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Li Z, Zhang B, Fang B, Gong H, Han Y, Pei S, Zhang S, Song G. Finite element analysis of a three-dimensional cervical spine model with muscles based on CT scan data. Comput Methods Biomech Biomed Engin 2024:1-11. [PMID: 38963151 DOI: 10.1080/10255842.2024.2373928] [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: 04/03/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The incidence of cervical spondylosis is increasing, gradually affecting people's normal lives. Establishing a finite element model of the cervical spine is one of the methods for studying cervical spondylosis. MRI (Magnetic Resonance Imaging) still has certain difficulties in transitioning from human imaging to establishing muscle models suitable for finite element analysis. Medical software provides specific morphologies and can generate muscle finite element models. Additionally, there is little research on the static analysis of cervical spine finite element models with solid muscle. PURPOSE A new method is proposed for establishing a finite element model of the cervical spine based on CT (Computed Tomography) data and medical software, and the model's effectiveness is validated. Human movement characteristics based on the force distribution in various parts are analyzed and predicted. METHODS The muscle model is reconstructed in medical software and a three-dimensional finite element model of the entire cervical spine (C0-C7) is established by combining muscle models with CT vertebral data models. 1.5 Nm of load is applied to the finite element model to simulate the cervical spine movement. RESULTS The finite element model was successfully established, and effectiveness was verified. Stress variations in various parts under six movements were obtained. The effectiveness of the model was basically verified. CONCLUSION The finite element model of the cervical spine for mechanical analysis can be successfully established by using medical software and CT data. In daily life, the C2-3, C3-4, C4-C5 intervertebral discs, rectus capitis posterior major, longus colli, and obliquus capitis inferior are more prone to injury.
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Affiliation(s)
- Zhi Li
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Bing Zhang
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Bin Fang
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Huiping Gong
- Department of Emergency, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Ying Han
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Shize Pei
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Shuqi Zhang
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
| | - Guangfei Song
- Faculty of Mechanical Engineering, Qilu University of Technology, Jinan, Shandong, China
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Kamp B, Radke KL, Knet M, Strunk R, Gallinnis PJ, Nagel AM, Filler TJ, Antoch G, Abrar DB, Frenken M, Wittsack HJ, Müller-Lutz A. Sodium MRI of the Lumbar Intervertebral Discs of the Human Spine: An Ex Vivo Study. J Magn Reson Imaging 2024. [PMID: 38963154 DOI: 10.1002/jmri.29521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Lower back pain affects 75%-85% of people at some point in their lives. The detection of biochemical changes with sodium (23Na) MRI has potential to enable an earlier and more accurate diagnosis. PURPOSE To measure 23Na relaxation times and apparent tissue sodium concentration (aTSC) in ex-vivo intervertebral discs (IVDs), and to investigate the relationship between aTSC and histological Thompson grade. STUDY TYPE Ex-vivo. SPECIMEN Thirty IVDs from the lumbar spines of 11 human body donors (4 female, 7 male, mean age 86 ± 8 years). FIELD STRENGTH/SEQUENCE 3 T; density-adapted 3D radial sequence (DA-3D-RAD). ASSESSMENT IVD 23Na longitudinal (T1), short and long transverse (T2s* and T2l*) relaxation times and the proportion of the short transverse relaxation (ps) were calculated for one IVD per spine sample (11 IVDs). Furthermore, aTSCs were calculated for all IVDs. The degradation of the IVDs was assessed via histological Thompson grading. STATISTICAL TESTS A Kendall Tau correlation (τ) test was performed between the aTSCs and the Thompson grades. The significance level was set to P < 0.05. RESULTS Mean 23Na relaxation parameters of a subset of 11 IVDs were T1 = 9.8 ± 1.3 msec, T2s* = 0.7 ± 0.1 msec, T2l* = 7.3 ± 1.1 msec, and ps = 32.7 ± 4.0%. A total of 30 IVDs were examined, of which 3 had Thompson grade 1, 4 had grade 2, 5 had grade 3, 5 had grade 4, and 13 had grade 5. The aTSC decreased with increasing degradation, being 274.6 ± 18.9 mM for Thompson grade 1 and 190.5 ± 29.5 mM for Thompson grade 5. The correlation between whole IVD aTSC and Thompson grade was significant and strongly negative (τ = -0.56). DATA CONCLUSION This study showed a significant correlation between aTSC and degenerative IVD changes. Consequently, aTSC has potential to be useful as an indicator of degenerative spinal changes. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Benedikt Kamp
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Karl Ludger Radke
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Marek Knet
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Rosanna Strunk
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Patrik J Gallinnis
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Timm J Filler
- Institute of Anatomy I, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Daniel B Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Miriam Frenken
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hans-Jörg Wittsack
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Anja Müller-Lutz
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Li Z, Wu Y, Liu M, Miao D, Zhang D, Ding W. A novel quantitative method to evaluate lumbar disc degeneration: MRI histogram analysis. 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 2024; 33:2420-2429. [PMID: 38705902 DOI: 10.1007/s00586-024-08279-6] [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] [Received: 01/24/2024] [Revised: 01/24/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE This study aimed to use MRI histogram analysis to routine MRI sequences to evaluate lumbar disc degeneration (LDD), illustrate the correlation between this novel method and the traditional Pfirrmann classification method, and more importantly, perform comprehensive agreement analysis of MRI histogram analysis in various situations to evaluate its objectivity and stability. METHODS Lumbar MRI images from 133 subjects were included in this study. LDD was classified into grades by Pfirrmann classification and was measured as peak separation value by MRI histogram analysis. Correlation analysis between the two methods was performed and cutoff values were determined. In addition, the agreement analysis of peak separation value was performed by intraclass correlation coefficient (ICC) in four scenarios, including inter-resolution, inter-observer, inter-regions of interest (ROI) and inter-slice. RESULTS Peak separation values were strongly correlated with Pfirrmann grades (r = - 0.847). The inter-resolution agreements of peak separation value between original image resolution of 2304 × 2304 and compressed image resolutions (1152 × 1152, 576 × 576, 288 × 288) were good to excellent (ICCs were 0.916, 0.876 and 0.822), except 144 × 144 was moderate (ICC = 533). The agreements of inter-observer (ICC = 0.982) and inter-ROI (ICC = 0.915) were excellent. Compared with the mid-sagittal slice, the inter-slice agreements were good for the first adjacent slices (ICCs were 0.826 and 0.844), and moderate to good for the second adjacent slices (ICC = 0.733 and 0.753). CONCLUSION MRI histogram analysis, used in routine MRI sequences, demonstrated a strong correlation with Pfirrmann classification and good agreements in various scenarios, expanding the range of application and providing an effective, objective and quantitative tool to evaluate LDD.
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Affiliation(s)
- Zhaohui Li
- Department of Spine Surgery, Hebei Medical University Third Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Yurui Wu
- School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang, 050017, China
| | - Mengyang Liu
- School of Public Health, Hebei Medical University, 361 East Zhongshan Road, Shijiazhuang, 050017, China
| | - Dazhuang Miao
- Department of Spine Surgery, Hebei Medical University Third Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Di Zhang
- Department of Spine Surgery, Hebei Medical University Third Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Wenyuan Ding
- Department of Spine Surgery, Hebei Medical University Third Hospital, 139 Ziqiang Road, Shijiazhuang, 050051, China.
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Zhang D, Du J, Shi J, Zhang Y, Jia S, Liu X, Wu Y, An Y, Zhu S, Pan D, Zhang W, Zhang Y, Feng S. A fully automatic MRI-guided decision support system for lumbar disc herniation using machine learning. JOR Spine 2024; 7:e1342. [PMID: 38817341 PMCID: PMC11137648 DOI: 10.1002/jsp2.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024] Open
Abstract
Background Normalized decision support system for lumbar disc herniation (LDH) will improve reproducibility compared with subjective clinical diagnosis and treatment. Magnetic resonance imaging (MRI) plays an essential role in the evaluation of LDH. This study aimed to develop an MRI-based decision support system for LDH, which evaluates lumbar discs in a reproducible, consistent, and reliable manner. Methods The research team proposed a system based on machine learning that was trained and tested by a large, manually labeled data set comprising 217 patients' MRI scans (3255 lumbar discs). The system analyzes the radiological features of identified discs to diagnose herniation and classifies discs by Pfirrmann grade and MSU classification. Based on the assessment, the system provides clinical advice. Results Eventually, the accuracy of the diagnosis process reached 95.83%. An 83.5% agreement was observed between the system's prediction and the ground-truth in the Pfirrmann grade. In the case of MSU classification, 95.0% precision was achieved. With the assistance of this system, the accuracy, interpretation efficiency and interrater agreement among surgeons were improved substantially. Conclusion This system showed considerable accuracy and efficiency, and therefore could serve as an objective reference for the diagnosis and treatment procedure in clinical practice.
