance tools to detect early intervertebral disc degeneration changes: a systematic review. Spine J 2023; 23:1435-1450. [PMID: 37247638 DOI: 10.1016/j.spinee.2023.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is the leading cause of disability worldwide, with a tremendous socioeconomic burden. It is mainly caused by intervertebral disc degeneration (IDD), a progressive and age-related process. Due to its ability to accurately characterize intervertebral disc morphology, magnetic resonance imaging (MRI) has been established as one of the most valuable tools in diagnosing IDD. Innovative quantitative MRI (qMRI) techniques able to detect the earliest signs of IDD have been increasingly reported. PURPOSE To systematically review available reports on the application of novel qMRI techniques to detect early IDD changes. STUDY DESIGN Systematic literature review. METHODS A systematic search of PubMed/MEDLINE, Scopus, CINAHL, EMBASE, CENTRAL and Cochrane databases was performed through January 21, 2023. Randomized and nonrandomized studies on innovative qMRI tools able to diagnose early biochemical and architectural IDD changes in patients with or without discogenic LBP were searched. Data on study population, follow-up time (when applicable) and MRI sequence used were recorded. The QUADAS-2 tool was utilized to assess the risk of bias of included studies. RESULTS A total of 39 articles published between 2005 and 2022 resulted from the search. All novel qMRI techniques showed an increased capacity to detect early IDD changes thanks to the ability to assess subtle alterations of water content, proteoglycan and glycosaminoglycan concentration, and increased levels of catabolic biomarkers compared to conventional MRI. CONCLUSIONS Innovative qMRI techniques have proven effective in identifying premature IDD changes. Further studies are needed to validate their application in wider populations and confirm their applicability in the clinical setting.
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Affiliation(s)
- Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Eugenio Giannarelli
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo A Mallio
- Department of Diagnostic Imaging and Interventional Radiology, Research Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo C Quattrocchi
- Department of Diagnostic Imaging and Interventional Radiology, Research Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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6
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Bouhsina N, Tur L, Hardel JB, Madec S, Rouleau D, Etienne F, Guicheux J, Clouet J, Fusellier M. Variable flip angle T1 mapping and multi-echo T2 and T2* mapping magnetic resonance imaging sequences allow quantitative assessment of canine lumbar disc degeneration. Vet Radiol Ultrasound 2023; 64:864-872. [PMID: 37549962 DOI: 10.1111/vru.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023] Open
Abstract
Magnetic resonance imaging is the gold standard for diagnosing intervertebral disc (IVD) degeneration in dogs. However, published methods for quantifying severity or progression of IVD degeneration are currently limited. Mapping MRI sequences are used in humans for quantifying IVD degeneration but have rarely been applied in dogs. The objective of this prospective, method comparison study was to evaluate variable flip angle T1 mapping and multiecho T2 and T2* mapping as methods for quantifying canine lumbar IVD degeneration in twenty canine patients without clinical signs of spinal disease. Ventral and dorsal lumbar IVD widths were measured on radiographs, and lumbar IVDs were assigned a qualitative Pfirrmann grade based on standard T2-weighted sequences. T1, T2, and T2* relaxation times of the nucleus pulposus (NP) were measured on corresponding maps using manual-drawn ROIs. Strong intra- and interrater agreements were found (P < 0.01) for NP relaxation times. Radiographic IVD widths and T1, T2, and T2* mapping NP relaxation times were negatively correlated with Pfirrmann grading (P < 0.01). Significant differences in T1 NP relaxation times were found between Pfirrmann grade I and the other grades (P < 0.01). Significant differences in T2 and T2* NP relaxation times were found between grade I and the other grades and between grades II and III (P < 0.01). Findings indicated that T1, T2, and T2* MRI mapping sequences are feasible in dogs. Measured NP relaxation times were repeatable and decreased when Pfirrmann grades increased. These methods may be useful for quantifying the effects of regenerative treatment interventions in future longitudinal studies.
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Affiliation(s)
- Nora Bouhsina
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes, France
- Department of Diagnostic Imaging, CRIP, ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Léa Tur
- Department of Diagnostic Imaging, CRIP, ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Jean-Baptiste Hardel
- Department of Diagnostic Imaging, CRIP, ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Stéphane Madec
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes, France
- Department of Diagnostic Imaging, CRIP, ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Dominique Rouleau
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes, France
- Department of Diagnostic Imaging, CRIP, ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Floriane Etienne
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes, France
- Department of Diagnostic Imaging, CRIP, ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Jérôme Guicheux
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes, France
| | - Johann Clouet
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes, France
| | - Marion Fusellier
- Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, Nantes, France
- Department of Diagnostic Imaging, CRIP, ONIRIS, College of Veterinary Medicine, Food Science and Engineering, Nantes, France
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7
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Bonnheim NB, Lazar AA, Kumar A, Akkaya Z, Zhou J, Guo X, O'Neill C, Link TM, Lotz JC, Krug R, Fields AJ. ISSLS Prize in Bioengineering Science 2023: Age- and sex-related differences in lumbar intervertebral disc degeneration between patients with chronic low back pain and asymptomatic controls. 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 2023; 32:1517-1524. [PMID: 36805320 PMCID: PMC10205694 DOI: 10.1007/s00586-023-07542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 10/18/2022] [Accepted: 01/13/2023] [Indexed: 02/20/2023]
Abstract
PURPOSE Clinical management of disc degeneration in patients with chronic low back pain (cLBP) is hampered by the challenge of distinguishing pathologic changes relating to pain from physiologic changes related to aging. The goal of this study was to use imaging biomarkers of disc biochemical composition to distinguish degenerative changes associated with cLBP from normal aging. METHODS T1ρ MRI data were acquired from 133 prospectively enrolled subjects for this observational study (80 cLBP, 53 controls; mean ± SD age = 43.9 ± 13.4 years; 61 females, 72 males). The mean T1ρ relaxation time in the nucleus pulposus (NP-T1ρ; n = 650 discs) was used as a quantitative biomarker of disc biochemical composition. Linear regression was used to assess associations between NP-T1ρ and age, sex, spinal level, and study group, and their interactions. RESULTS NP-T1ρ values were lower in cLBP patients than controls (70.8 ± 22.8 vs. 76.4 ± 22.2 ms, p = 0.009). Group differences were largest at L5-S1 (ΔT1ρcLBP-control = -11.3 ms, p < 0.0001), representing biochemical deterioration typically observed over a 9-12 year period (NP-T1ρ declined by 0.8-1.1 ms per year [95% CI]). Group differences were large in younger patients and diminished with age. Finally, the age-dependence of disc degeneration was stronger in controls than cLBP patients. CONCLUSION Aging effects on the biochemical composition of the L5-S1 disc may involve a relatively uniform set of factors from which many cLBP patients deviate. NP-T1ρ values at L5-S1 may be highly relevant to clinical phenotyping, particularly in younger individuals.
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Affiliation(s)
- Noah B Bonnheim
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Ann A Lazar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Anika Kumar
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Zehra Akkaya
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jiamin Zhou
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Xiaojie Guo
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Conor O'Neill
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California, San Francisco, USA.
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8
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Chen S, Sun D, Wang N, Fang X, Xi Z, Wang C, Chen H, Xie L. Current status and trends in quantitative MRI study of intervertebral disc degeneration: a bibliometric and clinical study analysis. Quant Imaging Med Surg 2023; 13:2953-2974. [PMID: 37179935 PMCID: PMC10167433 DOI: 10.21037/qims-22-1219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
Background Quantitative magnetic resonance imaging (MRI) has the function of noninvasive quantitative evaluation, providing unique advantages in intervertebral disc degeneration (IDD) assessment. Although studies exploring the field for domestic and international scholars are increasingly being published, there is a lack of systematic scientific measurement and clinical analysis of the literature in this field. Methods Articles published from the respective database establishment to September 30, 2022, were obtained from the Web of Science core collection (WOSCC), PubMed database, and ClinicalTrials.gov. The scientometric software (VOSviewer 1.6.18, CiteSpace 6.1.R3, Scimago Graphica, and R software) were used for bibliometric and knowledge graph visualization analysis. Results We included 651 articles from the WOSCC database and 3 clinical studies from ClinicalTrials.gov for literature analysis. With the passage of time, the number of articles in this field gradually increased. The United States and China were the top 2 countries in terms of the number of publications and citations, and Chinese publications lacked international cooperation and exchange. The author with the most publications was Schleich C, while the author with the most citations was Borthakur A, who have both made important contributions to research in this field. The journal publishing the most relevant articles was Spine, and the journal with the most mean times cited per study was Radiology, both of which are the authoritative journals in this field. Keyword co-occurrence, clustering, timeline view, and emergent analysis revealed that recent studies in this field have focused on quantifying the biochemical components of the degenerated intervertebral disc (IVD). There were few available clinical studies. The more recent clinical studies mainly used molecular imaging technology to explore the relationship between different quantitative MRI sequence values and the IVD biomechanical environment and biochemical components content. Conclusions The study provided a knowledge map of quantitative MRI for IDD research in terms of countries, authors, journals, cited literature, and keywords through bibliometric analysis, and systematically sorted the current status, hotspots, and clinical research features in the field to provide a reference for future research.
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Affiliation(s)
- Shuang Chen
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Daoxi Sun
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Nan Wang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaoyang Fang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chenyu Wang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Heng Chen
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lin Xie
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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9
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Meadows KD, Peloquin JM, Newman HR, Cauchy PJK, Vresilovic EJ, Elliott DM. MRI
‐based measurement of in vivo disc mechanics in a young population due to flexion, extension, and diurnal loading. JOR Spine 2023; 6:e1243. [PMID: 36994458 PMCID: PMC10041375 DOI: 10.1002/jsp2.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Intervertebral disc degeneration is often implicated in low back pain; however, discs with structural degeneration often do not cause pain. It may be that disc mechanics can provide better diagnosis and identification of the pain source. In cadaveric testing, the degenerated disc has altered mechanics, but in vivo, disc mechanics remain unknown. To measure in vivo disc mechanics, noninvasive methods must be developed to apply and measure physiological deformations. Aim Thus, this study aimed to develop methods to measure disc mechanical function via noninvasive MRI during flexion and extension and after diurnal loading in a young population. This data will serve as baseline disc mechanics to later compare across ages and in patients. Materials & Methods To accomplish this, subjects were imaged in the morning in a reference supine position, in flexion, in extension, and at the end of the day in a supine position. Disc deformations and vertebral motions were used to quantify disc axial strain, changes in wedge angle, and anterior-posterior (A-P) shear displacement. T2 weighted MRI was also used to evaluate disc degeneration via Pfirrmann grading and T2 time. All measures were then tested for effect of sex and disc level. Results We found that flexion and extension caused level-dependent strains in the anterior and posterior of the disc, changes in wedge angle, and A-P shear displacements. Flexion had higher magnitude changes overall. Diurnal loading did not cause level-dependent strains but did cause small level-dependent changes in wedge angle and A-P shear displacements. Discussion Correlations between disc degeneration and mechanics were largest in flexion, likely due to the smaller contribution of the facet joints in this condition. Conclusion In summary, this study established methods to measure in vivo disc mechanical function via noninvasive MRI and established a baseline in a young population that may be compared to older subjects and clinical disorders in the future.
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Affiliation(s)
- Kyle D. Meadows
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
| | - John M. Peloquin
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
| | - Harrah R. Newman
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
| | - Peter J. K. Cauchy
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
| | | | - Dawn M. Elliott
- Department of Biomedical Engineering University of Delaware Newark Delaware USA
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10
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Yang L, Sun C, Gong T, Li Q, Chen X, Zhang X. T1ρ, T2 and T2* mapping of lumbar intervertebral disc degeneration: a comparison study. BMC Musculoskelet Disord 2022; 23:1135. [PMID: 36575488 PMCID: PMC9793566 DOI: 10.1186/s12891-022-06040-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Early and accurate assessment of lumbar intervertebral disc degeneration (IVDD) is very important to therapeutic strategy. This study aims to correlate and compare the performances of T1ρ, T2 and T2* mapping for Pfirrmann grades and morphologic changes in the IVDD. METHODS This prospective study included 39 subjects with 195 lumbar discs. T1ρ, T2 and T2* mapping were performed, and T1ρ, T2 and T2* values of nucleus pulposus (NP), and anterior and posterior annulus fibrosus were measured. IVDD was assessed with Pfirrmann grading and morphologic changes (normal, bulging, herniation and annular fissure). The performances of T1ρ, T2 and T2* relaxation times were compared for detecting early (Pfirrmann grade II-III) and advanced degeneration (Pfirrmann grade IV-V), as well as for morphologic changes. RESULTS T2 relaxation times was strongly corelated with T1ρ and T2* relaxation times. Areas under the curves (AUCs) of T1ρ, T2 and T2* relaxation times of NP were 0.70, 0.87 and 0.80 for early degeneration, and 0.91, 0.95 and 0.82 for advanced degeneration, respectively. AUCs of T1ρ, T2 and T2* relaxation times of NP were 0.78, 0.83 and 0.64 for bulging discs, 0.87, 0.89 and 0.69 for herniated discs, and 0.79, 0.82 and 0.69 for annular tearing, respectively. The AUC of T2 relaxation time was significantly higher than those of T1ρ relaxation times (both P < 0.01) for early IVDD, and the AUCs of T1ρ and T2 relaxation times for assessing advanced degeneration and morphologic changes were similar (P > 0.05) but significantly higher than that of T2*relaxation time (P < 0.01). CONCLUSIONS T2 mapping performed better than T1ρ mapping for the detection of early IVDD. T1ρ and T2 mapping performed similarly but better than T2* mapping for advanced degeneration and morphologic changes of IVDD.