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Affiliation(s)
- Di Zhang
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Jiawei Du
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Jiaxiao Shi
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Yundong Zhang
- Beijing Longwood Valley CompanyBeijingPeople's Republic of China
| | - Siyue Jia
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Xingyu Liu
- Beijing Longwood Valley CompanyBeijingPeople's Republic of China
| | - Yu Wu
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Yicheng An
- Beijing Longwood Valley CompanyBeijingPeople's Republic of China
| | - Shibo Zhu
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Dayu Pan
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
| | - Wei Zhang
- School of Control Science and Engineering, Shandong UniversityJinanPeople's Republic of China
| | - Yiling Zhang
- Beijing Longwood Valley CompanyBeijingPeople's Republic of China
| | - Shiqing Feng
- Department of OrthopaedicsTianjin Medical University General HospitalTianjinPeople's Republic of China
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Xie J, Yang Y, Jiang Z, Zhang K, Zhang X, Lin Y, Shen Y, Jia X, Liu H, Yang S, Jiang Y, Ma L. MRI radiomics-based decision support tool for a personalized classification of cervical disc degeneration: a two-center study. Front Physiol 2024; 14:1281506. [PMID: 38235385 PMCID: PMC10791783 DOI: 10.3389/fphys.2023.1281506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/24/2023] [Indexed: 01/19/2024] Open
Abstract
Objectives: To develop and validate an MRI radiomics-based decision support tool for the automated grading of cervical disc degeneration. Methods: The retrospective study included 2,610 cervical disc samples of 435 patients from two hospitals. The cervical magnetic resonance imaging (MRI) analysis of patients confirmed cervical disc degeneration grades using the Pfirrmann grading system. A training set (1,830 samples of 305 patients) and an independent test set (780 samples of 130 patients) were divided for the construction and validation of the machine learning model, respectively. We provided a fine-tuned MedSAM model for automated cervical disc segmentation. Then, we extracted 924 radiomic features from each segmented disc in T1 and T2 MRI modalities. All features were processed and selected using minimum redundancy maximum relevance (mRMR) and multiple machine learning algorithms. Meanwhile, the radiomics models of various machine learning algorithms and MRI images were constructed and compared. Finally, the combined radiomics model was constructed in the training set and validated in the test set. Radiomic feature mapping was provided for auxiliary diagnosis. Results: Of the 2,610 cervical disc samples, 794 (30.4%) were classified as low grade and 1,816 (69.6%) were classified as high grade. The fine-tuned MedSAM model achieved good segmentation performance, with the mean Dice coefficient of 0.93. Higher-order texture features contributed to the dominant force in the diagnostic task (80%). Among various machine learning models, random forest performed better than the other algorithms (p < 0.01), and the T2 MRI radiomics model showed better results than T1 MRI in the diagnostic performance (p < 0.05). The final combined radiomics model had an area under the receiver operating characteristic curve (AUC) of 0.95, an accuracy of 89.51%, a precision of 87.07%, a recall of 98.83%, and an F1 score of 0.93 in the test set, which were all better than those of other models (p < 0.05). Conclusion: The radiomics-based decision support tool using T1 and T2 MRI modalities can be used for cervical disc degeneration grading, facilitating individualized management.
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Affiliation(s)
- Jun Xie
- Information Technology Center, West China Hospital of Sichuan University, Chengdu, China
- Information Technology Center, Sanya People’s Hospital, Sanya, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zekun Jiang
- College of Computer Science, Sichuan University, Chengdu, Sichuan, China
- West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Kerui Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuheng Lin
- West China Biomedical Big Data Center, Sichuan University, Chengdu, Sichuan, China
| | - Yiwei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuehai Jia
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shaofen Yang
- Cadre Health Section, Hezhou People’s Hospital, Hezhou, Guangxi, China
| | - Yang Jiang
- Department of Orthopedic Spine, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, Sichuan, China
| | - Litai Ma
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Pendleton J, Ng A. SPECT/CT Scan: A New Diagnostic Tool in Pain Medicine. Curr Pain Headache Rep 2023; 27:729-735. [PMID: 37837482 DOI: 10.1007/s11916-023-01177-4] [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] [Accepted: 09/11/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to evaluate the role of SPECT/CT in identifying facet joint arthropathy and the outcomes of interventions with SPECT/CT as an adjunct. RECENT FINDINGS A positive finding of facet arthropathy on SPECT/CT is associated with a higher likelihood of a unilateral procedure and a significantly more effective intervention compared with those performed on patients with facet arthropathy diagnosed only by clinical and/or radiologic examination. Surgical treatment of SPECT/CT-positive findings appears to have a good effect; however, due to limitations in the available studies, no strong conclusion can be drawn. SPECT/CT has a good correlation identifying pain generators in chronic neck and back pain. SPECT/CT-targeted facet interventions demonstrate a higher success rate, but SPECT/CT is not recommended as a first-line diagnostic tool prior to diagnostic facet interventions. More robust studies are needed to confirm the higher success of surgical treatment for SPECT/CT-positive facet arthropathy.
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Affiliation(s)
- James Pendleton
- Jefferson Pain Center, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew Ng
- Jefferson Pain Center, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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Schönnagel L, Muellner M, Suwalski P, Zhu J, Guven AE, Caffard T, Tani S, Camino-Willhuber G, Haffer H, Chiapparelli E, Amoroso K, Arzani A, Moser M, Shue J, Tan ET, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Abdominal aortic calcification is independently associated with lumbar endplate degeneration. 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; 32:3387-3393. [PMID: 37584697 DOI: 10.1007/s00586-023-07871-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Abdominal aortic calcification (AAC) is associated with lower back pain, reduced bone mineral density of the spine. Vascular changes could also affect the already sparsely perfused intervertebral endplate and intervertebral disc. METHODS Lumbar MRIs and lateral radiographs of patients with lower back pain were retrospectively analyzed. AAC was assessed on lateral lumbar radiographs according to the Kauppila score, with a maximum score of 24. Patients were grouped into no (AAC = 0), moderate (AAC 1 to ≤ 4), and severe AAC (AAC ≥ 5). Endplate and disc degeneration were classified according to the total endplate score (TEPS) and Pfirrmann classification. The associations between AAC and degenerative changes was analyzed with a generalized mixed model and was adjusted for age, sex, body mass index as well as diabetes mellitus, and smoking status. RESULTS A total of 217 patients (47.9% female) were included in the analysis, totaling 1085 intervertebral levels. Of those, 45 (20.7%) patients had moderate, and 39 (18%) had severe AAC. The results of the generalized mixed model showed no significant association between AAC and disc degeneration (p > 0.05). In contrast, a significant positive association between AAC and the severity of TEPS (β: 0.51, 95% CI: 1.92-2.12, p = 0.004) was observed in the multivariable analysis. CONCLUSIONS This study demonstrates an independent association between AAC and endplate degeneration. These findings expand our knowledge about the degenerative cascade of the lumbar spine and suggest that AAC might be a modifiable risk factor for endplate changes.
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Affiliation(s)
- Lukas Schönnagel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Muellner
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Phillip Suwalski
- Medical Heart Center of Charité CBF, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY, USA
| | - Ali E Guven
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Caffard
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Universitätsklinikum Ulm, Klinik Für Orthopädie, Ulm, Germany
| | - Soji Tani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Gaston Camino-Willhuber
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Henryk Haffer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Krizia Amoroso
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Artine Arzani
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Manuel Moser
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jennifer Shue
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY, USA
| | - Andrew A Sama
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Federico P Girardi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Frank P Cammisa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Alexander P Hughes
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine, New York City, NY, USA.
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Soydan Z, Bayramoglu E, Karasu R, Sayin I, Salturk S, Uvet H. An Automatized Deep Segmentation and Classification Model for Lumbar Disk Degeneration and Clarification of Its Impact on Clinical Decisions. Global Spine J 2023:21925682231200783. [PMID: 37698081 DOI: 10.1177/21925682231200783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
STUDY DESIGN Cross-sectional database study. OBJECTIVE The purpose of this study was to develop a successful, reproducible, and reliable convolutional neural network (CNN) model capable of segmentation and classification for grading intervertebral disc degeneration (IVDD), as well as quantify the network's impact on doctors' clinical decision-making. METHODS 5685 discs from 1137 patients were graded separately by four experienced doctors according to the Pfirrmann classification. A ground truth (GT) was established for each disc in accordance with the decision of the majority of doctors. The U-net model is used for segmentation. 1815 discs from 363 patients were used to train and test the U-net. The Inception V3 model is employed for classification. All discs were separated into two distinct sets: 90% in a training set and 10% in a test set. The performance metrics of these models were measured. Reliability tests were performed. The impact of CNN assistance on doctors was assessed. RESULTS Segmentation accuracy was .9597 with a .8717 Jaccard Index and a .9314 Sorensen Dice coefficient. Classification accuracy is .9346, and the F1 score is .9355. The intraclass correlation coefficient (ICC) and kappa values between CNN and GT were .95-.97. With CNN's assistance, the success rates of doctors increased by 7.9% to 22%. CONCLUSIONS The fully automated network outperformed doctors markedly in terms of accuracy and reliability. The results of CNN were comparable to those of other recent studies in the literature. It was determined that CNN's assistance had a substantial positive effect on the doctor's decision.
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Affiliation(s)
- Zafer Soydan
- Orthopedics and Traumatology, Bhtclinic İstanbul Tema Hospital, Nisantası University, Istanbul, Turkey
| | - Emru Bayramoglu
- Orthopedics and Traumatology, Bursa City Hospital, Bursa, Turkey
| | - Recep Karasu
- Orthopedics and Traumatology, Bursa City Hospital, Bursa, Turkey
| | - Irem Sayin
- Department of Mechatronics Engineering, Yildiz Technical University, Istanbul, Turkey
| | - Serkan Salturk
- Department of Informatics, Yildiz Technical University, Istanbul, Turkey
| | - Huseyin Uvet
- Department of Mechatronics Engineering, Yildiz Technical University, Istanbul, Turkey
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Chiu PF, Chang RCH, Lai YC, Wu KC, Wang KP, Chiu YP, Ji HR, Kao CH, Chiu CD. Machine Learning Assisting the Prediction of Clinical Outcomes following Nucleoplasty for Lumbar Degenerative Disc Disease. Diagnostics (Basel) 2023; 13:diagnostics13111863. [PMID: 37296715 DOI: 10.3390/diagnostics13111863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Lumbar degenerative disc disease (LDDD) is a leading cause of chronic lower back pain; however, a lack of clear diagnostic criteria and solid LDDD interventional therapies have made predicting the benefits of therapeutic strategies challenging. Our goal is to develop machine learning (ML)-based radiomic models based on pre-treatment imaging for predicting the outcomes of lumbar nucleoplasty (LNP), which is one of the interventional therapies for LDDD. METHODS The input data included general patient characteristics, perioperative medical and surgical details, and pre-operative magnetic resonance imaging (MRI) results from 181 LDDD patients receiving lumbar nucleoplasty. Post-treatment pain improvements were categorized as clinically significant (defined as a ≥80% decrease in the visual analog scale) or non-significant. To develop the ML models, T2-weighted MRI images were subjected to radiomic feature extraction, which was combined with physiological clinical parameters. After data processing, we developed five ML models: support vector machine, light gradient boosting machine, extreme gradient boosting, extreme gradient boosting random forest, and improved random forest. Model performance was measured by evaluating indicators, such as the confusion matrix, accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (AUC), which were acquired using an 8:2 allocation of training to testing sequences. RESULTS Among the five ML models, the improved random forest algorithm had the best performance, with an accuracy of 0.76, a sensitivity of 0.69, a specificity of 0.83, an F1 score of 0.73, and an AUC of 0.77. The most influential clinical features included in the ML models were pre-operative VAS and age. In contrast, the most influential radiomic features had the correlation coefficient and gray-scale co-occurrence matrix. CONCLUSIONS We developed an ML-based model for predicting pain improvement after LNP for patients with LDDD. We hope this tool will provide both doctors and patients with better information for therapeutic planning and decision-making.