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Affiliation(s)
- Li Yang
- grid.413087.90000 0004 1755 3939Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, 200032 People’s Republic of China
| | - Cong Sun
- grid.414350.70000 0004 0447 1045Department of Radiology, Beijing Hospital, National Center of Gerontology, No. 1 Da-Hua Road, Dong Dan, Beijing, 100730 China
| | - Tao Gong
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Quanlin Li
- grid.479672.9Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250012 Shandong China
| | - Xin Chen
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
| | - Xinjuan Zhang
- grid.460018.b0000 0004 1769 9639Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 Shandong China
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11
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Çavuşoğlu M, Pazahr S, Ciritsis AP, Rossi C. Quantitative 23 Na-MRI of the intervertebral disk at 3 T. NMR IN BIOMEDICINE 2022; 35:e4733. [PMID: 35307881 PMCID: PMC9540256 DOI: 10.1002/nbm.4733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
Monitoring the tissue sodium content (TSC) in the intervertebral disk geometry noninvasively by MRI is a sensitive measure to estimate changes in the proteoglycan content of the intervertebral disk, which is a biomarker of degenerative disk disease (DDD) and of lumbar back pain (LBP). However, application of quantitative sodium concentration measurements in 23 Na-MRI is highly challenging due to the lower in vivo concentrations and smaller gyromagnetic ratio, ultimately yielding much smaller signal relative to 1 H-MRI. Moreover, imaging the intervertebral disk geometry imposes higher demands, mainly because the necessary RF volume coils produce highly inhomogeneous transmit field patterns. For an accurate absolute quantification of TSC in the intervertebral disks, the B1 field variations have to be mitigated. In this study, we report for the first time quantitative sodium concentration in the intervertebral disks at clinical field strengths (3 T) by deploying 23 Na-MRI in healthy human subjects. The sodium B1 maps were calculated by using the double-angle method and a double-tuned (1 H/23 Na) transceive chest coil, and the individual effects of the variation in the B1 field patterns in tissue sodium quantification were calculated. Phantom measurements were conducted to evaluate the quality of the Na-weighted images and B1 mapping. Depending on the disk position, the sodium concentration was calculated as 161.6 mmol/L-347 mmol/L, and the mean sodium concentration of the intervertebral disks varies between 254.6 ± 54 mmol/L and 290.1 ± 39 mmol/L. A smoothing effect of the B1 correction on the sodium concentration maps was observed, such that the standard deviation of the mean sodium concentration was significantly reduced with B1 mitigation. The results of this work provide an improved integration of quantitative 23 Na-MRI into clinical studies in intervertebral disks such as degenerative disk disease and establish alternative scoring schemes to existing morphological scoring such as the Pfirrmann score.
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Affiliation(s)
- Mustafa Çavuşoğlu
- Institute of Diagnostic and Interventional Radiology, University Hospital ZurichUniversity of ZurichSwitzerland
| | | | - Alexander P. Ciritsis
- Institute of Diagnostic and Interventional Radiology, University Hospital ZurichUniversity of ZurichSwitzerland
| | - Cristina Rossi
- Institute of Diagnostic and Interventional Radiology, University Hospital ZurichUniversity of ZurichSwitzerland
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12
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Martin JT, Wesorick B, Oldweiler AB, Kosinski AS, Goode AP, DeFrate LE. In vivo fluid transport in human intervertebral discs varies by spinal level and disc region. JOR Spine 2022; 5:e1199. [PMID: 35783907 PMCID: PMC9238288 DOI: 10.1002/jsp2.1199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/25/2022] Open
Abstract
Background The lumbar discs are large, dense tissues that are primarily avascular, and cells residing in the central region of the disc are up to 6-8 mm from the nearest blood vessel in adults. To maintain homeostasis, disc cells rely on nutrient transport between the discs and adjacent vertebrae. Thus, diminished transport has been proposed as a factor in age-related disc degeneration. Methods In this study, we used magnetic resonance imaging (MRI) to quantify diurnal changes in T2 relaxation time, an MRI biomarker related to disc hydration, to generate 3D models of disc fluid distribution and determine how diurnal changes in fluid varied by spinal level. We recruited 10 participants (five males/five females; age: 21-30 years; BMI: 19.1-29.0 kg/m2) and evaluated the T2 relaxation time of each disc at 8:00 AM and 7:00 PM, as well as degeneration grade (Pfirrmann). We also measured disc height, volume, and perimeter in a subset of individuals as a preliminary comparison of geometry and transport properties. Results We found that the baseline (AM) T2 relaxation time and the diurnal change in T2 relaxation time were greatest in the cranial lumbar discs, decreasing along the lumbar spine from cranial to caudal. In cranial discs, T2 relaxation times decreased in each disc region (nucleus pulposus [NP], inner annulus fibrosus [IAF], and outer annulus fibrosus [OAF]), whereas in caudal discs, T2 relaxation times decreased in the NP but increased in the AF. Conclusions Fluid transport varied by spinal level, where transport was greatest in the most cranial lumbar discs and decreased from cranial to caudal along the lumbar spine. Future work should evaluate what level-dependent factors affect transport.
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Affiliation(s)
- John T. Martin
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Benjamin Wesorick
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
| | - Alexander B. Oldweiler
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Andrzej S. Kosinski
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biostatistics and BioinformaticsDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Adam P. Goode
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Louis E. DeFrate
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNorth CarolinaUSA
- Department of Biomedical EngineeringDuke UniversityDurhamNorth CarolinaUSA
- Department of Mechanical Engineering and Materials ScienceDuke UniversityDurhamNorth CarolinaUSA
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13
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Comparison of MRI T1, T2, and T2* mapping with histology for assessment of intervertebral disc degeneration in an ovine model. Sci Rep 2022; 12:5398. [PMID: 35354902 PMCID: PMC8967912 DOI: 10.1038/s41598-022-09348-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 03/21/2022] [Indexed: 11/08/2022] Open
Abstract
An easy, reliable, and time-efficient standardized approach for assessing lumbar intervertebral disc (IVD) degeneration with relaxation times measurements in pre-clinical and clinical studies is lacking. This prospective study aims to determine the most appropriate method for lumbar IVD degeneration (IDD) assessment in sheep by comparing three quantitative MRI sequences (variable-flip-angle T1 mapping, and multi-echo T2 and T2* mapping), correlating them with Pfirrmann grading and histology. Strong intra- and interrater agreements were found for Nucleus pulposus (NP) regions-of-interest (ROI). T1, T2, and T2* mapping correlated with Pfirrmann grading and histological scoring (p < 0.05) except for the most ventral rectangular ROI on T2 maps. Correlations were excellent for all of the T1 ROIs and the T2* NP ROIs. Highly significant differences in T1 values were found between all Pfirrmann grades except between grades I/II and between grades III/IV. Significant differences were identified in the T2 and the T2* values between all grades except between grades I/III. T1, T2, and T2* relaxation times measurements of the NP are an accurate and time-efficient tool to assess lumbar IDD in sheep. Variable-flip-angle T1 mapping may be further considered as a valuable method to investigate IDD and to assess the efficacy of regenerative treatments in longitudinal studies.
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14
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Tamagawa S, Sakai D, Nojiri H, Sato M, Ishijima M, Watanabe M. Imaging Evaluation of Intervertebral Disc Degeneration and Painful Discs-Advances and Challenges in Quantitative MRI. Diagnostics (Basel) 2022; 12:707. [PMID: 35328260 PMCID: PMC8946895 DOI: 10.3390/diagnostics12030707] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 01/07/2023] Open
Abstract
In recent years, various quantitative and functional magnetic resonance imaging (MRI) sequences have been developed and used in clinical practice for the diagnosis of patients with low back pain (LBP). Until now, T2-weighted imaging (T2WI), a visual qualitative evaluation method, has been used to diagnose intervertebral disc (IVD) degeneration. However, this method has limitations in terms of reproducibility and inter-observer agreement. Moreover, T2WI observations do not directly relate with LBP. Therefore, new sequences such as T2 mapping, T1ρ mapping, and MR spectroscopy have been developed as alternative quantitative evaluation methods. These new quantitative MRIs can evaluate the anatomical and physiological changes of IVD degeneration in more detail than conventional T2WI. However, the values obtained from these quantitative MRIs still do not directly correlate with LBP, and there is a need for more widespread use of techniques that are more specific to clinical symptoms such as pain. In this paper, we review the state-of-the-art methodologies and future challenges of quantitative MRI as an imaging diagnostic tool for IVD degeneration and painful discs.
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Affiliation(s)
- Shota Tamagawa
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan; (S.T.); (H.N.); (M.I.)
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan; (M.S.); (M.W.)
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan; (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan
| | - Hidetoshi Nojiri
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan; (S.T.); (H.N.); (M.I.)
| | - Masato Sato
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan; (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan; (S.T.); (H.N.); (M.I.)
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan; (M.S.); (M.W.)
- Center for Musculoskeletal Innovative Research and Advancement (C-MiRA), Tokai University Graduate School, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan
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15
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Savarese L, Menezes-Reis R, Jorge M, Salmon C, Herrero C, Nogueira-Barbosa M. Sagittal balance and intervertebral disc composition in patients with low back pain. Braz J Med Biol Res 2022; 55:e12015. [DOI: 10.1590/1414-431x2022e12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- L.G. Savarese
- Universidade de São Paulo, Brasil; Universidade de São Paulo, Brasil
| | | | - M. Jorge
- Universidade de São Paulo, Brasil
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16
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Biercher A, Meller S, Wendt J, Caspari N, Schmidt-Mosig J, De Decker S, Volk HA. Using Deep Learning to Detect Spinal Cord Diseases on Thoracolumbar Magnetic Resonance Images of Dogs. Front Vet Sci 2021; 8:721167. [PMID: 34796224 PMCID: PMC8593183 DOI: 10.3389/fvets.2021.721167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022] Open
Abstract
Deep Learning based Convolutional Neural Networks (CNNs) are the state-of-the-art machine learning technique with medical image data. They have the ability to process large amounts of data and learn image features directly from the raw data. Based on their training, these networks are ultimately able to classify unknown data and make predictions. Magnetic resonance imaging (MRI) is the imaging modality of choice for many spinal cord disorders. Proper interpretation requires time and expertise from radiologists, so there is great interest in using artificial intelligence to more quickly interpret and diagnose medical imaging data. In this study, a CNN was trained and tested using thoracolumbar MR images from 500 dogs. T1- and T2-weighted MR images in sagittal and transverse planes were used. The network was trained with unremarkable images as well as with images showing the following spinal cord pathologies: intervertebral disc extrusion (IVDE), intervertebral disc protrusion (IVDP), fibrocartilaginous embolism (FCE)/acute non-compressive nucleus pulposus extrusion (ANNPE), syringomyelia and neoplasia. 2,693 MR images from 375 dogs were used for network training. The network was tested using 7,695 MR images from 125 dogs. The network performed best in detecting IVDPs on sagittal T1-weighted images, with a sensitivity of 100% and specificity of 95.1%. The network also performed very well in detecting IVDEs, especially on sagittal T2-weighted images, with a sensitivity of 90.8% and specificity of 98.98%. The network detected FCEs and ANNPEs with a sensitivity of 62.22% and a specificity of 97.90% on sagittal T2-weighted images and with a sensitivity of 91% and a specificity of 90% on transverse T2-weighted images. In detecting neoplasms and syringomyelia, the CNN did not perform well because of insufficient training data or because the network had problems differentiating different hyperintensities on T2-weighted images and thus made incorrect predictions. This study has shown that it is possible to train a CNN in terms of recognizing and differentiating various spinal cord pathologies on canine MR images. CNNs therefore have great potential to act as a “second eye” for imagers in the future, providing a faster focus on the altered image area and thus increasing workflow in radiology.