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Affiliation(s)
- Po-Fan Chiu
- Spine Center, China Medical University Hospital, Taichung 404327, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung 404327, Taiwan
| | - Robert Chen-Hao Chang
- Department of Electrical Engineering, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yung-Chi Lai
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 404327, Taiwan
| | - Kuo-Chen Wu
- Center of Artificial Intelligence, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei 10617, Taiwan
| | - Kuan-Pin Wang
- Center of Artificial Intelligence, China Medical University Hospital, Taichung 404327, Taiwan
- Department of Computer Science and Engineering, National Chung Hsing University, Taichung 40227, Taiwan
| | - You-Pen Chiu
- Spine Center, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 404327, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung 404327, Taiwan
| | - Hui-Ru Ji
- Spine Center, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 404327, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung 404327, Taiwan
| | - Chia-Hung Kao
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 404327, Taiwan
- Center of Artificial Intelligence, China Medical University Hospital, Taichung 404327, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung 404327, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
| | - Cheng-Di Chiu
- Spine Center, China Medical University Hospital, Taichung 404327, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung 404327, Taiwan
- School of Medicine, China Medical University, Taichung 404327, Taiwan
- Graduate Institute of Biomedical Science, China Medical University, Taichung 404327, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan
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10
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Varga M, Kantorová L, Langaufová A, Štulík J, Lančová L, Srikandarajah N, Kaiser R. Role of Single-Photon Emission Computed Tomography Imaging in the Diagnosis and Treatment of Chronic Neck or Back Pain Caused by Spinal Degeneration: A Systematic Review. World Neurosurg 2023; 173:65-78. [PMID: 36803686 DOI: 10.1016/j.wneu.2023.02.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Chronic neck or back pain is a common clinical problem. The most likely cause is degenerative change, whereas other causes are relatively rare. There is increasing evidence on using hybrid single-photon emission computed tomography (SPECT) to identify the pain generator in spine degeneration. This systematic review explores the diagnostic and therapeutic evidence on chronic neck or back pain examined by SPECT. METHODS This review is reported in accordance with the PRISMA guidelines. In October 2022, we searched the following sources: MEDLINE, Embase, CINAHL, SCOPUS, and 3 other sources. Titles and abstracts were screened and classified into diagnostic studies, facet block studies, and surgical studies. We synthesized the results narratively. RESULTS The search yielded 2347 records. We identified 10 diagnostic studies comparing SPECT or SPECT/computed tomography (CT) with magnetic resonance imaging, CT, scintigraphy, or clinical examination. Furthermore, we found 8 studies comparing the effect of facet block intervention in SPECT-positive and SPECT-negative patients with cervicogenic headache, neck pain, and lower back pain. Five surgical studies describing the effect of fusion for facet arthropathy in the craniocervical junction, subaxial cervical spine, or the lumbar spine were identified. CONCLUSIONS According to the available literature, a positive finding on SPECT in facet arthropathy is associated with a significantly higher facet blockade effect. Surgical treatment of positive findings has a good effect, but this has not been confirmed by controlled studies. SPECT/CT might therefore be a useful method in the evaluation of patients with neck or back pain, especially in cases of unclear findings or multiple degenerative changes.
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Affiliation(s)
- Michal Varga
- Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Lucia Kantorová
- The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Alena Langaufová
- The Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jan Štulík
- Department of Spinal Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Lucie Lančová
- Department of Nuclear Medicine and Endocrinology, Second Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Nisaharan Srikandarajah
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
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11
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The current state of radiodiagnostics of degenerative changes in the lumbar spine (literature review). ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.6.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Examination of the spine using radiological methods remains the most frequently conducted study in the outpatient practice of almost any radiologist. In most cases, changes in the spine are degenerative and dystrophic in nature. These changes in the spine are the leading cause of loss of activity among adults and the elderly, and cover a wide range of age-related structural changes. It is of great importance to understand the possibilities and limitations of radiological methods of diagnostics. The description of morphological changes observed in degenerative and dystrophic changes requires the use of unified terminology and classifications among clinicians and radiologists.The aim. To present modern concepts in the assessment of degenerative changes of the spine using radiological methods. A description of the standardized international nomenclature of intervertebral disc pathology and current classifications of spinal canal stenosis are presented.Material and methods. For literature search, we used electronic databases MEDLINE (PubMed), eLibrary, EMBASE and Cochrane Library with a selection of sources published from 2000 to 2021. We analyzed the works devoted to the diagnosis of degenerative changes in lumbar spine and to degenerative stenosis.Conclusion. The key to productive communication between physicians is the uniformity or standardization of terminology and definitions used. It is important that the protocol of description, its terms, semantic expressions be uniform and understandable to specialists who are involved in the diagnosis and treatment of the spine. Magnetic resonance imaging is a valuable method in the diagnosis of degenerative changes of the spinal column, but it has its limitations.
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12
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Sun K, Jiang J, Wang Y, Sun X, Zhu J, Xu X, Sun J, Shi J. The role of nerve fibers and their neurotransmitters in regulating intervertebral disc degeneration. Ageing Res Rev 2022; 81:101733. [PMID: 36113765 DOI: 10.1016/j.arr.2022.101733] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/11/2022] [Accepted: 09/11/2022] [Indexed: 01/31/2023]
Abstract
Intervertebral disc degeneration (IVDD) has been the major contributor to chronic lower back pain (LBP). Abnormal apoptosis, senescence, and pyroptosis of IVD cells, extracellular matrix (ECM) degradation, and infiltration of immune cells are the major molecular alternations during IVDD. Changes at tissue level frequently occur at advanced IVD tissue. Ectopic ingrowth of nerves within inner annulus fibrosus (AF) and nucleus pulposus (NP) tissue has been considered as the primary cause for LBP. Innervation at IVD tissue mainly included sensory and sympathetic nerves, and many markers for these two types of nerves have been detected since 1940. In fact, in osteoarthritis (OA), beyond pain transmission, the direct regulation of neuropeptides on functions of chondrocytes have attracted researchers' great attention recently. Many physical and pathological similarities between joint and IVD have shed us the light on the neurogenic mechanism involved in IVDD. Here, an overview of the advances in the nervous system within IVD tissue will be performed, with a discussion on in the role of nerve fibers and their neurotransmitters in regulating IVDD. We hope this review can attract more research interest to address neuromodulation and IVDD itself, which will enhance our understanding of the contribution of neuromodulation to the structural changes within IVD tissue and inflammatory responses and will help identify novel therapeutic targets and enable the effective treatment of IVDD disease.
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Affiliation(s)
- Kaiqiang Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China; Department of Orthopedics, Naval Medical Center of PLA, China
| | - Jialin Jiang
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Yuan Wang
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Xiaofei Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Jian Zhu
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Ximing Xu
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China
| | - Jingchuan Sun
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China.
| | - Jiangang Shi
- Department of Orthopedic Surgery, Changzheng Hospital, Navy Medical University, No.415 Fengyang Road, Shanghai 200003, China.
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Kampmann A, Hiller W, Weberskirch R. Efficient Synthesis of Macromolecular DO3A@Gn Derivatives for Potential Application in MRI Diagnostics: From Polymer Conjugates to Polymer Nanoparticles. MACROMOL CHEM PHYS 2022. [DOI: 10.1002/macp.202200211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anne‐Larissa Kampmann
- Fakultät für Chemie und Chemische Biologie Otto‐Hahn Str. 6, TU Dortmund, Otto‐Hahn Str. 6 TU, D‐44227 Dortmund Germany
| | - Wolf Hiller
- Fakultät für Chemie und Chemische Biologie Otto‐Hahn Str. 6, TU Dortmund, Otto‐Hahn Str. 6 TU, D‐44227 Dortmund Germany
| | - Ralf Weberskirch
- Fakultät für Chemie und Chemische Biologie Otto‐Hahn Str. 6, TU Dortmund, Otto‐Hahn Str. 6 TU, D‐44227 Dortmund Germany
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14
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Jiang J, Hu J, Cai HP, Niu L, Zheng ML, Chen X, Zhang WZ. Radiographic analysis of dynamic lumbar motion during the five-repetition sit-to-stand test in degenerative lumbar spondylolisthesis. BMC Musculoskelet Disord 2022; 23:800. [PMID: 35996131 PMCID: PMC9394038 DOI: 10.1186/s12891-022-05761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background To investigate the mechanisms of low back pain triggered by the five-repetition sit-to-stand test (5R-STS test) in degenerative lumbar spondylolisthesis (DLS) from radiographic perspective, as well as to determine the most useful diagnostic modalities in the evaluation of segmental instability. Methods We retrospectively performed a study of 78 patients (23 men and 55 women) with symptomatic DLS at L4/5 in our institution between April 2020 and December 2021. Each patient was assessed by using the 5R-STS test and received a series of radiographs including the upright standing, normal sitting, standing flexion–extension radiographs, and supine sagittal MR images. Enrolled patients were divided into two groups based on the 5R-STS test score: severe group and mild group. Translational and angular motion was determined by comparing normal sitting radiograph (N) with upright standing radiograph (U) (Combined, NU), flexion/extension radiographs (FE) as well as normal sitting radiograph (N) with a supine sagittal MR image (sMR) (Combined, N-sMR). Results Overall, 78 patients were enrolled, and there were 31(39.7%) patients in group S and 47(60.3%) patients in group M, with an average age of 60.7 ± 8.4 years. The normal sitting radiograph demonstrated the maximum slip percentage (SP) and the highest kyphotic angle both in group S and group M. Compared with group M, group S revealed significantly higher SP in the normal sitting position (24.1 vs 19.6; p = 0.002). The lumbar slip angular in group S with a sitting position was significantly higher than that in group M (-5.2 vs -1.3; p < 0.001). All patients in group S had objective functional impairment (OFI) and 28 patients of them were diagnosed with lumbar instability by using the combination of normal sitting radiograph (N) and supine sagittal MR image (sMR) (Combined, N-sMR). Conclusion DLS patients with positive sign of the 5R-STS test is a distinct subgroup associated with lumbar instability. The modality of the combination of normal sitting radiograph (N) and supine sagittal MR image (sMR) had a significant advantage in terms of the ability to identify segmental instability.