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Affiliation(s)
- Anika Biercher
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Jakob Wendt
- Caspari, Schmidt-Mosig u. Wendt-vetvise GbR, Hannover, Germany
| | - Norman Caspari
- Caspari, Schmidt-Mosig u. Wendt-vetvise GbR, Hannover, Germany
| | | | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Holger Andreas Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
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17
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Wang L, Han M, Wong J, Zheng P, Lazar AA, Krug R, Fields AJ. Evaluation of human cartilage endplate composition using MRI: Spatial variation, association with adjacent disc degeneration, and in vivo repeatability. J Orthop Res 2021; 39:1470-1478. [PMID: 32592504 PMCID: PMC7765737 DOI: 10.1002/jor.24787] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 02/04/2023]
Abstract
Cartilage endplate (CEP) biochemical composition may influence disc degeneration and regeneration. However, evaluating CEP composition in patients remains a challenge. We used T2* mapping from ultrashort echo-time (UTE) magnetic resonance imaging (MRI), which is sensitive to CEP hydration, to investigate spatial variations in CEP T2* values and to determine how CEP T2* values correlate with adjacent disc degeneration. Thirteen human cadavers (56.4 ± 12.7 years) and seven volunteers (36.9 ± 10.9 years) underwent 3T MRI, including UTE and T1ρ mapping sequences. Spatial mappings of T2* values in L4-S1 CEPs were generated from UTE images and compared between subregions. In the abutting discs, mean T1ρ values in the nucleus pulposus were compared between CEPs with high vs low T2* values. To assess in vivo repeatability, precision errors in mean T2* values, and intraclass correlation coefficients (ICC) were measured from repeat scans. Results showed that CEP T2* values were highest centrally and lowest posteriorly. In the youngest individuals (<50 years), who had mild-to-moderately degenerated Pfirrmann grade II-III discs, low CEP T2* values associated with severer disc degeneration: T1ρ values were 26.7% lower in subjects with low CEP T2* values (P = .025). In older individuals, CEP T2* values did not associate with disc degeneration (P = .39-.62). Precision errors in T2* ranged from 1.7 to 2.6 ms, and reliability was good-to-excellent (ICC = 0.89-0.94). These findings suggest that deficits in CEP composition, as indicated by low T2* values, associate with severer disc degeneration during the mild-to-moderate stages. Measuring CEP T2* values with UTE MRI may clarify the role of CEP composition in patients with mild-to-moderate disc degeneration.
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Affiliation(s)
- Linshanshan Wang
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Misung Han
- Department of Radiology & Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Jason Wong
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Patricia Zheng
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Ann A. Lazar
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCalifornia,Department of Preventive and Restorative Dental SciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Roland Krug
- Department of Radiology & Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Aaron J. Fields
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
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18
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Le Maitre CL, Dahia CL, Giers M, Illien‐Junger S, Cicione C, Samartzis D, Vadala G, Fields A, Lotz J. Development of a standardized histopathology scoring system for human intervertebral disc degeneration: an Orthopaedic Research Society Spine Section Initiative. JOR Spine 2021; 4:e1167. [PMID: 34337340 PMCID: PMC8313169 DOI: 10.1002/jsp2.1167] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Histopathological analysis of intervertebral disc (IVD) tissues is a critical domain of back pain research. Identification, description, and classification of attributes that distinguish abnormal tissues form a basis for probing disease mechanisms and conceiving novel therapies. Unfortunately, lack of standardized methods and nomenclature can limit comparisons of results across studies and prevent organizing information into a clear representation of the hierarchical, spatial, and temporal patterns of IVD degeneration. Thus, the following Orthopaedic Research Society (ORS) Spine Section Initiative aimed to develop a standardized histopathology scoring scheme for human IVD degeneration. METHODS Guided by a working group of experts, this prospective process entailed a series of stages that consisted of reviewing and assessing past grading schemes, surveying IVD researchers globally on current practice and recommendations for a new grading system, utilizing expert opinion a taxonomy of histological grading was developed, and validation performed. RESULTS A standardized taxonomy was developed, which showed excellent intra-rater reliability for scoring nucleus pulposus (NP), annulus fibrosus (AF), and cartilaginous end plate (CEP) regions (interclass correlation [ICC] > .89). The ability to reliably detect subtle changes varied by IVD region, being poorest in the NP (ICC: .89-.95) where changes at the cellular level were important, vs the AF (ICC: .93-.98), CEP (ICC: .97-.98), and boney end plate (ICC: .96-.99) where matrix and structural changes varied more dramatically with degeneration. CONCLUSIONS The proposed grading system incorporates more comprehensive descriptions of degenerative features for all the IVD sub-tissues than prior criteria. While there was excellent reliability, our results reinforce the need for improved training, particularly for novice raters. Future evaluation of the proposed system in real-world settings (eg, at the microscope) will be needed to further refine criteria and more fully evaluate utility. This improved taxonomy could aid in the understanding of IVD degeneration phenotypes and their association with back pain.
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Affiliation(s)
| | - Chitra L. Dahia
- Orthopaedic Soft Tissue Research ProgramHospital for Special SurgeryNew YorkNew YorkUSA
- Department of Cell and Developmental BiologyWeill Cornell Medicine, Graduate School of Medical SciencesNew YorkNew YorkUSA
| | - Morgan Giers
- School of Chemical, Biological, and Environmental EngineeringOregon State UniversityCorvallisOregonUSA
| | | | - Claudia Cicione
- Laboratory of Regenerative Orthopaedics, Department of Orthopaedic and Trauma SurgeryCampus Bio‐Medico University of RomeRomeItaly
| | - Dino Samartzis
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- International Spine Research and Innovation InitiativeRush University Medical CenterChicagoIllinoisUSA
| | - Gianluca Vadala
- Laboratory of Regenerative Orthopaedics, Department of Orthopaedic and Trauma SurgeryCampus Bio‐Medico University of RomeRomeItaly
| | - Aaron Fields
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - Jeffrey Lotz
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
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19
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Raudner M, Schreiner MM, Hilbert T, Kober T, Weber M, Szelényi A, Windhager R, Juras V, Trattnig S. Clinical implementation of accelerated T 2 mapping: Quantitative magnetic resonance imaging as a biomarker for annular tear and lumbar disc herniation. Eur Radiol 2021; 31:3590-3599. [PMID: 33274406 PMCID: PMC8128819 DOI: 10.1007/s00330-020-07538-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/20/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluates GRAPPATINI, an accelerated T2 mapping sequence combining undersampling and model-based reconstruction to facilitate the clinical implementation of T2 mapping of the lumbar intervertebral disc. METHODS Fifty-eight individuals (26 females, 32 males, age 23.3 ± 8.0 years) were prospectively examined at 3 T. This cohort study consisted of 19 patients, 20 rowers, and 19 volunteers. GRAPPATINI was conducted with the same parameters as a conventional 2D multi-echo spin-echo (MESE) sequence in 02:27 min instead of 13:18 min. Additional T2 maps were calculated after discarding the first echo (T2-WO1ST) and only using even echoes (T2-EVEN). Segmentation was done on the four most central slices. The resulting T2 values were compared for all four measurements. RESULTS T2-GRAPPATINI, T2-MESE, T2-EVEN, and T2-WO1ST of the nucleus pulposus of normal discs differed significantly from those of bulging discs or herniated discs (all p < 0.001). For the posterior annular region, only T2-GRAPPATINI showed a significant difference (p = 0.011) between normal and herniated discs. There was a significant difference between T2-GRAPPATINI, T2-MESE, T2-EVEN, and T2-WO1ST of discs with and without an annular tear for the nucleus pulposus (all p < 0.001). The nucleus pulposus' T2 at different degeneration states showed significant differences between all group comparisons of Pfirrmann grades for T2-GRAPPATINI (p = 0.000-0.018), T2-MESE (p = 0.000-0.015), T2-EVEN (p = 0.000-0.019), and T2-WO1ST (p = 0.000-0.015). CONCLUSIONS GRAPPATINI facilitates the use of T2 values as quantitative imaging biomarkers to detect disc pathologies such as degeneration, lumbar disc herniation, and annular tears while simultaneously shortening the acquisition time from 13:18 to 2:27 min. KEY POINTS • T2-GRAPPATINI, T2-MESE, T2-EVEN, and T2-WO1ST of the nucleus pulposus of normal discs differed significantly from those of discs with bulging or herniation (all p < 0.001). • The investigated T2 mapping techniques differed significantly in discs with and without annular tearing (all p < 0.001). • The nucleus pulposus' T2 showed significant differences between different stages of degeneration in all group comparisons for T2-GRAPPATINI (p = 0.000-0.018), T2-MESE (p = 0.000-0.015), T2-EVEN (p = 0.000-0.019), and T2-WO1ST (p = 0.000-0.015).
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Affiliation(s)
- Marcus Raudner
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria
- Christian Doppler Laboratory for Clinical Molecular MR Imaging (MOLIMA), Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Vienna, Austria
| | - Markus M Schreiner
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria
| | - Anna Szelényi
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Vladimir Juras
- Christian Doppler Laboratory for Clinical Molecular MR Imaging (MOLIMA), Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Science, Bratislava, Slovakia
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Lazarettgasse 14, 1090, Vienna, Austria.
- Christian Doppler Laboratory for Clinical Molecular MR Imaging (MOLIMA), Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Vienna, Austria.
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Quantitative assessment of the lumbar intervertebral disc via T2 shows excellent long-term reliability. PLoS One 2021; 16:e0249855. [PMID: 33852631 PMCID: PMC8046347 DOI: 10.1371/journal.pone.0249855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/25/2021] [Indexed: 12/05/2022] Open
Abstract
Methodologies for the quantitative assessment of the spine tissues, in particular the intervertebral disc (IVD), have not been well established in terms of long-term reliability. This is required for designing prospective studies. 1H water T2 in the IVD (“T2”) has attained wider use in assessment of the lumbar intervertebral discs via magnetic resonance imaging. The reliability of IVD T2 measurements are yet to be established. IVD T2 was assessed nine times at regular intervals over 368 days on six anatomical slices centred at the lumbar spine using a spin-echo multi-echo sequence in 12 men. To assess repeatability, intra-class correlation co-efficients (ICCs), standard error of the measurement, minimal detectable difference and co-efficients of variation (CVs) were calculated along with their 95% confidence intervals. Bland-Altman analysis was also performed. ICCs were above 0.93, with the exception of nuclear T2 at L5/S1, where the ICC was 0.88. CVs of the central-slice nucleus sub-region ranged from 4.3% (average of all levels) to 10.1% for L5/S1 and between 2.2% to 3.2% for whole IVD T2 (1.8% for the average of all levels). Averaging between vertebral levels improved reliability. Reliability of measurements was least at L5/S1. ICCs of degenerated IVDs were lower. Test-retest reliability was excellent for whole IVD and good to excellent for IVD subregions. The findings help to establish the long-term repeatability of lumbar IVD T2 for the implementation of prospective studies and determination of significant changes within individuals.
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21
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Costi JJ, Ledet EH, O'Connell GD. Spine biomechanical testing methodologies: The controversy of consensus vs scientific evidence. JOR Spine 2021; 4:e1138. [PMID: 33778410 PMCID: PMC7984003 DOI: 10.1002/jsp2.1138] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022] Open
Abstract
Biomechanical testing methodologies for the spine have developed over the past 50 years. During that time, there have been several paradigm shifts with respect to techniques. These techniques evolved by incorporating state-of-the-art engineering principles, in vivo measurements, anatomical structure-function relationships, and the scientific method. Multiple parametric studies have focused on the effects that the experimental technique has on outcomes. As a result, testing methodologies have evolved, but there are no standard testing protocols, which makes the comparison of findings between experiments difficult and conclusions about in vivo performance challenging. In 2019, the international spine research community was surveyed to determine the consensus on spine biomechanical testing and if the consensus opinion was consistent with the scientific evidence. More than 80 responses to the survey were received. The findings of this survey confirmed that while some methods have been commonly adopted, not all are consistent with the scientific evidence. This review summarizes the scientific literature, the current consensus, and the authors' recommendations on best practices based on the compendium of available evidence.