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Affiliation(s)
- Jiang Jiang
- Department of Orthopedics, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China
| | - Jun Hu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hai-Ping Cai
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lei Niu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Meng-Long Zheng
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xi Chen
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China. .,, Hefei, China.
| | - Wen-Zhi Zhang
- Department of Orthopedics, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China. .,, Hefei, China.
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15
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Theodorou DJ, Theodorou SJ, Gelalis ID, Kakitsubata Y. Lumbar Intervertebral Disc and Discovertebral Segment, Part 1: An Imaging Review of Normal Anatomy. Cureus 2022; 14:e25558. [PMID: 35784982 PMCID: PMC9249043 DOI: 10.7759/cureus.25558] [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] [Accepted: 05/31/2022] [Indexed: 12/03/2022] Open
Abstract
The intervertebral disc is designated the most important cartilaginous articulation of the vertebral column that functions to withstand compressive biomechanical forces and confer strength and flexibility to the spine. A thorough study of the complex fine structure and anatomic relationships of the intervertebral disc is essential for the characterization of the integrity of each individual structure in the discovertebral segment. This elaborate work in human cadavers explores the sophisticated internal structure of the normal intervertebral disc and the discovertebral segment, providing detailed data derived from the dissection of specimens through imaging and close anatomic-histologic correlation. Familiarity with the normal appearances and basic functional properties of the lumbar intervertebral disc and discovertebral segment is fundamental for the recognition of aberrations that may have important clinical implications in patients with low back pain. In Part I of this article, the anatomic structure and features of the discovertebral complex in adults will be described.
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16
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Lu X, Zhu Z, Pan J, Feng Z, Lv X, Battié MC, Wang Y. Traumatic vertebra and endplate fractures promote adjacent disc degeneration: evidence from a clinical MR follow-up study. Skeletal Radiol 2022; 51:1017-1026. [PMID: 34599674 DOI: 10.1007/s00256-021-03846-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The integrity of endplate is important for maintaining the health of adjacent disc and trabeculae. Yet, pathological impacts of traumatic vertebra and endplate fractures were less studied using clinical approaches. This study aims to investigate their effects on the development of adjacent disc degeneration, segmental kyphosis, Modic changes (MCs), and high-intensity zones (HIZs). MATERIALS AND METHODS Magnetic resonance (MR) images of patients with acute traumatic vertebral compression fractures (T11-L5) were studied. On MR images, endplate fractures were evaluated as present or absent. Disc signal, height, bulging area, sagittal Cobb angle, MCs, and HIZs were measured on baseline and follow-up MR images to study the changes of the disc in relation to vertebra fractures and endplate fractures. RESULTS Ninety-seven patients were followed up for 15.4 ± 14.0 months. There were 123 fractured vertebrae, including 79 (64.2%) with endplate fractures and 44 (35.8%) without. Both the adjacent and control discs decreased in signal and height over time (p < 0.001), and the disc adjacent to vertebral fractures had greater signal and height loss than the control disc (p < 0.05). In the presence of endplate fractures, the adjacent discs had greater signal decrease in follow-up (p < 0.05), as compared to those without endplate fractures. Sagittal Cobb angle significantly increased in segments with endplate fractures (p < 0.05). Vertebra fractures were associated with new occurrence of MCs in the fractured vertebra (p < 0.001) but not HIZs in the adjacent disc. CONCLUSIONS Traumatic vertebral fractures were associated with accelerated adjacent disc degeneration, which appears to be further promoted by concomitant endplate fractures. Endplate fractures were associated with progression of segmental kyphosis.
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Affiliation(s)
- Xuan Lu
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, China
| | - Zhiwei Zhu
- Department of Radiology, Dongyang People's Hospital, Dongyang, China
| | - Jianjiang Pan
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, China
| | - Zhiyun Feng
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, China
| | - Xiaoqiang Lv
- Department of Orthopedic Surgery, Dongyang People's Hospital, Dongyang, China
| | - Michele C Battié
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, ON, Canada
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, 310003, China.
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17
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Wei Z, Lombardi AF, Lee RR, Wallace M, Masuda K, Chang EY, Du J, Bydder GM, Yang W, Ma YJ. Comprehensive assessment of in vivo lumbar spine intervertebral discs using a 3D adiabatic T 1ρ prepared ultrashort echo time (UTE-Adiab-T 1ρ) pulse sequence. Quant Imaging Med Surg 2022; 12:269-280. [PMID: 34993077 PMCID: PMC8666733 DOI: 10.21037/qims-21-308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/19/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND T1ρ has been extensively reported as a sensitive biomarker of biochemical changes in the nucleus pulposus (NP) and annulus fibrosis of intervertebral discs (IVDs). However, no T1ρ study of cartilaginous endplates (CEPs) has yet been reported because the relatively long echo times (TEs) of conventional clinical T1ρ sequences cannot effectively capture the fast-decaying magnetic resonance signals of CEPs, which have very short T2/T2*s. This can be overcome by using ultrashort echo time (UTE) T1ρ acquisitions. METHODS Seventeen subjects underwent UTE with adiabatic T1ρ preparation (UTE-Adiab-T1ρ) and T2-weighted fast spin echo imaging of their lumbar spines. Each IVD was manually segmented into seven regions (i.e., outer anterior annulus fibrosis, inner anterior annulus fibrosis, outer posterior annulus fibrosis, inner posterior annulus fibrosis, superior CEP, inferior CEP, and NP). T1ρ values of these sub-regions were correlated with IVD modified Pfirrmann grades and subjects' ages. In addition, T1ρ values were compared in subjects with and without low back pain (LBP). RESULTS Correlations of T1ρ values of the outer posterior annulus fibrosis, superior CEP, inferior CEP, and NP with modified Pfirrmann grades were significant (P<0.05) with R values of 0.51, 0.36, 0.38, and -0.94, respectively. Correlations of T1ρ values of the outer anterior annulus fibrosis, outer posterior annulus fibrosis, and NP with ages were significant with R equal to 0.52, 0.71, and -0.76, respectively. T1ρ differences of the outer posterior annulus fibrosis, inferior CEP, and NP between the subjects with and without LBP were significant (P=0.005, 0.020, and 0.000, respectively). CONCLUSIONS The UTE-Adiab-T1ρ sequence can quantify T1ρ of whole IVDs including CEPs. This is an advance, and of value for comprehensive assessment of IVD degeneration.
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Affiliation(s)
- Zhao Wei
- Department of Radiology, University of California San Diego, La Jolla, CA, USA;,Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China;,University of Chinese Academy of Sciences, Beijing, China
| | - Alecio F. Lombardi
- Department of Radiology, University of California San Diego, La Jolla, CA, USA;,Research Service, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Roland R. Lee
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Mark Wallace
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Koichi Masuda
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, CA, USA
| | - Eric Y. Chang
- Department of Radiology, University of California San Diego, La Jolla, CA, USA;,Research Service, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Graeme M. Bydder
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
| | - Wenhui Yang
- Institute of Electrical Engineering, Chinese Academy of Sciences, Beijing, China;,University of Chinese Academy of Sciences, Beijing, China
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, La Jolla, CA, USA
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18
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Kirnaz S, Capadona C, Wong T, Goldberg JL, Medary B, Sommer F, McGrath LB, Härtl R. Fundamentals of Intervertebral Disc Degeneration. World Neurosurg 2021; 157:264-273. [PMID: 34929784 DOI: 10.1016/j.wneu.2021.09.066] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/16/2022]
Abstract
Lumbar disc degeneration is one of the leading causes of chronic low back pain. The degenerative cascade is often initiated by an imbalance between catabolic and anabolic processes in the intervertebral discs. As a consequence of extracellular matrix degradation, neoinnervation and neovascularization take place. Ultimately, this degenerative process results in disc bulging and loss of nucleus pulposus and water content and subsequent loss of disc height. Most patients respond to conservative management and surgical interventions well initially, yet a significant number of patients continue to suffer from chronic low back pain. Because of the high prevalence of long-term discogenic pain, regenerative biological therapies, including gene therapies, growth factors, cellular-based injections, and tissue-engineered constructs, have attracted significant attention in light of their potential to directly address the degenerative process. Understanding the pathophysiology of degenerative disc disease is important in both refining existing technologies and developing innovative techniques to reverse the degenerative processes in the discs. In this review, we aimed to cover the underlying pathophysiology of degenerative disc disease as well as its associated risk factors and give a comprehensive summary about the developmental, structural, radiological, and biomechanical properties of human intervertebral discs.
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Affiliation(s)
- Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Charisse Capadona
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Taylor Wong
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Lynn B McGrath
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA.
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19
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Lagerstrand K, Brisby H, Hebelka H. Associations between high-intensity zones, endplate, and Modic changes and their effect on T2-mapping with and without spinal load. J Orthop Res 2021; 39:2703-2710. [PMID: 33751635 DOI: 10.1002/jor.25024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
The purpose was to investigate if high intensity zones (HIZ), Modic (MC), and endplate changes (EPC) display different behaviors measured with quantitative magnetic resonance imaging (MRI) with and without loading of the spine and if there is a simultaneous presence of these features in the same motion segment. 130 motion segments in patients with chronic low back pain (n = 26, 25-69 year, mean 38 year, 11 males) were examined. HIZs, MCs, and EPCs (i.e., structural findings, reflecting calcifications, erosions, and fissures) were determined with standardized MRI. Different T2-values with and without loading for these features were then determined with the quantitative MRI method T2-mapping. Significantly different behaviors were found in the spinal tissues with associated HIZs, MC, and EPC (p < 0.004). HIZ (62% of patients, 1-2/patient) was associated with EPC (100% of patients, 1-7/patient) (p = 0.0003 and 0.0004 for upper and lower EPs), with an occurrence of 91% for upper and 71% for lower endplates adjacent to discs with HIZ. MC (81% of patients, 1-3/patient) were associated with EPC (p < 0.0001) with an occurrence of 87% for endplates adjacent to vertebrae with MC. The occurrence of both HIZ and MC was 43% (p = 0.0001) for upper and 29% (p = 0.003) for lower vertebrae. HIZ was associated with simultaneous presence of both MC and EPC in the same motion segment. T2-mapping was found to objectively reflect changes in the spinal tissues associated with HIZs, MC, and EPC.