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Affiliation(s)
- John J. Costi
- Biomechanics and Implants Research Group, Medical Device Research Institute, College of Science and EngineeringFlinders UniversityAdelaideAustralia
| | - Eric H. Ledet
- Department of Biomedical EngineeringRensselaer Polytechnic InstituteTroyNew YorkUSA
- Research and Development ServiceStratton VA Medical CenterAlbanyNew YorkUSA
| | - Grace D. O'Connell
- Department of Mechanical EngineeringUniversity of California‐BerkeleyBerkeleyCaliforniaUSA
- Department of Orthopaedic SurgeryUniversity of California‐San FranciscoSan FranciscoCaliforniaUSA
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22
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The Optimal Timing of Hydrogel Injection for Treatment of Intervertebral Disc Degeneration: Quantitative Analysis Based on T1ρ MR Imaging. Spine (Phila Pa 1976) 2020; 45:E1451-E1459. [PMID: 32890300 DOI: 10.1097/brs.0000000000003667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Animal experimental study. OBJECTIVE The aim of this study was to investigate the optimal time of hydrogel injection for regenerating intervertebral disc degeneration (IDD) based on T1ρ magnetic resonance imaging (MRI). SUMMARY OF BACKGROUND DATA Currently, different approaches are being pursued to regenerate the IDD. However, the optimal timing for the regenerative intervention is unclear. METHODS The slowly, progressive IDD models were established in 18 rhesus monkeys. On the basis of the MR T1ρ values of the discs, the rhesus monkeys were divided into severe (T1ρ values: <81 ms), moderate (T1ρ values: 81∼95 ms), and mild (T1ρ values: 96∼110 ms) degeneration groups. Biocompatible hydrogel was injected into the central part of the nucleus pulposus of the discs under fluoroscopic guidance. Treatment effects were investigated using radiography, T1ρ MRI, and histology until 12 months postoperatively. RESULTS After injection, the T1ρ values of all the discs increased significantly at 1 month postoperatively, and then remained at approximately 110 ms in the mild and moderate groups during the whole observation period, with no significant difference compared to the values at 1 month (P > 0.05). However, in the severe group, the T1ρ values decreased significantly after 1 month and leveled at approximately 70 ms after 6 months, with significant difference compared to the values at 1 month (P < 0.05). In the mild and moderate groups, there were no significant differences between preoperative histological scores and those at 12 months (P > 0.05). However, the histological score in the severe group at 12 months was significantly higher than the preoperative scores (P < 0.05). CONCLUSION This study suggested that the moderate degenerative stage of IDD (T1ρ values from 95 to 80 ms) could be the optimal time for hydrogel injection aimed at the regenerative intervention, based on T1ρ-MR imaging technique and quantitative analysis. LEVEL OF EVIDENCE N/A.
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Meadows KD, Johnson CL, Peloquin JM, Spencer RG, Vresilovic EJ, Elliott DM. Impact of pulse sequence, analysis method, and signal to noise ratio on the accuracy of intervertebral disc T 2 measurement. JOR Spine 2020; 3:e1102. [PMID: 33015575 PMCID: PMC7524248 DOI: 10.1002/jsp2.1102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022] Open
Abstract
Noninvasive assessments of intervertebral disc health and degeneration are critical for addressing disc degeneration and low back pain. Magnetic resonance imaging (MRI) is exceptionally sensitive to tissue with high water content, and measurement of the MR transverse relaxation time, T 2, has been applied as a quantitative, continuous, and objective measure of disc degeneration that is linked to the water and matrix composition of the disc. However, T 2 measurement is susceptible to inaccuracies due to Rician noise, T 1 contamination, and stimulated echo effects. These error generators can all be controlled for with proper data collection and fitting methods. The objective of this study was to identify sequence parameters to appropriately acquire MR data and to establish curve fitting methods to accurately calculate disc T 2 in the presence of noise by correcting for Rician noise. To do so, we compared T 2 calculated from the typical monoexponential (MONO) fits and noise corrected exponential (NCEXP) fits. We examined how the selected sequence parameters altered the calculated T 2 in silico and in vivo. Typical MONO fits were frequently poor due to Rician noise, and NCEXP fits were more likely to provide accurate T 2 calculations. NCEXP is particularly less biased and less uncertain at low SNR. This study showed that the NCEXP using sequences with data from 20 echoes out to echo times of ~300 ms is the best method for calculating T 2 of discs. By acquiring signal data out to longer echo times and accounting for Rician noise, the curve fitting is more robust in calculating T 2 despite the noise in the data. This is particularly important when considering degenerate discs or AF tissue because the SNR of these regions is lower.
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Affiliation(s)
- Kyle D Meadows
- Biomedical Engineering University of Delaware Newark Delaware USA
| | - Curtis L Johnson
- Biomedical Engineering University of Delaware Newark Delaware USA
| | - John M Peloquin
- Biomedical Engineering University of Delaware Newark Delaware USA
| | - Richard G Spencer
- National Institute on Aging, National Institutes of Health Baltimore Maryland USA
| | | | - Dawn M Elliott
- Biomedical Engineering University of Delaware Newark Delaware USA
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Raudner M, Schreiner MM, Weber M, Juras V, Stelzeneder D, Windhager R, Trattnig S. Compositional magnetic resonance imaging in the evaluation of the intervertebral disc: Axial vs sagittal T 2 mapping. J Orthop Res 2020; 38:2057-2064. [PMID: 32293737 PMCID: PMC7496420 DOI: 10.1002/jor.24691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 02/04/2023]
Abstract
The aim of this study was to assess T2 values of the lumbar intervertebral discs in the axial and sagittal plane views and assess their respective interobserver reliability. The lumbar intervertebral discs of 23 symptomatic patients (11 female; 12 male; mean age, 44.1 ± 10.6; range, 24-64 years) were examined at 3T. Region-of-interest (ROI) analysis was performed on axial and sagittal T2 maps by two independent observers. Intraclass correlation coefficient (ICC) was assessed for every ROI. The interobserver agreement was excellent for the nucleus pulposus (NP) in the sagittal (0.951; 95% confidence interval [CI], 0.926-0.968) and axial (0.921; 95% CI, 0.845-0.955) planes. The posterior 20% region showed a higher ICC in the axial vs the sagittal assessment (0.845; 95% CI, 0.704-0.911 vs 0.819; 95% CI, 0.744-0.873). The same was true for the posterior 10%, with the axial ROI showing a higher ICC (0.923; 95% CI, 0.865-0.953 vs 0.628; 95% CI, 0.495-0.732). The intraobserver agreement was excellent for every ROI except the sagittal 10% region, which showed good performance (0.869; 95% CI, 0.813-0.909). The sagittal nucleus pulposus was the best-performing ROI with regard to intra- and interobserver agreement in the T2 assessment of the lumbar intervertebral disc. However, the axial NP showed more stable agreements overall and across the value range. In addition, the annular analysis showed better inter- and intraobserver agreement in the axial plane view. Clinical significance: Based on the presented analysis, we highly recommend that further studies use axial T2 mapping due to the higher intra- and interreader agreement.
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Affiliation(s)
- Marcus Raudner
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria,Department of Biomedical Imaging and Image‐guided Therapy, Christian Doppler Laboratory for Clinical Molecular Magnetic Resonance Imaging (MOLIMA), High Field MR CenterMedical University of ViennaViennaAustria
| | - Markus M. Schreiner
- Department of Orthopedics and Trauma SurgeryMedical University of ViennaViennaAustria
| | - Michael Weber
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Vladimir Juras
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria,Department of Biomedical Imaging and Image‐guided Therapy, Christian Doppler Laboratory for Clinical Molecular Magnetic Resonance Imaging (MOLIMA), High Field MR CenterMedical University of ViennaViennaAustria
| | - David Stelzeneder
- Department of Orthopedics and Trauma SurgeryMedical University of ViennaViennaAustria,Department of Orthopedics and Trauma SurgeryHanusch HospitalViennaAustria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma SurgeryMedical University of ViennaViennaAustria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria,Department of Biomedical Imaging and Image‐guided Therapy, Christian Doppler Laboratory for Clinical Molecular Magnetic Resonance Imaging (MOLIMA), High Field MR CenterMedical University of ViennaViennaAustria
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Ogon I, Takebayashi T, Takashima H, Morita T, Terashima Y, Yoshimoto M, Yamashita T. Imaging diagnosis for intervertebral disc. JOR Spine 2020; 3:e1066. [PMID: 32211585 PMCID: PMC7084050 DOI: 10.1002/jsp2.1066] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 12/19/2022] Open
Abstract
Various functional magnetic resonance imaging (MRI) techniques have been investigated in recent years and are being used in clinical practice for the patients with low back pain (LBP). MRI is an important modality for diagnosing intervertebral disc (IVD) degeneration. In recent years, there have been several reported attempts to use MRI T2 mapping and MRI T1ρ mapping to quantify lumbar disc degeneration. MRI T2 mapping involves digitizing water content, proteoglycan content, and collagen sequence breakdown as relaxation times (T2 values) at each site. These digitized values are used to create a map, that is, then used to quantitatively evaluate the metabolite concentrations within IVD tissues. MRI T2 mapping utilizes the T2 relaxation time to quantify moisture content and the collagen sequence breakdown. MRI T1ρ mapping digitizes water molecule dispersion within the cartilaginous matrix to evaluate the degree of cartilaginous degeneration. Magnetic resonance spectroscopy is a less-invasive diagnostic test that provides biochemical information. Adequate analysis of the IVD has not yet been performed, although there are indications of a relationship between the adipose content of the multifidus muscle in the low back and LBP. The ultra short TE technique has been recently used to investigate lumbar cartilaginous endplates. Unlike diagnosis based on contrast-enhanced images of the IVD, which depends on the recurrence of pain that is determined subjectively, MRI-based diagnosis is less-invasive and based on objective imaging findings. It is therefore expected to play a key role in the diagnostic imaging of IVD conditions in the future.
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Affiliation(s)
- Izaya Ogon
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Tsuneo Takebayashi
- Department of Orthopaedic SurgerySapporo Maruyama Orthopaedic HospitalSapporoJapan
| | - Hiroyuki Takashima
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Tomonori Morita
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Yoshinori Terashima
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoJapan
| | - Toshihiko Yamashita
- Department of Orthopaedic SurgerySapporo Medical University School of MedicineSapporoJapan
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Mai R, Tan H, Zhao Y, Jia J, Liu W, Tian Y, Yuan S, Liu X. Diagnostic value and clinical significance of magnetic resonance imaging with the FS-PD-TSE sequence in diagnosing lumbar cartilaginous endplate failure. 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 2020; 29:1121-1130. [DOI: 10.1007/s00586-020-06338-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/01/2019] [Accepted: 02/08/2020] [Indexed: 12/31/2022]
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Abou Khadrah RS, Dawoud MF, Abo-Elsafa AA, Elkilany AM. Advanced trends in magnetic resonance imaging in assessment of lumbar intervertebral degenerative disk disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0042-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundT2 mapping and DWI are newly quantitated method for disk degeneration assessment; they were used in the determination of an early stage of intervertebral disk degeneration. T2 mapping was quantitatively sensitive for detecting the early stage and aging-related changes in intervertebral disk degeneration. Furthermore, T2 mapping and apparent diffusion coefficient values (ADC) in lumbar intervertebral disks indirectly correlated with the Pfirrmann grades in IVDD and age-related disk degeneration. The aim of this study is to evaluate the sensitivity of T2 mapping and apparent diffusion coefficient in the determination of an early stage of intervertebral disk degeneration.ResultsT2 relaxometry values were found to decrease with the increased disk degeneration except in grade V where it was found to be increased again. There was a negative correlation between T2 values and semi-quantitative grading (Pfirrmann Grading) of disk degeneration and T2 values were significantly different when comparing grade I to V. A T2 value of nucleus pulposus (NP) was more sensitive than annulus fibrosus (AF) and entire of the disk. ADC values were found to decrease with the increased degree of disk degeneration; there was a weakly significant negative correlation between age and T2 mapping values, ADC values of nucleus pulposus, and entire of disk.ConclusionT2 mapping was significantly different when comparing grade I to V while ADC value had a significant weak negative correlation with age, so T2 mapping and to a little extent ADC can be used for quantitative analysis of early disk generation seeking for early diagnosis and better management.