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Affiliation(s)
- Kerstin Lagerstrand
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Brisby
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Tarnoki AD, Tarnoki DL, Oláh C, Szily M, Kovacs DT, Dienes A, Piroska M, Forgo B, Pinheiro M, Ferreira P, Kostyál L, Meszaros M, Pako J, Kunos L, Bikov A. Lumbar spine abnormalities in patients with obstructive sleep apnoea. Sci Rep 2021; 11:16233. [PMID: 34376739 PMCID: PMC8355280 DOI: 10.1038/s41598-021-95667-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022] Open
Abstract
Previous studies suggested cervical spondylosis as a risk factor for development of obstructive sleep apnoea (OSA). We aimed to assess lumbar disc degeneration in patients with OSA and correlate the findings with symptoms and disease severity. Twenty-seven patients with OSA and 29 non-OSA controls underwent sleep studies and lumbar magnetic resonance imaging (MRI), and completed the Epworth Sleepiness Scale and the 24-item Roland-Morris Disability Questionnaire (RMDQ) questionnaires. Plasma klotho was determined with enzyme-linked immunosorbent assay. Patients with OSA had higher number of disc bulges (4.6 ± 3.7 vs. 1.7 ± 2.5, p < 0.01) and anterior spondylophytes (2.7 ± 4.2 vs. 0.8 ± 2.1, p < 0.01), increased disc degeneration (total Pfirrmann score 16.7 ± 4.7 vs. 13.2 ± 4.1, p < 0.01) and vertebral fatty degeneration (7.8 ± 4.7 vs. 3.8 ± 3.7, p < 0.01). There was no difference in the RMDQ score (0/0-3.5/ vs. 0/0-1/, p > 0.05). Markers of OSA severity, including the oxygen desaturation index and percentage of total sleep time spent with saturation < 90% as well as plasma levels of klotho were correlated with the number of disc bulges and anterior spondylophytes (all p < 0.05). OSA is associated with lumbar spondylosis. Our study highlights the importance of lumbar imaging in patients with OSA reporting lower back pain.
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Affiliation(s)
- Adam Domonkos Tarnoki
- Medical Imaging Centre, Semmelweis University, 78/A Üllői street, 1082, Budapest, Hungary.
| | - David Laszlo Tarnoki
- Medical Imaging Centre, Semmelweis University, 78/A Üllői street, 1082, Budapest, Hungary
| | - Csaba Oláh
- Department of Neurosurgery, Borsod-Abaúj-Zemplén County and University Teaching Hospital, Miskolc, Hungary
| | - Marcell Szily
- Medical Imaging Centre, Semmelweis University, 78/A Üllői street, 1082, Budapest, Hungary
| | - Daniel T Kovacs
- Medical Imaging Centre, Semmelweis University, 78/A Üllői street, 1082, Budapest, Hungary
| | - András Dienes
- Medical Imaging Centre, Semmelweis University, 78/A Üllői street, 1082, Budapest, Hungary
| | - Marton Piroska
- Medical Imaging Centre, Semmelweis University, 78/A Üllői street, 1082, Budapest, Hungary
| | - Bianka Forgo
- Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marina Pinheiro
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Musculoskeletal Health, Sydney, Australia
| | - Paulo Ferreira
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Musculoskeletal Health, Sydney, Australia
| | - László Kostyál
- Department of Neurosurgery, Borsod-Abaúj-Zemplén County and University Teaching Hospital, Miskolc, Hungary
| | - Martina Meszaros
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.,Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Judit Pako
- National Koranyi Institute for Pulmonology, Budakeszi, Hungary
| | - Laszlo Kunos
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Andras Bikov
- Department of Pulmonology, Semmelweis University, Budapest, Hungary.,Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
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21
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Winn A, Martin A, Castellon I, Sanchez A, Lavi ES, Munera F, Nunez D. Spine MRI: A Review of Commonly Encountered Emergent Conditions. Top Magn Reson Imaging 2021; 29:291-320. [PMID: 33264271 DOI: 10.1097/rmr.0000000000000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the last 2 decades, the proliferation of magnetic resonance imaging (MRI) availability and continuous improvements in acquisition speeds have led to significantly increased MRI utilization across the health care system, and MRI studies are increasingly ordered in the emergent setting. Depending on the clinical presentation, MRI can yield vital diagnostic information not detectable with other imaging modalities. The aim of this text is to report on the up-to-date indications for MRI of the spine in the ED, and review the various MRI appearances of commonly encountered acute spine pathology, including traumatic injuries, acute non traumatic myelopathy, infection, neoplasia, degenerative disc disease, and postoperative complications. Imaging review will focus on the aspects of the disease process that are not readily resolved with other modalities.
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Affiliation(s)
- Aaron Winn
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Adam Martin
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Ivan Castellon
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Allen Sanchez
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | | | - Felipe Munera
- University of Miami, Jackson Memorial Hospital, Miami, FL
| | - Diego Nunez
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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22
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Sönksen SE, Kühn SR, Noblé HJ, Knopf H, Ehling J, Jakobs FM, Frischmuth J, Weber F. Incidental Finding Prevalences in 3-Tesla Brain and Spine MRI of Military Pilot Applicants. Aerosp Med Hum Perform 2021; 92:146-152. [PMID: 33754971 DOI: 10.3357/amhp.5749.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION: Incidental findings in brain and spine MRI are common. In aerospace medicine, pilot selection may be affected by improved sensitivity of modern MRI devices. We investigated the occurrence of medically unfit rates caused by incidental findings in military pilot applicants using a 3-Tesla scanner as compared to the outcomes of a lower field strength 1-Tesla device based on similar screening protocols.METHODS: A total of 3315 military pilot applicants were assessed by a standardized German Air Force Imaging Screening Protocol and retrospectively subdivided into two cohorts, one of which was assessed by 1-Tesla MRI (2012-2015; N 1782), while in the second cohort (2016-2019; N 1808), a 3-Tesla MRI was used. Cohorts were statistically analyzed relating to three entities of incidental findings: 1) intervertebral disc displacements, 2) intracerebral vessel malformations, and 3) other abnormal findings in the brain.RESULTS: Pooled prevalences of incidental findings in medically unfit applicants significantly increased by use of 3-Tesla MRI as compared to lower resolution 1-Tesla MRI. Regarding the spine, prevalences more than doubled (1.46 vs. 4.99%; P < 0.05) for intervertebral disc displacements. Similarly, prevalences of cerebral vessel malformations as well as other abnormal CNS incidental findings considerably increased by use of 3-Tesla MRI (0.28 vs. 1.67%; P < 0.05, and 5.12 vs. 9.80%; P < 0.05). Effect sizes and correlations were substantial in all conditions analyzed (Cohens d > 0.8; Pearsons r > 0.75).CONCLUSIONS: Our data suggest a strong dependency of incidental cerebrospinal findings on image resolution and sensitivity of MRI devices used for screening, which is enhanced by refined imaging protocols and followed by increased medical unfit rates in prospective aviators. Adjusted strategies in the assessment of such lesions are needed to redefine their natural history and physiological impact, and to optimize screening protocols for future pilot selection.Snksen S-E, Khn SR, Nobl H-J, Knopf H, Ehling J, Jakobs FM, Frischmuth J, Weber F. Incidental finding prevalences in 3-Tesla brain and spine MRI of military pilot applicants. Aerosp Med Hum Perform. 2021; 92(3):146152.
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23
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Henkelmann J, Denecke T, Pieroh P, Einhorn S, von der Hoeh NH, Heyde CE, Voelker A. Total spine magnetic resonance imaging for detection of multifocal infection in pyogenic spondylodiscitis: a retrospective observational study. BMC Musculoskelet Disord 2021; 22:78. [PMID: 33446170 PMCID: PMC7807525 DOI: 10.1186/s12891-020-03928-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Due to the unspecific symptoms of spondylodiscitis (SpD), an early radiological examination is necessary. However, controversially discussed is the need for magnetic resonance imaging of the entire spine to exclude multisegmental infections and to determine the required surgical interventions. The aims of this study were to assess the incidence of multilevel non-contiguous pyogenic SpD and compare comorbidities, pain symptoms, and subsequent surgical strategies between unifocal (uSpD) and multifocal (mSpD) SpD. METHODS We retrospectively evaluated the data of patients with confirmed, surgically treated, pyogenic SpD who had received a total spine MRI in a single spine center between 2016 and 2018. MRI findings were classified according to Pola-classification and demographics, duration of clinical symptoms (pain and neurology) and Charlson Comorbidity-Index (CCI) results were compared between uSpD und mSpD groups. Surgical therapy was evaluated in patients with mSpD. RESULTS uSpD was detected by MRI in 69 of 79 patients (87%). Of these, mSpD was detected in 10 patients (13%) with 21 infected segments (cervical and/ or thoracic and/ or lumbar region). Age and CCI were similar between uSpD and mSpD and 24 of all SpD regions were clinically unapparent. All patients with uSpD were treated operatively. In seven patients with mSpD, all infected levels of the spine were treated surgically in a one-stage procedure; one patient had a two-stage procedure and one patient had surgery at the lumbar spine, and an additional infected segment of the upper thoracic spine was treated conservatively. One patient died before a planned two-stage procedure was performed. CONCLUSIONS Due to mSpD being found in approximately 13% of SpD cases, and considering the risk of overlooking an mSpD case, MRI imaging of the total spine is recommended. The detection of multiple infection levels can have an impact on the therapeutic strategy chosen.
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Affiliation(s)
- Jeanette Henkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Timm Denecke
- Department for Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Philipp Pieroh
- Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Stephanie Einhorn
- Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Nicolas H von der Hoeh
- Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Anna Voelker
- Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
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24
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Differentiating epidural fibrosis from disc herniation on contrast-enhanced and unenhanced MRI in the postoperative lumbar spine. Skeletal Radiol 2020; 49:1819-1827. [PMID: 32524168 DOI: 10.1007/s00256-020-03488-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine diagnostic confidence and inter-observer/intra-observer agreement in differentiating epidural fibrosis from disc herniation and lumbar spinal stenosis parameters on magnetic resonance images (MRI) in postoperative lumbar spines with (Gad-MRI) and without (unenhanced MRI) intravenous gadolinium-based contrast agent. SUBJECTS AND METHODS N = 124 lumbar spine MRI examinations of four groups were included: 1-6 months, 7-18 months, 19-36 months, more than 37 months between lumbar spine surgery and imaging. Two radiologists evaluated Gad-MRI and unenhanced MRI: diagnostic confidence was determined as confident or unconfident. Inter-observer and intra-observer agreement were assessed in differentiating epidural fibrosis from disc herniation and for lumbar spinal stenosis parameters on MRI. Fisher's exact test and Cohen's kappa served for statistics. RESULTS Diagnostic confidence in differentiating epidural fibrosis from disc herniation was significantly higher on Gad-MR images compared with unenhanced MRI at 1-18 months for observer 1 and at 1-6 months postoperatively for observer 2 (p values: 0.01-0.025). Inter-observer agreement at 1-6 months postoperatively for identification of epidural fibrosis was higher on Gad-MRI (kappa values: 0.53 versus 0.24). Inter-observer and intra-observer agreement for identification of disc herniation and for assessment of lumbar spinal stenosis parameters revealed inconsistent data, without a trend for higher inter-observer or intra-observer agreement on Gad-MRI compared with unenhanced MRI (kappa values: 0.17-0.75). CONCLUSION Gad-MR images compared with unenhanced MRI improved diagnostic confidence and agreement in differentiating epidural fibrosis from disc herniation for both observers in the first 6 months and for one observer in the first 18 months after lumbar spine surgery. After 18 months, Gad-MR images compared with unenhanced MRI did neither improve confidence nor agreement.
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25
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Sollmann N, Mönch S, Riederer I, Zimmer C, Baum T, Kirschke JS. Imaging of the degenerative spine using a sagittal T2-weighted DIXON turbo spin-echo sequence. Eur J Radiol 2020; 131:109204. [PMID: 32801054 DOI: 10.1016/j.ejrad.2020.109204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/03/2020] [Accepted: 07/28/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of a sagittal T2-weighted DIXON turbo spin-echo (TSE) sequence and to assess whether fat-only images could replace dedicated sagittal T1-weighted sequences for magnetic resonance imaging (MRI) of the degenerative spine. METHOD 35 patients (56.5 ± 19.8 years, 62.9 % males) with lumbar back pain (LBP) who underwent MRI of the lumbar spine including a sagittal T2-weighted DIXON sequence (acquisition time: 3:25 min) and T1-weighted sequence (acquisition time: 3:03 min) were included. Two image layouts (layout 1: fat-only AND water-only AND in-phase images of the DIXON sequence; layout 2: water-only AND in-phase images of the DIXON sequence AND T1-weighted images) were evaluated by two readers (R1 and R2) concerning degenerative changes including diagnostic confidence (1 - low, 2 - intermediate, and 3 - high) and signal changes of vertebral bone marrow (BM). Results were compared between readers and layouts. RESULTS No differences were observed in the number of detected pathologies on a segment-wise level, nor in the number of segments affected by degenerative changes when comparing evaluations of layout 1 and layout 2 for each reader. Diagnostic confidence was high without a statistically significant difference between the readings of both layouts (R1: layout 1: 2.79 ± 0.41, layout 2: 2.81 ± 0.39, p = 0.53; R2: layout 1: 2.99 ± 0.07, layout 2: 2.99 ± 0.07, p = 0.99). CONCLUSIONS In patients with LBP, MRI using a sagittal T2-weighted DIXON sequence and no separate T1-weighted sequence might be sufficient to accurately detect common degenerative changes with high diagnostic confidence. Sparing dedicated T1-weighted sequences can considerably reduce overall scan time.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Sebastian Mönch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Isabelle Riederer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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26
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Xu L, Zhang Y, Min X, Li L, Ling Q, Xu S, Liu L, Cao P, Wang L, Wang J, Du G. Refractory lower urinary tract symptoms in patients with lumbar disc hernia relieved by non-surgical treatment. World J Urol 2020; 39:1597-1605. [PMID: 32613324 DOI: 10.1007/s00345-020-03330-9] [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: 03/16/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Refractory lower urinary tract symptoms (LUTS) coexisting with lumbar disc hernia (LDH) have been shown to resolve following LDH surgery, implying that LDH causes these LUTS. The purpose of this study was to report outcomes in patients with refractory LUTS and LDH following non-surgical treatment targeting LDH. METHODS A retrospective cohort study was conducted using outpatient data collected at Tongji Hospital, China, between 2016 and 2018. This study included 131 adult patients with refractory LUTS and LDH. Patients were stratified into two groups. Group A underwent non-surgical treatment for LDH plus pharmacological treatment for LUTS. Group B underwent only pharmacological treatment for LUTS. The International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) score, and uroflowmetry were used to evaluate outcomes. RESULTS In group A, following treatment, the maximum flow rate (Qmax) increased by 3.92 ml/s (p < 0.001), the IPSS reduced by 5.99 points (p < 0.001), and the QoL score decreased by 1.51 points (p < 0.001). In group B, the Qmax increased by 0.09 ml/s (p = 0.833), the IPSS reduced by 0.72 points (p = 0.163), and the QoL score decreased by 0.07 points (p = 0.784). CONCLUSIONS LUTS can be relieved by a combination of pharmacological treatment for LUTS and non-surgical treatment for LDH in some refractory LUTS patients with LDH. MRI is recommended for these patients.
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Affiliation(s)
- Lei Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Yong Zhang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Xiangde Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Lina Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Qing Ling
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Shengfei Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Libo Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Peng Cao
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Jianming Wang
- Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China
| | - Guanghui Du
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, People's Republic of China.
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27
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Ling Z, Li L, Chen Y, Hu H, Zhao X, Wilson J, Qi Q, Liu D, Wei F, Chen X, Lu J, Zhou Z, Zou X. Changes of the end plate cartilage are associated with intervertebral disc degeneration: A quantitative magnetic resonance imaging study in rhesus monkeys and humans. J Orthop Translat 2020; 24:23-31. [PMID: 32542179 PMCID: PMC7281301 DOI: 10.1016/j.jot.2020.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/10/2020] [Accepted: 04/09/2020] [Indexed: 02/04/2023] Open
Abstract
Background The end plate plays an important role in intervertebral disc degeneration progression. The aim of the study was to examine the compositional and structural changes of the end plate with age and to investigate the correlation between end plate and disc degeneration by T1ρ and T2 map magnetic resonance imaging. Methods There were 12 young monkeys (6-7 years old), 20 aged monkeys (14-17 years old) and 12 human participants (30-50 years old) in this study. T1ρ or T2 map values of the nucleus pulposus and end plate cartilage were analyzed according to Pfirrmann grades and age. Afterwards, micro computed tomography and histological analysis were used to confirm the end plate changes in monkeys. Pearson’s correlation was performed to investigate the relationship between end plate and disc degeneration. Results In monkeys, T1ρ (r=-0.794, P<0.001) and T2 map values (r=-0.8, P<0.001) of the nucleus pulposus were negatively associated with Pfirrmann grades. Moreover, the T2 map was more suitable than T1ρ for the evaluation of end plate degeneration. Age was an important influence factor of end plate and disc degeneration, which was confirmed by microcomputed tomography, Safranin O/fast green staining, and collagen II staining. The T2 map value of lower end plate degeneration positively correlated with that of the intervertebral discs in monkeys (R2=0.3133, P<0.001) and humans (R2=0.2092, P<0.001). Conclusion This study suggests that the compositional and structural changes of the end plate can be quantitatively evaluated by T2 map. Furthermore, cartilage end plate degeneration is associated with disc degeneration during ageing. The translational potential of this article A better understanding of how the cartilage end plate affects disc degeneration is needed, which may propose a new clinical application using T2 map to evaluate end plate degeneration.
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Affiliation(s)
- Zemin Ling
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Liangping Li
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.,Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Chen
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Hao Hu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiaoxiao Zhao
- Department of Radiology, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, China
| | - Jordan Wilson
- Department of Orthopaedics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Qihua Qi
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Delong Liu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Fuxin Wei
- Department of Orthopaedic Surgery, The Seventh Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Shenzhen, China
| | - Xiaoying Chen
- Department of Emergency, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Jianhua Lu
- Department of Radiology, Johns Hopkins Hospital, Baltimore, USA
| | - Zhiyu Zhou
- Department of Orthopaedic Surgery, The Seventh Affiliated Hospital and Orthopedic Research, Institute of Sun Yat-sen University, Shenzhen, China
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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Rida MA, Chandran V. Challenges in the clinical diagnosis of psoriatic arthritis. Clin Immunol 2020; 214:108390. [PMID: 32200113 DOI: 10.1016/j.clim.2020.108390] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/17/2020] [Indexed: 01/15/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic heterogeneous inflammatory musculoskeletal disease. The non-specific and often subtle manifestations make early diagnosis and subsequent treatment challenging. In the absence of diagnostic criteria and biomarkers, the diagnosis is often delayed leading to poor long-term outcomes. In addition, the differential diagnosis of a patient presenting with arthritis in the setting of skin psoriasis is wide due to symptom overlap with many other diseases. Peripheral arthritis, dactylitis, enthesitis and axial arthritis are the 4 domains of musculoskeletal involvement in PsA and careful examination of each domain by a rheumatologist is the first step for a correct diagnosis. Other extra-musculoskeletal features such as the presence of uveitis, inflammatory bowel disease, nail psoriasis and elevated acute phase reactants aid in the diagnosis of PsA. Screening patients with skin psoriasis using validated questionnaires might help in early diagnosis especially when coupled with imaging.