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28
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Zhu Y, Liu Y, Ying L, Liu X, Zheng H, Liang D. Bio-SCOPE: fast biexponential T 1ρ mapping of the brain using signal-compensated low-rank plus sparse matrix decomposition. Magn Reson Med 2019; 83:2092-2106. [PMID: 31762102 DOI: 10.1002/mrm.28067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/28/2019] [Accepted: 10/14/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop and evaluate a fast imaging method based on signal-compensated low-rank plus sparse matrix decomposition to accelerate data acquisition for biexponential brain T1ρ mapping (Bio-SCOPE). METHODS Two novel strategies were proposed to improve reconstruction performance. A variable-rate undersampling scheme was used with a varied acceleration factor for each k-space along the spin-lock time direction, and a modified nonlinear thresholding scheme combined with a feature descriptor was used for Bio-SCOPE reconstruction. In vivo brain T1ρ mappings were acquired from 4 volunteers. The fully sampled k-space data acquired from 3 volunteers were retrospectively undersampled by net acceleration rates (R) of 4.6 and 6.1. Reference values were obtained from the fully sampled data. The agreement between the accelerated T1ρ measurements and reference values was assessed with Bland-Altman analyses. Prospectively undersampled data with R = 4.6 and R = 6.1 were acquired from 1 volunteer. RESULTS T1ρ -weighted images were successfully reconstructed using Bio-SCOPE for R = 4.6 and 6.1 with signal-to-noise ratio variations <1 dB and normalized root mean square errors <4%. Accelerated and reference T1ρ measurements were in good agreement for R = 4.6 (T1ρ s : 18.6651 ± 1.7786 ms; T1ρ l : 88.9603 ± 1.7331 ms) and R = 6.1 (T1ρ s : 17.8403 ± 3.3302 ms; T1ρ l : 88.0275 ± 4.9606 ms) in the Bland-Altman analyses. T1ρ parameter maps from prospectively undersampled data also show reasonable image quality using the Bio-SCOPE method. CONCLUSION Bio-SCOPE achieves a high net acceleration rate for biexponential T1ρ mapping and improves reconstruction quality by using a variable-rate undersampling data acquisition scheme and a modified soft-thresholding algorithm in image reconstruction.
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Affiliation(s)
- Yanjie Zhu
- Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yuanyuan Liu
- Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,University of Chinese Academy of Sciences, Beijing, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Leslie Ying
- Department of Biomedical Engineering and Department of Electrical Engineering, University at Buffalo, The State University of New York, Buffalo, New York
| | - Xin Liu
- Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Dong Liang
- Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Arpinar VE, Gliedt JA, King JA, Maiman DJ, Muftuler LT. Oswestry Disability Index scores correlate with MRI measurements in degenerating intervertebral discs and endplates. Eur J Pain 2019; 24:346-353. [DOI: 10.1002/ejp.1490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/12/2019] [Accepted: 09/30/2019] [Indexed: 11/11/2022]
Affiliation(s)
- V. Emre Arpinar
- Center for Imaging Research Medical College of Wisconsin Milwaukee WI USA
| | - Jordan A. Gliedt
- Department of Neurosurgery Medical College of Wisconsin Milwaukee WI USA
| | - Jeffrey A. King
- Department of Neurosurgery Medical College of Wisconsin Milwaukee WI USA
| | - Dennis J. Maiman
- Department of Neurosurgery Medical College of Wisconsin Milwaukee WI USA
| | - L. Tugan Muftuler
- Center for Imaging Research Medical College of Wisconsin Milwaukee WI USA
- Department of Neurosurgery Medical College of Wisconsin Milwaukee WI USA
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30
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Kolf AK, Konieczny M, Hesper T, Hosalkar H, Schleich C, Antoch G, Krauspe R, Bittersohl B. T2* Mapping of the Adult Intervertebral Lumbar Disc: Normative Data and Analysis of Diurnal Effects. J Orthop Res 2019; 37:1956-1962. [PMID: 31042306 DOI: 10.1002/jor.24327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
In this prospective study, we sought to establish normative data for T2* analysis of lumbar intervertebral discs (IVDs). Further, potential diurnal effects regarding T2* relaxometry of the lower spine were examined. Lumbar IVDs of young, healthy, adult men (n = 20) and women (n = 20; mean age = 24.5 ± 2.9 years) were assessed. Magnetic resonance imaging including T2* mapping was performed on a 3-T scanner. Mid-sagittal T2* values were obtained in five regions: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. Zonal and segmental differences, as well as diurnal variations between the T2* analysis in the morning and the evening and effects of unloading, were analyzed. Discs with signs of degeneration on morphological images or imaging artifacts were excluded. We noted a zonal and segmental T2* distribution with high values in the NP, low T2* values in the AF and a T2* increase towards the caudal NP. We observed no diurnal differences between the mean T2* values in the morning and in the evening (p = 0.748). The effect of unloading the spine was low (maximum T2* difference between four measurements = 13.6 ms; significant difference noted only between the 0 and 15-min measurement). The T2* values obtained in this study will serve as normative values for future T2* measurements. There are no diurnal influences, and we suggest that unloading of the spine has no demonstrable effect after 30 min on the T2* results. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1956-1962, 2019.
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Affiliation(s)
- Anna-Katharina Kolf
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Markus Konieczny
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Tobias Hesper
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - HarishS Hosalkar
- Center for Hip Preservation and Children's Orthopedics, & The Hosalkar Institute for Joint Preservation and Injury Care, San Diego, California
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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Veraa S, Bergmann W, Wijnberg ID, Back W, Vernooij H, Nielen M, van den Belt AJM. Equine cervical intervertebral disc degeneration is associated with location and MRI features. Vet Radiol Ultrasound 2019; 60:696-706. [PMID: 31353764 PMCID: PMC6899552 DOI: 10.1111/vru.12794] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/23/2019] [Accepted: 05/30/2019] [Indexed: 12/31/2022] Open
Abstract
Morphology of the equine cervical intervertebral disc is different from that in humans and small companion animals and published imaging data are scarcely available. The objectives of this exploratory, methods comparison study were (a) to describe MRI features of macroscopically nondegenerated and degenerated intervertebral discs (b) to test associations between spinal location and macroscopic degeneration or MRI‐detected annular protrusion and between MRI‐detected annular protrusion and macroscopic degeneration, and (c) to define MRI sequences for characterizing equine cervical intervertebral disc degeneration. Ex vivo MRI of intervertebral discs was performed in 11 horses with clinical signs related to the cervical region prior to macroscopic assessment. Mixed‐effect logistic regression modeling included spinal location, MRI‐detected annular protrusion, and presence of macroscopic degeneration with “horse” as random effect. Odds ratio and 95% confidence interval were determined. Reduced signal intensity in proton density turbo SE represented intervertebral disc degeneration. Signal voids due to presence of gas and/or hemorrhage were seen in gradient echo sequences. Presence of macroscopic intervertebral disc degeneration was significantly associated with spinal location with odds being higher in the caudal (C5 to T1) versus cranial (C2 to C5) part of the cervical vertebral column. Intervertebral discs with MRI‐detected annular protrusion grades 2‐4 did have higher odds than with grade 1 to have macroscopic degeneration. It was concluded that MRI findings corresponded well with gross macroscopic data. Magnetic resonance imaging of the equine cervical intervertebral disc seems to be a promising technique, but its potential clinical value for live horses needs to be explored further in a larger and more diverse population of horses.
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Affiliation(s)
- Stefanie Veraa
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Wilhelmina Bergmann
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Inge D Wijnberg
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Willem Back
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hans Vernooij
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Mirjam Nielen
- Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Antoon-Jan M van den Belt
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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The importance of level stratification for quantitative MR studies of lumbar intervertebral discs: a cross-sectional analysis in 101 healthy adults. 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; 28:2153-2161. [PMID: 31309335 DOI: 10.1007/s00586-019-06059-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/31/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate whether quantitative T2-times depend on lumbar intervertebral disc (IVD) level. METHODS The lumbar spine (Th12/L1-L5/S1) of 101 participants (53.5% female, 30.0[± 3.6]years, 173.5[± 9.6]cm and 69.9[± 13.4]kg), without history of back pain, was examined on a 3T scanner with sagittal T2-mapping. All IVDs were stratified according to Pfirrmann grade and lumbar level, with mean T2-time determined for the entire IVD volume and in five subregions of interests. RESULTS Significant level-dependent T2-time differences were detected, both for the entire IVD volume and its subregions. For the entire IVD volume, Pfirrmann grade 2 IVDs displayed 9-18% higher T2-times in Th12/L1 IVDs compared to L2/L3-L5/S1 IVDs (0.001 > p < 0.004) and significantly different T2-times in L1/L2-L2/L3 IVDs compared to most of the IVDs in the lower lumbar spine. In Pfirrmann grades 1, 3 and 4 IVDs, no significant level-dependent T2-time differences were observed for the entire IVD. More pronounced results were observed when comparing IVD subregions, with significant level-dependent differences also within Pfirrmann grade 1 and grade 3 IVDs. For example, in posterior IVD subregions mean T2-time was 80-82% higher in Th12/L1 compared to L3/L4-L4/L5 Pfirrmann grade 1 IVDs (p < 0.05) and 10-14% higher in L5/S1 compared to L3/L4-L4/L5 Pfirrmann grade 3 IVDs (0.02 > p < 0.001). DISCUSSION Significant level-dependent T2-time differences within several Pfirrmann grades, both for the entire IVD volume and for multiple IVD subregions, were shown in this large cohort study. The T2-time differences between levels existed in both non-degenerated and degenerated IVDs. These findings show the importance of stratifying for lumbar level when quantitative IVD studies are performed using T2-mapping. These slides can be retrieved under Electronic Supplementary Material.
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Novel Application of the Pfirrmann Disc Degeneration Grading System to 9.4T MRI: Higher Reliability Compared to 3T MRI. Spine (Phila Pa 1976) 2019; 44:E766-E773. [PMID: 31205169 DOI: 10.1097/brs.0000000000002967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Reliability study. OBJECTIVE To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI. SUMMARY OF BACKGROUND DATA MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques. METHODS Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation. RESULTS Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI. CONCLUSION 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications. LEVEL OF EVIDENCE 3.
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Vadapalli R, Mulukutla R, Vadapalli AS, Vedula RR. Quantitative Predictive Imaging Biomarkers of Lumbar Intervertebral Disc Degeneration. Asian Spine J 2019; 13:527-534. [PMID: 30966725 PMCID: PMC6680034 DOI: 10.31616/asj.2018.0166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Abstract
Study Design Observational comparative study. Purpose To compare fractional anisotropy (FA) maps with T2 values of the nucleus pulposus (NP) and annulus fibrosus (AF) of intervertebral discs in healthy volunteers and patients to develop a predictive disc health scale. Overview of Literature T2-weighted magnetic resonance imaging (MRI) is not sensitive to early morphological changes and provides no quantitative biomarker profile for early degeneration. Methods We examined 59 healthy controls and 59 patients with back pain by MRI using T2 relaxometry and diffusion tensor imaging (DTI). Each group was divided into three age subgroups: A (<30 years, n=12); B (30-50 years, n=26); and C (>50 years, n=21). We obtained FA values for AF and NP and T2 values for NP for each intervertebral disc. Furthermore, we calculated the FA (AF/NP) ratios. Results We categorized 590 intervertebral discs from 118 participants, 566 of which were analyzed with T2 relaxometry and DTI. The T2 values were as follows: subgroup A, 55.8±4.4 ms; B, 48.5±6.9 ms; C, 45.8±8.7 ms (p<0.050). The T2 values for the healthy controls of the subgroups A, B, and C were >120 ms, 90-100 ms, and 70 ms, respectively (p<0.001). Control subgroup A had higher T2 values and AF/NP ratios than subgroups B and C; the AF values were not significantly different. Control subgroup B had higher T2 values and AF/NP ratios than subgroup C but lower FA (NP). Conclusions FA maps of the AF/NP ratio and T2 values of NP are potential microstructure biomarkers of normal and degenerating discs and can help detect early degeneration using a predictive disc health score on a continuous scale.
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Affiliation(s)
- Rammohan Vadapalli
- Department of Radiology, Krishna Institute of Medical Sciences, Secunderabad, India
| | | | | | - Rajanikanth Rao Vedula
- Department of Radiology and Imaging,Krishna Institute of Medical Sciences, Secunderabad, India
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Fujii K, Yamazaki M, Kang JD, Risbud MV, Cho SK, Qureshi SA, Hecht AC, Iatridis JC. Discogenic Back Pain: Literature Review of Definition, Diagnosis, and Treatment. JBMR Plus 2019; 3:e10180. [PMID: 31131347 PMCID: PMC6524679 DOI: 10.1002/jbm4.10180] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/21/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Discogenic back pain is multifactorial; hence, physicians often struggle to identify the underlying source of the pain. As a result, discogenic back pain is often hard to treat—even more so when clinical treatment strategies are of questionable efficacy. Based on a broad literature review, our aim was to define discogenic back pain into a series of more specific and interacting pathologies, and to highlight the need to develop novel approaches and treatment strategies for this challenging and unmet clinical need. Discogenic pain involves degenerative changes of the intervertebral disc, including structural defects that result in biomechanical instability and inflammation. These degenerative changes in intervertebral discs closely intersect with the peripheral and central nervous systems to cause nerve sensitization and ingrowth; eventually central sensitization results in a chronic pain condition. Existing imaging modalities are nonspecific to pain symptoms, whereas discography methods that are more specific have known comorbidities based on intervertebral disc puncture and injection. As a result, alternative noninvasive and specific diagnostic methods are needed to better diagnose and identify specific conditions and sources of pain that can be more directly treated. Currently, there are many treatments/interventions for discogenic back pain. Nevertheless, many surgical approaches for discogenic pain have limited efficacy, thus accentuating the need for the development of novel treatments. Regenerative therapies, such as biologics, cell‐based therapy, intervertebral disc repair, and gene‐based therapy, offer the most promise and have many advantages over current therapies. © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research
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Affiliation(s)
- Kengo Fujii
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA.,Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery University of Tsukuba Tsukuba Japan
| | - James D Kang
- Department of Orthopaedic Surgery Brigham and Women's Hospital Harvard Medical School Boston MA USA
| | - Makarand V Risbud
- Department of Orthopaedic Surgery Sidney Kimmel Medical College Thomas Jefferson University Philadelphia PA USA
| | - Samuel K Cho
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery Hospital for Special Surgery New York NY USA
| | - Andrew C Hecht
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
| | - James C Iatridis
- Leni & Peter W. May Department of Orthopaedics Icahn School of Medicine at Mount Sinai New York NY USA
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Krug R, Joseph GB, Han M, Fields A, Cheung J, Mundada M, Bailey J, Rochette A, Ballatori A, McCulloch CE, McCormick Z, O'Neill C, Link TM, Lotz J. Associations between vertebral body fat fraction and intervertebral disc biochemical composition as assessed by quantitative MRI. J Magn Reson Imaging 2019; 50:1219-1226. [PMID: 30701594 DOI: 10.1002/jmri.26675] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is an interplay between the intervertebral disc (IVD) and the adjacent bone marrow that may play a role in the development of IVD degeneration and might influence chronic lower back pain (CLBP). PURPOSE To apply novel quantitative MRI techniques to assess the relationship between vertebral bone marrow fat (BMF) and biochemical changes in the adjacent IVD. STUDY TYPE Prospective. SUBJECTS Forty-six subjects (26 female and 20 male) with a mean age of 47.3 ± 12.0 years. FIELD STRENGTH/SEQUENCE 3 T MRI; a combined T1ρ and T2 mapping pulse sequence and a 3D spoiled gradient recalled sequence with six echoes and iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) reconstruction algorithm. ASSESSMENT Using quantitative MRI, the vertebral BMF fraction was measured as well as the biochemical composition (proteoglycan and collagen content) of the IVD. Furthermore, clinical Pfirrmann grading, Oswestry disability index (ODI), and visual analog scale (VAS) was assessed. STATISTICAL TESTS Mixed random effects models accounting for multiple measurements per subject were used to assess the relationships between disc measurements and BMF. RESULTS The relationships between BMF (mean) and T1ρ /T2 (mean and SD) were significant, with P < 0.05. Significant associations (P < 0.001) were found between clinical scores (Pfirrmann, ODI, and VAS) with T1ρ /T2 (mean and SD). BMF mean was significantly related to ODI (P = 0.037) and VAS (P = 0.043), but not with Pfirrmann (P = 0.451). In contrast, BMF SD was significantly related to Pfirrmann (P = 0.000) but not to ODI (P = 0.064) and VAS (P = 0.13). DATA CONCLUSION Our study demonstrates significant associations between BMF and biochemical changes in the adjacent IVD, both assessed by quantitative MRI; this may suggest that the conversion of hematopoietic bone marrow to fatty bone marrow impairs the supply of available nutrients to cells in the IVD and may thereby accelerate disc degeneration. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:1219-1226.
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Affiliation(s)
- Roland Krug
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gabrielle B Joseph
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Misung Han
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Aaron Fields
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Justin Cheung
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Maya Mundada
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeannie Bailey
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Alice Rochette
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Alexander Ballatori
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Zachary McCormick
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Conor O'Neill
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey Lotz
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
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Alkalay R, David H. Diffusion based MR measurements correlates with age-related changes in human intervertebral disks. Clin Biomech (Bristol, Avon) 2019; 61:38-45. [PMID: 30458331 PMCID: PMC9202488 DOI: 10.1016/j.clinbiomech.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Understanding the association between MR parameters and age related deterioration in human intervertebral disks forms an important step in the development of clinical diagnostic protocols for disk disease. METHODS Ten unfixed thoracic and lumbar cadaver disk joints, age 37-81 years were imaged at 9.4 T using T2 relaxation (CPMG) and ADC (DWI spin echo) MR protocols. For each MR parameter, spatial maps were computed from the axial images, with the AF and NP segmented based on the T2 maps. Linear regression tested for the correlation between mean and variance (COV) of T2 and ADC with age in the disk, nucleus and annulus, and the effect of thoracic vs. lumbar spine on these correlations. FINDINGS In the disk, age negatively correlated with mean ADC (P < 0.001) and positively with COV of ADC (P < 0.001) and T2 (P < 0.05). Age was negatively correlated with mean T2 (P < 0.01), mean ADC (P < 0.001) and positively with COV of ADC (P < 0.001) and T2 (P < 0.05) in the NP and positively correlated with mean T2 (P < 0.05), COV of ADC (P < 0.01) and T2 (P < 0.05) and negatively with mean ADC (P < 0.05) in the AF. Compared to thoracic disks, lumbar disks showed higher mean ADC (P < 0.05), lower mean T2 (P < 0.001) and higher COV of ADC (P < 0.01) and T2 (P < 0.05). INTERPRETATION Compared to T2, MR diffusion was a more sensitive measure of age mediated changes in disk tissues. Strong differences in the association of MR parameters with age between the lumbar and thoracic suggest that mechanical environment effects tissue specific MR parameters' association with age.
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Affiliation(s)
- Ron Alkalay
- Center for Advanced Orthopaedic Studies, Department of Orthopedics, Beth Israel Deaconess Medical Center and Harvard medical School, Boston, MA, United States.
| | - Hackney David
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard medical School, Boston, MA, United States of America
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Daly CD, Ghosh P, Badal T, Shimmon R, Jenkin G, Oehme D, Cooper-White J, Sher I, Chandra RV, Goldschlager T. A Comparison of Two Ovine Lumbar Intervertebral Disc Injury Models for the Evaluation and Development of Novel Regenerative Therapies. Global Spine J 2018; 8:847-859. [PMID: 30560038 PMCID: PMC6293427 DOI: 10.1177/2192568218779988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY DESIGN Large animal research. OBJECTIVE Lumbar discectomy is the most commonly performed spinal surgical procedure. We investigated 2 large animal models of lumbar discectomy in order to study the regenerative capacity of mesenchymal stem cells following disc injury. METHODS Twelve adult ewes underwent baseline 3-T magnetic resonance imaging (MRI) followed by lumbar intervertebral disc injury by either drill bit (n = 6) or annulotomy and partial nucleotomy (APN) (n = 6). Necropsies were performed 6 months later. Lumbar spines underwent 3-T and 9.4-T MRI prior to histological, morphological and biochemical analysis. RESULTS Drill bit-injured (DBI) and APN-injured discs demonstrated increased Pfirrmann grades relative to uninjured controls (P < .005), with no difference between the 2 models. Disc height index loss was greater in the APN group compared with the DBI group (P < .005). Gross morphology injury scores were higher in APN than DBI discs (P < .05) and both were higher than controls (P < .005). Proteoglycan was reduced in the discs of both injury models relative to controls (P < .005), but lower in the APN group (P < .05). Total collagen of the APN group disc regions was higher than DBI and control discs (P < .05). Histology revealed more matrix degeneration, vascular infiltration, and granulation in the APN model. CONCLUSION Although both models produced disc degeneration, the APN model better replicated the pathobiology of human discs postdiscectomy. We therefore concluded that the APN model was a more appropriate model for the investigation of the regenerative capacity of mesenchymal stem cells administered postdiscectomy.
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Affiliation(s)
- Chris D. Daly
- Monash University, Clayton, Victoria, Australia,Monash Medical Centre, Clayton, Victoria, Australia,Chris D. Daly, The Ritchie Centre, Hudson Institute
of Medical Research, Monash University, 246 Clayton Road, Clayton, Victoria, 3168,
Australia.
| | - Peter Ghosh
- Monash University, Clayton, Victoria, Australia,Proteobioactives, Pty Ltd, Sydney, New South Wales, Australia
| | - Tanya Badal
- University of Technology Sydney, Broadway, New South Wales, Australia
| | - Ronald Shimmon
- University of Technology Sydney, Broadway, New South Wales, Australia
| | | | - David Oehme
- St Vincent’s Hospital, Fitzroy, Victoria, Australia
| | | | - Idrees Sher
- Monash University, Clayton, Victoria, Australia,Monash Medical Centre, Clayton, Victoria, Australia
| | - Ronil V. Chandra
- Monash University, Clayton, Victoria, Australia,Monash Medical Centre, Clayton, Victoria, Australia
| | - Tony Goldschlager
- Monash University, Clayton, Victoria, Australia,Monash Medical Centre, Clayton, Victoria, Australia
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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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40
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Foltz MH, Kage CC, Johnson CP, Ellingson AM. Noninvasive Assessment of Biochemical and Mechanical Properties of Lumbar Discs Through Quantitative Magnetic Resonance Imaging in Asymptomatic Volunteers. J Biomech Eng 2018; 139:2648280. [PMID: 28779522 DOI: 10.1115/1.4037549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 01/07/2023]
Abstract
Intervertebral disc degeneration is a prevalent phenomenon associated with back pain. It is of critical clinical interest to discriminate disc health and identify early stages of degeneration. Traditional clinical T2-weighted magnetic resonance imaging (MRI), assessed using the Pfirrmann classification system, is subjective and fails to adequately capture initial degenerative changes. Emerging quantitative MRI techniques offer a solution. Specifically, T2* mapping images water mobility in the macromolecular network, and our preliminary ex vivo work shows high predictability of the disc's glycosaminoglycan content (s-GAG) and residual mechanics. The present study expands upon this work to predict the biochemical and biomechanical properties in vivo and assess their relationship with both age and Pfirrmann grade. Eleven asymptomatic subjects (range: 18-62 yrs) were enrolled and imaged using a 3T MRI scanner. T2-weighted images (Pfirrmann grade) and quantitative T2* maps (predict s-GAG and residual stress) were acquired. Surface maps based on the distribution of these properties were generated and integrated to quantify the surface volume. Correlational analyses were conducted to establish the relationship between each metric of disc health derived from the quantitative T2* maps with both age and Pfirrmann grade, where an inverse trend was observed. Furthermore, the nucleus pulposus (NP) signal in conjunction with volumetric surface maps provided the ability to discern differences during initial stages of disc degeneration. This study highlights the ability of T2* mapping to noninvasively assess the s-GAG content, residual stress, and distributions throughout the entire disc, which may provide a powerful diagnostic tool for disc health assessment.