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Affiliation(s)
- Mohamad Ali Rida
- Psoriatic Disease Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vinod Chandran
- Psoriatic Disease Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
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Okano I, Salzmann SN, Jones C, Ortiz Miller C, Shirahata T, Rentenberger C, Shue J, Carrino JA, Sama AA, Cammisa FP, Girardi FP, Hughes AP. The impact of degenerative disc disease on regional volumetric bone mineral density (vBMD) measured by quantitative computed tomography. Spine J 2020; 20:181-190. [PMID: 31125693 DOI: 10.1016/j.spinee.2019.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT It has been reported that degenerative disc disease (DDD) is associated with higher spinal bone mineral density (BMD) based on previous studies that used dual X-ray absorptiometry (DXA). However, DDD is often associated with proliferative bone changes and can lead to an overestimation of BMD measured with DXA. Trabecular volumetric BMD (vBMD) in the vertebral body measured with quantitative computed tomography (QCT) is less affected by those changes and can be a favorable alternative to DXA for patients with degenerative spinal changes. PURPOSE The purpose of this study is to investigate the effect of DDD on regional trabecular vBMDs in the vertebral body measured by QCT. STUDY DESIGN/SETTING Cross-sectional observational study at a single academic institution. PATIENTS SAMPLE Consecutive patients undergoing posterior lumbar spinal fusion between 2014 and 2017 who had a routine preoperative CT scan and magnetic resonance imaging (MRI) within a 90-day interval. OUTCOME MEASURES Regional trabecular vBMDs in the vertebral body by QCT. METHODS QCT measurements were conducted in L1-S1 vertebral trabecular bone. Any apparent sclerotic lesions that might affect vBMD values were excluded from the region of interest. The vBMDs of each level were defined as the average vBMD of the upper and lower vertebrae. To evaluate DDD, Pfirrmann grade, Modic grade, total end plate score, and vacuum phenomenon were documented. Univariate regression analysis and multivariate analyses with a linear mixed model adjusted with individual variability of segmental vBMDs were conducted with vBMD as the response variable. RESULTS Of 143 patients and 715 disc levels, 125 patients and 596 discs met our inclusion criteria. Mean vBMD (±standard deviation [SD]) of all levels was 119.0±39.6 mg/cm3. After adjusting for all covariates, Pfirrmann grade was not an independent contributor to vBMD, but the presence of any Modic change (type 1, β=6.8, p≤.001; type 2, β=6.7, p<.001; type 3, β=43.6, p<.001), high TEPS (score 10-12, β=14.2, p<.001), or vacuum phenomenon (β=9.0, p<.001) was shown to be independent contributors to vBMD. CONCLUSIONS Our results showed that the presence of certain end plate lesions (Modic changes and high TEPS) on MRI was significantly associated with increased regional QCT-vBMDs in the vertebral body, but no significant association was observed with disc nucleus pathology, unless it was associated with a vacuum phenomenon. When end plate lesions with Modic changes and high TEPS are present at the measuring level, care must be taken to interpret vBMD values, which might be overestimations even if the trabecular area appears normal.
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Affiliation(s)
- Ichiro Okano
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Stephan N Salzmann
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Conor Jones
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Courtney Ortiz Miller
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Toshiyuki Shirahata
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA; Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Colleen Rentenberger
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
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Gwak GT, Hwang UJ, Jung SH, Kim HA, Kim JH, Kwon OY. Comparison of MRI cross-sectional area and functions of core muscles among asymptomatic individuals with and without lumbar intervertebral disc degeneration. BMC Musculoskelet Disord 2019; 20:576. [PMID: 31787092 PMCID: PMC6886205 DOI: 10.1186/s12891-019-2960-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/20/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Previous studies suggested that patients with symptomatic intervertebral disc degeneration (IDD) of lumbar spine have reduced cross-sectional area (CSA) and functions of core muscles. However, reduced CSA and functions of core muscles have been observed not only in patients with symptomatic IDD but also in patients with other subgroups of low back pain (LBP). Thus, it is uncertain whether reduced CSA and functions of core muscles lead to IDD and LBP, or pain leads to reduced CSA and functions of core muscles in patients with symptomatic IDD. Therefore, this study aimed to compare the CSA and functions of core muscles between asymptomatic participants with and without IDD in magnetic resonance imaging (MRI). METHODS Twenty asymptomatic participants (12 men and 8 women) participated in this study. Ten participants had asymptomatic IDD at L4-5. The others were healthy controls (without IDD at all levels of lumbar spine). The CSA of core muscles was measured using MRI. Maximal isometric trunk flexor strength and side bridge strength were measured by a Smart KEMA strength sensor. Trunk flexor endurance test, side bridge endurance test and plank endurance test were used to measure core endurance. Double legs loading test was used to measure core stability. Mann-Whitney U test was used to compare the differences between two groups. RESULTS There were no significant differences in core muscle functions between the two groups (p > 0.05). Moreover, there was no significant difference in CSA between the two groups (p > 0.05). CONCLUSIONS There was no significant difference in CSA and core muscle functions between asymptomatic participants with and without IDD. These findings indicate that a degenerative or bulging disc in asymptomatic individuals has little effect on CSA and functions of core muscles, especially in young age. Therefore, the general core endurance test or strength test could not differentiate asymptomatic people with and without IDD of lumbar spine. TRIAL REGISTRATION NUMBER Clinical Research information Service. KCT0004061. Registered 13 June 2019. retrospectively registered.
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Affiliation(s)
- Gyeong-tae Gwak
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea
| | - Ui-jae Hwang
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea
| | - Sung-hoon Jung
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea
| | - Hyun-a Kim
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea
| | - Jun-hee Kim
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea
| | - Oh-yun Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, Republic of Korea
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Wang M, Tsang A, Tam V, Chan D, Cao P, Wu EX. Multiparametric MR Investigation of Proteoglycan Diffusivity, T
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Relaxation, and Concentration in an Ex Vivo Model of Intervertebral Disc Degeneration. J Magn Reson Imaging 2019; 51:1390-1400. [DOI: 10.1002/jmri.26979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Min Wang
- College of Biomedical Engineering and Instrument ScienceZhejiang University Hangzhou China
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR China
- Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University Baltimore Maryland USA
| | - Adrian Tsang
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR China
| | - Vivian Tam
- School of Biomedical Sciences, Li Ka Shing Faculty of MedicineThe University of Hong Kong SAR China
| | - Danny Chan
- School of Biomedical Sciences, Li Ka Shing Faculty of MedicineThe University of Hong Kong SAR China
| | - Peng Cao
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR China
| | - Ed X. Wu
- Laboratory of Biomedical Imaging and Signal Processing, The University of Hong Kong, Hong Kong SAR China
- Department of Electrical and Electronic Engineering, The University of Hong Kong, Hong Kong SAR China
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Beack JY, Chun HJ, Bak KH, Choi KS, Bae IS, Kim KD. Risk Factors of Secondary Lumbar Discectomy of a Herniated Lumbar Disc after Lumbar Discectomy. J Korean Neurosurg Soc 2019; 62:586-593. [PMID: 31484233 PMCID: PMC6732352 DOI: 10.3340/jkns.2019.0085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/30/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To study risk factors of secondary lumbar discectomy (LD) for recurrent herniated lumbar disc (HLD) and identify methods to lower the rate of recurrence.
Methods Data from 160 patients who underwent primary LD were collected retrospectively. Demographic features, radiologic findings including Pfirrmann disc degeneration, and surgical information were analyzed to compare risks between revision and non-revision patients.
Results The revision rate was 15% (24 patients), and the mean follow-up was 28.3 months. HLD recurrence was not related to any demographic characteristics. Primary and secondary LD were most common at the L4–5 level, but the level of operation was not significantly associated with revision. Primary LD most commonly had a Pfirrmann disc degeneration grade of 3, followed by 4. For recurrent HLD, Pfirrmann grade 4 was most common and was statistically significant (p<0.05). A body mass index (BMI) over 30 was considered obese and was significantly related with HLD revision (p<0.05).
Conclusion Patients with high BMI or severe disc degeneration should be informed of HLD revision.
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Affiliation(s)
- Joo Yul Beack
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyoung Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Koang Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - In-Suk Bae
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kee D Kim
- Department of Neurological Surgery, University of California, Davis, CA, USA
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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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Five-year development of lumbar disc degeneration-a prospective study. Skeletal Radiol 2019; 48:871-879. [PMID: 30255192 DOI: 10.1007/s00256-018-3062-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the impact of demographic, clinical, and genetic factors as well as herniated discs on 5-year development of disc degeneration in the lumbar spine, and to investigate associations between changes in lumbar degenerative findings and pain. MATERIALS AND METHODS In 144 patients with lumbar radicular pain or low back pain, we scored disc degeneration, herniated discs, and high-intensity zones in the posterior annulus fibrosus on lumbar magnetic resonance imaging (MRI) at baseline and 5-year follow-up. Genotyping (TaqMan assay) was performed for genes encoding vitamin D receptor (VDR), collagen XIα (COL11A), matrix metalloproteinase 1/9 (MMP1/MMP9), and interleukin 1α/1RN (IL-1α/IL-1RN). Associations were analyzed using multivariate linear regression adjusted for age, sex, smoking, body mass index, and baseline scores for degenerated discs and herniated discs (when analyzing impact of baseline factors) or for pain (when analyzing associations with pain). RESULTS Progression of disc degeneration over 5 years was significantly (p < 0.001) related to higher age and less disc degeneration at baseline, but not to sex, smoking, body mass index, herniated discs, or variants in the studied genes. No associations were identified between changes in disc degeneration or high-intensity zones and pain at 5-year follow-up. However, increased number of herniated discs over 5 years was associated with pain at rest (p = 0.019). CONCLUSIONS Age and disc degeneration at baseline, rather than genetic factors, influenced the 5-year development of disc degeneration in patients with lumbar radicular pain or low back pain. Development of herniated discs was related to pain at rest.