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Affiliation(s)
- Mary H Foltz
- Department of Rehabilitation Medicine, University of Minnesota, MMC 388 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455 e-mail:
| | - Craig C Kage
- Department of Rehabilitation Medicine, University of Minnesota, MMC 388 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455 e-mail:
| | - Casey P Johnson
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota, 2021 6th Street S.E., Minneapolis, MN 55455 e-mail:
| | - Arin M Ellingson
- Department of Rehabilitation Medicine, University of Minnesota, MMC 388 Mayo, 420 Delaware Street SE, Minneapolis, MN 55455 e-mail:
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Berg-Johansen B, Han M, Fields AJ, Liebenberg EC, Lim BJ, Larson PE, Gunduz-Demir C, Kazakia GJ, Krug R, Lotz JC. Cartilage Endplate Thickness Variation Measured by Ultrashort Echo-Time MRI Is Associated With Adjacent Disc Degeneration. Spine (Phila Pa 1976) 2018; 43:E592-E600. [PMID: 28984733 PMCID: PMC5882595 DOI: 10.1097/brs.0000000000002432] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A magnetic resonance imaging study of human cadaver spines. OBJECTIVE To investigate associations between cartilage endplate (CEP) thickness and disc degeneration. SUMMARY OF BACKGROUND DATA Damage to the CEP is associated with spinal injury and back pain. However, CEP morphology and its association with disc degeneration have not been well characterized. METHODS Ten lumbar motion segments with varying degrees of disc degeneration were harvested from six cadaveric spines and scanned with magnetic resonance imaging in the sagittal plane using a T2-weighted two-dimensional (2D) sequence, a three-dimensional (3D) ultrashort echo-time (UTE) imaging sequence, and a 3D T1ρ mapping sequence. CEP thicknesses were calculated from 3D UTE image data using a custom, automated algorithm, and these values were validated against histology measurements. Pfirrmann grades and T1ρ values in the disc were assessed and correlated with CEP thickness. RESULTS The mean CEP thickness calculated from UTE images was 0.74 ± 0.04 mm. Statistical comparisons between histology and UTE-derived measurements of CEP thickness showed significant agreement, with the mean difference not significantly different from zero (P = 0.32). Within-disc variation of T1ρ (standard deviation) was significantly lower for Pfirrmann grade 4 than Pfirrmann grade 3 (P < 0.05). Within-disc variation of T1ρ and adjacent CEP thickness heterogeneity (coefficient of variation) had a significant negative correlation (r = -0.65, P = 0.04). The standard deviation of T1ρand the mean CEP thickness showed a moderate positive correlation (r = 0.40, P = 0.26). CONCLUSION This study demonstrates that quantitative measurements of CEP thickness measured from UTE magnetic resonance imaging are associated with disc degeneration. Our results suggest that variability in CEP thickness and T1ρ, rather than their mean values, may serve as valuable diagnostic markers for disc degeneration. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Britta Berg-Johansen
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
| | - Misung Han
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Ellen C Liebenberg
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Brandon J Lim
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Peder Ez Larson
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Cigdem Gunduz-Demir
- Department of Computer Engineering, Bilkent University, Ankara, Turkey
- Neuroscience Graduate Program, Bilkent University, Ankara, Turkey
| | - Galateia J Kazakia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
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42
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Togao O, Hiwatashi A, Wada T, Yamashita K, Kikuchi K, Tokunaga C, Keupp J, Yoneyama M, Honda H. A Qualitative and Quantitative Correlation Study of Lumbar Intervertebral Disc Degeneration Using Glycosaminoglycan Chemical Exchange Saturation Transfer, Pfirrmann Grade, and T1-ρ. AJNR Am J Neuroradiol 2018; 39:1369-1375. [PMID: 29748204 DOI: 10.3174/ajnr.a5657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/09/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Glycosaminoglycan chemical exchange saturation transfer (gagCEST) imaging allows the direct measurement and mapping of glycosaminoglycans. In this study, we aimed to evaluate the usefulness of gagCEST imaging in the quantitative assessment of intervertebral disc degeneration in a comparison with Pfirrmann grade and T1-ρ measurements. MATERIALS AND METHODS Ninety-six lumbar intervertebral discs in 24 volunteers (36.0 ± 8.5 years of age, 21 men and 3 women) were examined with both gagCEST imaging and T1-ρ measurements. The gagCEST imaging was performed at 3T with a saturation pulse with 1.0-second duration and the B1 amplitude of 0.8 μT followed by imaging by a 2D fast spin-echo sequence. The Z-spectra were obtained at 25 frequency offsets from -3 to +3 ppm (step, 0.25 ppm). A point-by-point B0 correction was performed with a B0 map. The gagCEST signal and T1-ρ values were measured in the nucleus pulposus in each intervertebral disc. The Pfirrmann grades were assessed on T2-weighted images. RESULTS The gagCEST signal at grade I (5.36% ± 2.79%) was significantly higher than those at Pfirrmann grade II (3.15% ± 1.40%, P = .0006), grade III (0.14% ± 1.03%, P < .0001), grade IV (-1.75% ± 2.82%, P < .0001), and grade V (-1.47% ± 0.36%, P < .0001). The gagCEST signal at grade II was significantly higher than those of grade III (P < .0001), grade IV (P < .0001), and grade V (P < .0001). The gagCEST signal was significantly correlated negatively with Pfirrmann grade (P < .0001) and positively correlated with T1-ρ (P < .0001). CONCLUSIONS GagCEST imaging could be a reliable and quantitative technique for assessing intervertebral disc degeneration.
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Affiliation(s)
- O Togao
- From the Department of Clinical Radiology (O.T., A.H., K.Y., K.K., H.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - A Hiwatashi
- From the Department of Clinical Radiology (O.T., A.H., K.Y., K.K., H.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Wada
- Division of Radiology (T.W., C.T.), Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - K Yamashita
- From the Department of Clinical Radiology (O.T., A.H., K.Y., K.K., H.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - K Kikuchi
- From the Department of Clinical Radiology (O.T., A.H., K.Y., K.K., H.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - C Tokunaga
- Division of Radiology (T.W., C.T.), Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - J Keupp
- Philips Research (J.K.), Hamburg, Germany
| | | | - H Honda
- From the Department of Clinical Radiology (O.T., A.H., K.Y., K.K., H.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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43
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Evaluation of Lumbar Intervertebral Disc Degeneration Using T1ρ and T2 Magnetic Resonance Imaging in a Rabbit Disc Injury Model. Asian Spine J 2018; 12:317-324. [PMID: 29713414 PMCID: PMC5913024 DOI: 10.4184/asj.2018.12.2.317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/04/2017] [Accepted: 07/23/2017] [Indexed: 12/19/2022] Open
Abstract
Study Design An in vivo histologic and magnetic resonance imaging (MRI) study of lumbar intervertebral disc (IVD) degeneration was conducted. Purpose To clarify the sensitivity and efficacy of T1ρ/T2 mapping for IVD degeneration, the correlation between T1ρ/T2 mapping and degenerative grades and histological findings in the lumbar IVD were investigated. Overview of Literature The early signs of IVD degeneration are proteoglycan loss, dehydration, and collagen degradation. Recently, several quantitative MRI techniques have been developed; T2 mapping can be used to evaluate hydration and collagen fiber integrity within cartilaginous tissue, and T1ρ mapping can be used to evaluate hydration and proteoglycan content. Methods Using New Zealand White rabbits, annular punctures of the IVD were made 10 times at L2/3, 5 times at L3/4, and one time at L4/5 using an 18-gauge needle (n=6) or a 21-gauge needle (n=6). At 4 and 8 weeks post-surgery, MRI was performed including T1ρ and T2 mapping. The degree of IVD degeneration was macroscopically assessed using the Thompson grading system. All specimens were cut for hematoxylin and eosin, safranin-O, and toluidine blue staining. Results Disc degeneration became more severe as the number of punctures increased and when the larger needle was used. T1ρ and T2 values were significantly different between grade 1 and grade 3 IVDs, grade 1 and grade 4 IVDs, grade 2 and grade 3 IVDs, and grade 2 and grade 4 IVDs (p<0.05). There was a significant difference between grade 1 and grade 2 IVDs only in terms of T1ρ values (p<0.05). Conclusions T1ρ and T2 quantitative MRI could detect these small differences. Our results suggest that T1ρ and T2 mapping are sensitive to degenerative changes of lumbar IVDs and that T1ρ mapping can be used as a clinical tool to identify early IVD degeneration.
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44
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Paul CPL, Smit TH, de Graaf M, Holewijn RM, Bisschop A, van de Ven PM, Mullender MG, Helder MN, Strijkers GJ. Quantitative MRI in early intervertebral disc degeneration: T1rho correlates better than T2 and ADC with biomechanics, histology and matrix content. PLoS One 2018; 13:e0191442. [PMID: 29381716 PMCID: PMC5790235 DOI: 10.1371/journal.pone.0191442] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/04/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Low-back pain (LBP) has been correlated to the presence of intervertebral disc (IVD) degeneration on T2-weighted (T2w) MRI. It remains challenging, however, to accurately stage degenerative disc disease (DDD) based on T2w MRI and measurements of IVD height, particularly for early DDD. Several quantitative MRI techniques have been introduced to detect changes in matrix composition signifying early DDD. In this study, we correlated quantitative T2, T1rho and Apparent Diffusion Coefficient (ADC) values to disc mechanical behavior and gold standard early DDD markers in a graded degenerated lumbar IVD caprine model, to assess their potential for early DDD detection. Methods Lumbar caprine IVDs were injected with either 0.25 U/ml or 0.5 U/ml Chondroïtinase ABC (Cabc) to trigger early DDD-like degeneration. Injection with phosphate-buffered saline (PBS) served as control. IVDs were cultured in a bioreactor for 20 days under axial physiological loading. High-resolution 9.4 T MR images were obtained prior to intervention and after culture. Quantitative MR results were correlated to recovery behavior, histological degeneration grading, and the content of glycosaminoglycans (GAGs) and water. Results Cabc-injected IVDs showed aberrancies in biomechanics and loss of GAGs without changes in water-content. All MR sequences detected changes in matrix composition, with T1rho showing largest changes pre-to-post in the nucleus, and significantly more than T2 and ADC. Histologically, degeneration due to Cabc injection was mild. T1rho nucleus values correlated strongest with altered biomechanics, histological degeneration score, and loss of GAGs. Conclusions T2- and T1rho quantitative MR-mapping detected early DDD changes. T1rho nucleus values correlated better than T2 and ADC with biomechanical, histological, and GAG changes. Clinical implementation of quantitative MRI, T1rho particularly, could aid in distinguishing DDD more reliably at an earlier stage in the degenerative process.
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Affiliation(s)
- Cornelis P L Paul
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Theodoor H Smit
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Magda de Graaf
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Roderick M Holewijn
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Arno Bisschop
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center (AMC), Amsterdam, the Netherlands
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45
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Khan AN, Jacobsen HE, Khan J, Filippi CG, Levine M, Lehman RA, Riew KD, Lenke LG, Chahine NO. Inflammatory biomarkers of low back pain and disc degeneration: a review. Ann N Y Acad Sci 2018; 1410:68-84. [PMID: 29265416 DOI: 10.1111/nyas.13551] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022]
Abstract
Biomarkers are biological characteristics that can be used to indicate health or disease. This paper reviews studies on biomarkers of low back pain (LBP) in human subjects. LBP is the leading cause of disability, caused by various spine-related disorders, including intervertebral disc degeneration, disc herniation, spinal stenosis, and facet arthritis. The focus of these studies is inflammatory mediators, because inflammation contributes to the pathogenesis of disc degeneration and associated pain mechanisms. Increasingly, studies suggest that the presence of inflammatory mediators can be measured systemically in the blood. These biomarkers may serve as novel tools for directing patient care. Currently, patient response to treatment is unpredictable with a significant rate of recurrence, and, while surgical treatments may provide anatomical correction and pain relief, they are invasive and costly. The review covers studies performed on populations with specific diagnoses and undefined origins of LBP. Since the natural history of LBP is progressive, the temporal nature of studies is categorized by duration of symptomology/disease. Related studies on changes in biomarkers with treatment are also reviewed. Ultimately, diagnostic biomarkers of LBP and spinal degeneration have the potential to shepherd an era of individualized spine medicine for personalized therapeutics in the treatment of LBP.
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Affiliation(s)
- Aysha N Khan
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Hayley E Jacobsen
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Jansher Khan
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | | | | | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - Nadeen O Chahine
- Department of Orthopedic Surgery, Columbia University, New York, New York.,Department of Biomedical Engineering, Columbia University, New York, New York
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46
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Wang W, Hou J, Lv D, Liang W, Jiang X, Han H, Quan X. Multimodal quantitative magnetic resonance imaging for lumbar intervertebral disc degeneration. Exp Ther Med 2017; 14:2078-2084. [PMID: 28962127 PMCID: PMC5609182 DOI: 10.3892/etm.2017.4786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/17/2017] [Indexed: 01/08/2023] Open
Abstract
The present study investigated the application of the T1ρ and T2 relaxation mapping magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the evaluation of intervertebral disc degeneration (IDD). A total of 93 asymptomatic subjects were imaged with T1ρ and T2 mapping, as well as DWI. Pfirrmann grading was performed and correlation analysis was conducted for T1ρ, T2 and DWI results with the grading results and age. Pfirrmann grading indicated 69 cases of grade I, 240 cases of grade II, 101 cases of grade III, 43 cases of grade IV and 12 cases of grade V. MRI showed that the T1ρ values of the nucleus pulposi at L4/5 and L5/S1 were significantly reduced (P<0.05) and no significant differences were observed in the T2 values compared with the values of the nucleus pulposus at L1/2, L2/3 and L3/4. The apparent diffusion coefficient (ADC) values of L1/2 were significantly decreased from L2/3 and L3/4 (P<0.05). Correlation analysis revealed that the T1ρ, T, and ADC values were positively correlated with each other. Moreover, the T1ρvalues were significantly decreased with the increase of Pfirrmann grades (P<0.05), with the exception of grades IV and V. However, T2 and ADC values were not significantly different between grades I and II or IV and V. In addition, the T1ρ, T2 and ADC values were significantly decreased with the increase of age in patients with IDD (P<0.05). T1ρ and T2 mapping and DWI are promising techniques for the in vivo diagnosis of IDD, which may be useful in determining the appropriate prevention and treatment options for the disease.
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Affiliation(s)
- Wei Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China.,Department of Radiology, Guangzhou First People's Hospital, Guangzhou, Guangdong 510180, P.R. China.,Department of Radiology and Beijing MRI Technology Research Laboratory, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Jin Hou
- Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510260, P.R. China
| | - Deyong Lv
- Department of Radiology, Dongying People's Hospital of Shandong, Dongying, Shandong 257091, P.R. China
| | - Wen Liang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, Guangzhou, Guangdong 510180, P.R. China
| | - Hongbin Han
- Department of Radiology and Beijing MRI Technology Research Laboratory, Peking University Third Hospital, Beijing 100191, P.R. China
| | - Xianyue Quan
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
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47
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Zhang Y, Hu J, Duan C, Hu P, Lu H, Peng X. Correlation study between facet joint cartilage and intervertebral discs in early lumbar vertebral degeneration using T2, T2* and T1ρ mapping. PLoS One 2017; 12:e0178406. [PMID: 28570641 PMCID: PMC5453520 DOI: 10.1371/journal.pone.0178406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 05/14/2017] [Indexed: 01/31/2023] Open
Abstract
Recent advancements in magnetic resonance imaging have allowed for the early detection of biochemical changes in intervertebral discs and articular cartilage. Here, we assessed the feasibility of axial T2, T2* and T1ρ mapping of the lumbar facet joints (LFJs) to determine correlations between cartilage and intervertebral discs (IVDs) in early lumbar vertebral degeneration. We recruited 22 volunteers and examined 202 LFJs and 101 IVDs with morphological (sagittal and axial FSE T2-weighted imaging) and axial biochemical (T2, T2* and T1ρ mapping) sequences using a 3.0T MRI scanner. IVDs were graded using the Pfirrmann system. Mapping values of LFJs were recorded according to the degeneration grades of IVDs at the same level. The feasibility of T2, T2* and T1ρ in IVDs and LFJs were analyzed by comparing these mapping values across subjects with different rates of degeneration using Kruskal-Wallis tests. A Pearson's correlation analysis was used to compare T2, T2* and T1ρ values of discs and LFJs. We found excellent reproducibility in the T2, T2* and T1ρ values for the nucleus pulposus (NP), anterior and posterior annulus fibrosus (PAF), and LFJ cartilage (intraclass correlation coefficients 0.806-0.955). T2, T2* and T1ρ mapping (all P<0.01) had good Pfirrmann grade performances in the NP with IVD degeneration. LFJ T2* values were significantly different between grades I and IV (PL = 0.032, PR = 0.026), as were T1ρ values between grades II and III (PL = 0.002, PR = 0.006) and grades III and IV (PL = 0.006, PR = 0.001). Correlations were moderately negative for T1ρ values between LFJ cartilage and NP (rL = -0.574, rR = -0.551), and between LFJ cartilage and PAF (rL = -0.551, rR = -0.499). T1ρ values of LFJ cartilage was weakly correlated with T2 (r = 0.007) and T2* (r = -0.158) values. Overall, we show that axial T1ρ effectively assesses early LFJ cartilage degeneration. Using T1ρ analysis, we propose a link between LFJ degeneration and IVD NP or PAF changes.
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Affiliation(s)
- Yi Zhang
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Chunyue Duan
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Ping Hu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Hongbin Lu
- Department of Sports Medicine and Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Xianjing Peng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
- * E-mail:
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Xie R, Ruan L, Chen L, Zhou K, Yuan J, Ji W, Jing G, Huang X, Shi Q, Chen C. T2 relaxation time for intervertebral disc degeneration in patients with upper back pain: initial results on the clinical use of 3.0 Tesla MRI. BMC Med Imaging 2017; 17:9. [PMID: 28143419 PMCID: PMC5282844 DOI: 10.1186/s12880-017-0182-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/23/2017] [Indexed: 12/20/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is a useful non-invasive tool for evaluating abnormalities of intervertebral discs. However, there are few studies which applied functional MRI techniques to investigate degenerative changes in cervical and cervicothoracic junction (CTJ) spine among adults. The aim of this study was to compare T2 relaxation time measurement evaluation with morphological grading for assessing cervical and CTJ intervertebral discs (IVD) in the patients suffering neck, shoulder, and upper back pain. Methods Sixty-three patients (378 IVDs) and 60 asymptomatic volunteers (360 IVDs) of the cervical and CTJ discs were assessed using a 3.0 T magnetic resonance imaging (MRI) protocol, including an sagittal T2 relaxation time protocol. The relaxation time values of the nucleus pulposus (NP) were recorded and all discs were visually graded according to Pfirrman’s grading system. The correlation between T2 relaxation time values and qualitative clinical grading of degeneration, patient age, sex and anatomic level were analyzed Results There is a clear trend of decreasing mean T2 values of the NP associate with increasing Pfirrmann grades (C2-T1) for both patients and asymptotic volunteers. Significant T2 differences were seen among grades I-V (P < 0.05). However, grade V was not observed in the CTJ. Linear correlation analysis revealed a strong negative association between T2 values of the NP and Pfirrmann grade (r = −0.588, r = −0.808) of C2-7 and C7T1. Age were also significantly correlated NP T2 values (r = −0.525, r = −0.723) for patients and volunteers. Moreover, the receiver operating characteristic analysis for average measures in a range from 0.70-0.79 (C2-7) to 0.84-0.89 (C7T1) for patients. Conclusions T2 quantitation provides a more sensitive and robust approach for detecting and characterizing the early stage of IVD degeneration and age-associated disc changes. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0182-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raoying Xie
- Department of Orthopaedics, the First Affiliated Hospital, Wenzhou Medical University, Nan baixiang Road, Shangcai Village, Wenzhou, 325000, Zhejiang, People's Republic of China.,Department of Radiation and chemotherapy division, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Linhui Ruan
- Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Lei Chen
- Department of Orthopaedics, the First Affiliated Hospital, Wenzhou Medical University, Nan baixiang Road, Shangcai Village, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Kai Zhou
- Department of Orthopaedics, the First Affiliated Hospital, Wenzhou Medical University, Nan baixiang Road, Shangcai Village, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jiandong Yuan
- Department of Orthopaedics, the First Affiliated Hospital, Wenzhou Medical University, Nan baixiang Road, Shangcai Village, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Wei Ji
- Department of Orthopaedics, Navy General Hospital, Beijing, People's Republic of China
| | - Guangjian Jing
- Department of Orthopaedics, the First Affiliated Hospital, Wenzhou Medical University, Nan baixiang Road, Shangcai Village, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Xiaojing Huang
- Department of Orthopaedics, the First Affiliated Hospital, Wenzhou Medical University, Nan baixiang Road, Shangcai Village, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Qinglei Shi
- Siemens Ltd, China Healthcare Sector MR Business Group, Beijing, People's Republic of China
| | - Chun Chen
- Department of Orthopaedics, the First Affiliated Hospital, Wenzhou Medical University, Nan baixiang Road, Shangcai Village, Wenzhou, 325000, Zhejiang, People's Republic of China.
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Galley J, Maestretti G, Koch G, Hoogewoud HM. Real T1 relaxation time measurement and diurnal variation analysis of intervertebral discs in a healthy population of 50 volunteers. Eur J Radiol 2016; 87:13-19. [PMID: 28065371 DOI: 10.1016/j.ejrad.2016.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/21/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To measure the real T1 relaxation time of the lumbar intervertebral discs in a young and healthy population, using different inversion recovery times, and assess diurnal variation. MATERIAL AND METHODS Intervertebral discs from D12 to S1 of 50 healthy volunteers from 18 to 25 years old were evaluated twice the same day, in the morning and in the late afternoon. Dedicated MRI sequences with different inversion recovery times (from 100 to 2500ms) were used to calculate the real T1 relaxation time. Three regions of interest (ROIs) were defined in each disc, the middle representing the nucleus pulposus (NP) and the outer parts the annulus fibrosus (AF) anterior and posterior. Diurnal variation and differences between each disc level were analyzed. RESULTS T1 mean values in the NP were 1142±12ms in the morning and 1085±13ms in the afternoon, showing a highly significant decrease of 57ms (p<0.001). A highly significant difference between the levels of the spine was found. The mean T1 of the anterior part of the AF was 577±9ms in the morning and 554±8ms in the afternoon. For the posterior part, the mean values were 633±8ms in the morning and 581±7ms in the evening. It shows a highly significant decrease of 23ms for the anterior part and 51ms for the posterior part (all p<0.001). CONCLUSION T1 mapping is a promising method of intervertebral disc evaluation. Significant diurnal variation and difference between levels of the lumbar spine were demonstrated. A potential use for longitudinal study in post-operative follow up or sport medicine needs to be evaluated.
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Affiliation(s)
- J Galley
- Department of Radiology, HFR Fribourg, Hôpital Cantonal, Switzerland.
| | - G Maestretti
- Department of Orthopedic Surgery, HFR Fribourg, Hôpital Cantonal, Switzerland
| | - G Koch
- Department of Radiology, HFR Fribourg, Hôpital Cantonal, Switzerland
| | - H-M Hoogewoud
- Department of Radiology, HFR Fribourg, Hôpital Cantonal, Switzerland
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Hwang D, Kim S, Abeydeera NA, Statum S, Masuda K, Chung CB, Siriwanarangsun P, Bae WC. Quantitative magnetic resonance imaging of the lumbar intervertebral discs. Quant Imaging Med Surg 2016; 6:744-755. [PMID: 28090450 DOI: 10.21037/qims.2016.12.09] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Human lumbar spine is composed of multiple tissue components that serve to provide structural stability and proper nutrition. Conventional magnetic resonance (MR) imaging techniques have been useful for evaluation of IVD, but inadequate at imaging the discovertebral junction and ligamentous tissues due primarily to their short T2 nature. Ultrashort time to echo (UTE) MR techniques acquire sufficient MR signal from these short T2 tissues, thereby allowing direct and quantitative evaluation. This article discusses the anatomy of the lumbar spine, MR techniques available for morphologic and quantitative MR evaluation of long and short T2 tissues of the lumbar spine, considerations for T2 relaxation modeling and fitting, and existing and new techniques for spine image post-processing, focusing on segmentation. This article will be of interest to radiologic and orthopaedic researchers performing lumbar spine imaging.
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Affiliation(s)
- Dosik Hwang
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA; ; School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Sewon Kim
- School of Electrical and Electronic Engineering, Yonsei University, Seoul, Korea
| | - Nirusha A Abeydeera
- Department of Radiology, University of California-San Diego, La Jolla, CA, USA
| | - Sheronda Statum
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA; ; Department of Radiology, University of California-San Diego, La Jolla, CA, USA
| | - Koichi Masuda
- Department of Orthopaedic Surgery, University of California-San Diego, La Jolla, CA, USA
| | - Christine B Chung
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA; ; Department of Radiology, University of California-San Diego, La Jolla, CA, USA
| | - Palanan Siriwanarangsun
- Department of Radiology, University of California-San Diego, La Jolla, CA, USA;; Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Won C Bae
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA; ; Department of Radiology, University of California-San Diego, La Jolla, CA, USA
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