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Jiang X, Chen D. Magnetic resonance imaging analysis of work-related chronic low back pain: comparisons of different lumbar disc patterns. J Pain Res 2018; 11:2687-2698. [PMID: 30464586 PMCID: PMC6216966 DOI: 10.2147/jpr.s162988] [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] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Currently, there is a lack of comparative research about different lumbar disc patterns in patients with work-related chronic low back pain (CLBP) based on magnetic resonance imaging (MRI) analysis. Therefore, this study, on different patterns of lumbar disc degeneration or herniation in patients with CLBP, is valuable. In this study, we retrospectively investigated lumbar degenerative changes in patients with CLBP by using MRI analysis. Materials and methods Two hundred and eighty-three patients (110 women and 173 men) with work-related CLBP were enrolled and divided into four groups based on intervertebral disc morphology from MRI analysis, including normal discs (ND) group, degenerative discs (DD) group, bulging discs (BD) group, and herniated discs (HD) group. Demographic characteristics, occupational information, Visual Analog Scale (VAS) scores, and Oswestry Disability Index (ODI) scores were analyzed. Moreover, multiple parameters were investigated in the MRI analysis. Results The mean age of all 283 patients was 41.8±12.0 years (range, 18-80) and the mean duration of CLBP for all patients was 24.5±24.9 months. There were no significant differences in the patients' BMI, history of smoking, and education level (P>0.05). The three most common occupational types were manual worker, desk worker, and technician. The VAS and ODI scores of patients with CLBP in the DD, BD, and HD groups were significantly higher than those of patients in the ND group (P<0.05). The degrees of degeneration of L4/5 and L5/S1 were significantly higher than those of other intervertebral discs (P<0.05). The disc heights of L4/5 in the BD and HD groups were significantly lower than those of the ND group (P<0.05) and the disc height of L5/S1 in the HD group was significantly lower than that of the ND group (P<0.05). At the neutral position, the distances of L3/4, L4/5, and L5/S1 discs' bulge/herniation in the BD and HD groups were significantly higher than those in the ND and DD groups (P<0.05). Conclusion In summary, more severe degenerative changes of lower lumbar discs (L4/5 and L5/S1) such as higher degree of degeneration of disc, lower disc height, and significant displacement of disc were found in patients with work-related CLBP based on MRI analysis.
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Affiliation(s)
- Xin Jiang
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China,
| | - Dong Chen
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China,
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Farshad M, Sutter R, Hoch A. Severity of foraminal lumbar stenosis and the relation to clinical symptoms and response to periradicular infiltration-introduction of the "melting sign". Spine J 2018; 18:294-299. [PMID: 28739476 DOI: 10.1016/j.spinee.2017.07.176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 06/25/2017] [Accepted: 07/17/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Nerve root compression causing symptomatic radiculopathy can occur within the intervertebral foramen. Sagittal magnetic resonance imaging (MRI) sequences are reliable in detection of nerve root contact to intraforaminal disc material, but a clinically relevant classification of degree of contact is lacking. PURPOSE This study aimed to investigate a potential relation of amount of contact between intraforaminal disc material and nerve root to clinical findings and response after periradicular corticosteroid infiltration. STUDY DESIGN A post hoc analysis of a prospective cohort was carried out. PATIENT SAMPLE Patients who underwent computed tomography (CT)-guided periradicular corticosteroid infiltration (L1-L5) at our institution (January 2014 to May 2016) were included. OUTCOME MEASURES The medical records and radiographic imaging were reviewed. METHODS T2-weighted MRI of the lumbar spine of patients with single-level symptomatic radiculopathy with (responders, n=28) or without (non-responders, n=14) pain relief after periradicular infiltration with corticosteroids were measured and compared by two independent readers to determine the amount of intraforaminal nerve root contact with the intervertebral disc ("melting" of the T2-hypointense signal). Pain relief was defined with a pain level decrease of >50% on a visual analogue scale and lack of pain relief with a pain level decrease of <25%, respectively. The amount of T2-hypointensity melting of disc and nerve root was categorized to 0%, 1%-25%, and over 25%. RESULTS Reader one identified 0% T2-melting in none of the responders, 1%-25% melting in 13 patients (46.4%), 26%-50% in 15 of the 28 patients (53.6%) with pain relief after periradicular corticosteroid infiltration (responders), with a mean amount of T2-melting of 5.9±2.1 mm, whereas the non-responder group had 0% T2-melting in 2 patients (14.3%), 1%-25% T2-melting in 11 patients (78.6%), and 26%-50% in 1 patient (7.1%), with a mean amount of T2-melting of 2.6±1.9 mm (p<.05). Reader two identified 0% T2-melting in none, 1%-25% T2-melting in 15 (53.6%) patients, and 26%-50% in 13 of the 28 responders (46.4%), with mean amount of 6.3±1.9 mm. In the non-responder group 0% T2-melting was seen in 3 patients (21.4%), 1%-25% T2-melting in 10 patients (71.4%), and 26%-50% in 1 patient (7.1%), with a mean amount of T2-melting of 2.7±1.9 mm (p<.05). None of the MRI showed T2-melting in over 50% of the circumference of the intraforaminal nerve root. A T2-melting of >25% had a high specificity of 93% but a sensitivity of 50%, thus a positive likelihood ratio of 7.5, to identify those with a pain relief of more than 50% after infiltration. CONCLUSION The amount of T2-melting of disc material and nerve root on sagittal MRI (>25%) predicts the amount of pain relief by periradicular infiltration in patients with intraforaminal nerve root irritation.
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Affiliation(s)
- Mazda Farshad
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - Reto Sutter
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Armando Hoch
- Division of Spine Surgery and Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
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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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Hu X, Chen M, Pan J, Liang L, Wang Y. Is it appropriate to measure age-related lumbar disc degeneration on the mid-sagittal MR image? A quantitative image study. 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 2017; 27:1073-1081. [PMID: 29147797 DOI: 10.1007/s00586-017-5357-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/09/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Even though phenotypes of disc degeneration vary on different sagittal magnetic resonance images (MRI), measurements typically are acquired on the mid-sagittal MRI. This study investigated the appropriateness of using the mid-sagittal MRI to measure various phenotypes of age-related disc degeneration. METHODS Lumbar spine MRIs of 66 subjects (mean age 50.3 years, standard deviation 16.5 years, range 22-84 years) were studied. An image analysis program Spine Explorer was used to obtain quantitative measurements for disc height, bulging, and signal on para- and mid-sagittal T2-weighted MRIs. Measurements on para- and mid-sagittal MRIs and their associations with age were compared. RESULTS Measurements of disc height, signal, and posterior disc bulging acquired on the mid-sagittal MRI were greater than those on the para-sagittal MRIs. Disc height measurements were not linearly associated with age. Greater age was correlated with greater anterior (r = 0.45, P < 0.001) and posterior (r = 0.33, P < 0.01) bulging on para-sagittal MRIs, but not posterior disc bulging on the mid-sagittal MRI (r = - 0.10, P > 0.05). Disc signal intensity measurements on the mid-sagittal MRI had stronger correlations with age than those on para-sagittal MRIs. Mean and standard deviation of disc signal intensity acquired on the mid-sagittal MRI had the strongest correlations with age among all measures of disc degeneration studied (r = - 0.50, - 0.67, respectively, P < 0.001 for both). CONCLUSIONS Disc signal measurements acquired on the mid-sagittal MRI were reliable and had strong correlations with age and thus can be used as an appropriate measure of disc degeneration. Disc bulging had better be measured on para-sagittal MRIs. Although severe disc narrowing clearly is a sign of severe disc degeneration, disc height was not linearly associated with age.
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Affiliation(s)
- Xiaojian Hu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Mingjian Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Jianjiang Pan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, People's Republic of China
| | - Liang Liang
- The Wallace H. Coulter, Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, 30313, USA
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, People's Republic of China.
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Rim DC. Quantitative Pfirrmann Disc Degeneration Grading System to Overcome the Limitation of Pfirrmann Disc Degeneration Grade. KOREAN JOURNAL OF SPINE 2016; 13:1-8. [PMID: 27123023 PMCID: PMC4844654 DOI: 10.14245/kjs.2016.13.1.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 12/15/2022]
Abstract
Objective Pfirrmann disc degeneration grade is one of morphologic disc degeneration grading system and it was reliable on routine T2-weighted magnetic resonance (MR) images. The purpose of this study was to evaluate the agreement of Pfirrmann disc degeneration grade, and check the alternative technique of disc degeneration grading system. Methods Fifteen volunteers (4 medical doctors related to spinal disease, 2 medical doctors not related to spinal disease, 6 nurses in spinal hospital, and 3 para-medicines) were included in this study. Three different digitalized MR images were provided all volunteers, and they checked Pfirrmann disc degeneration grade of each disc levels after careful listening to explanation. Indeed, all volunteers checked the signal intensity of disc degeneration at the points of nucleus pulposus (NP), disc membrane, ligaments, fat, and air to modify the quantitative Pfirrmann disc degeneration grade. Results Total 225 grade results of Pfirrmann disc degeneration grade and 405 signal intensity results of quantitative Pfirrmann disc degeneration grade were analyzed. Average interobserver agreement was "moderate (mean±standard deviation, 0.575±0.251)" from poor to excellent. Completely agreed levels of Pfirrmann disc degeneration grade were only 4 levels (26.67%), and the disagreement levels were observed in 11 levels; two different grades in 8 levels (53.33%) and three different grades in 3 levels (20%). Quantitative Pfirrmann disc degeneration showed relatively cluster distribution with the interobserver deviations of 0.41-1.56 at the ratio of NP and disc membrane, and it showed relatively good cluster and distribution indicating that the proposed grading system has good discrimination ability. Conclusion Pfirrmann disc degeneration grade showed the limitation of different interobserver results, but this limitation could be overcome by using quantitative techniques of MR signal intensity. Further evaluation is needed to access its advantage and reliabilities.
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Affiliation(s)
- Dae Cheol Rim
- Department of Neurosurgery, Kim Young Soo Spine & Joint Hospital, Seoul, Korea
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