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Ding Y, Liu L, Shi J, Zhang X, Chen R, Xu S. Biochemical changes in lumbar facet joint and disc degeneration by T2* mapping. BMC Musculoskelet Disord 2024; 25:224. [PMID: 38504210 PMCID: PMC10953206 DOI: 10.1186/s12891-024-07265-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND To investigate the biochemical changes in lumbar facet joint (LFJ) and intervertebral disc (IVD) with different degenerative grade by T2* mapping. METHODS Sixty-eight patients with low back pain (study group) and 20 volunteers (control group) underwent standard MRI protocols and axial T2* mapping. Morphological evaluation of LFJ and IVD were performed on T2-weighted imaging according to Weishaupt and Pfirrmann grading system, respectively. T2* values of LFJ and of AF (anterior annulus fibrosus), NP (nucleus pulposus), and PF (posterior annulus fibrosus) in IVD were measured. Kruskal-Wallis test and Wilcoxon rank-sum test were used to compare T2* values of subjects with different degenerative grade. RESULTS The mean T2* value of grade 0 LFJ (21.68[17.77,26.13]) was higher than those of grade I (18.42[15.68,21.8], p < 0.001), grade II (18.98[15.56,22.76], p = 0.011) and grade III (18.38[16.05,25.07], p = 0.575) LFJ in study group, and a moderate correlation was observed between T2* value and LFJ grade (rho=-0.304, p < 0.001) in control group. In the analysis of IVD, a moderate correlation was observed between AF T2* value and IVD grade (rho=-0.323, p < 0.001), and between NP T2* value and IVD grade (rho=-0.328, p < 0.001), while no significant difference was observed between the T2* values of PF in IVD of different grade in study group. CONCLUSIONS Downward trend of T2* values can be found in LFJ, AF and NP as the degenerative grade rised. But in elderly patients with low back pain, no change trend was found in LFJ due to increased fluid accumulation in the joint space.
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Affiliation(s)
- Yi Ding
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China
- Department of Spine Surgery, Ganzhou Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, 341000, China
| | - Liping Liu
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China
- Department of Spine Surgery, Ganzhou Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, 341000, China
| | - Jiangyou Shi
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China
| | - Xiaodong Zhang
- Department of Medical Imaging, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China
| | - Rongchun Chen
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, Jiangxi, 341000, China.
- Department of Spine Surgery, Ganzhou Hospital, Jiangxi Medical College, Nanchang University, Ganzhou, Jiangxi, 341000, China.
| | - Shuaishuai Xu
- Department of Nuclear Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwu Road, Jinan, Shandong, 250021, China.
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Russo F, Ambrosio L, Giannarelli E, Vorini F, Mallio CA, Quattrocchi CC, Vadalà G, Papalia R, Denaro V. Innovative quantitative magnetic resonance tools to detect early intervertebral disc degeneration changes: a systematic review. Spine J 2023; 23:1435-1450. [PMID: 37247638 DOI: 10.1016/j.spinee.2023.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is the leading cause of disability worldwide, with a tremendous socioeconomic burden. It is mainly caused by intervertebral disc degeneration (IDD), a progressive and age-related process. Due to its ability to accurately characterize intervertebral disc morphology, magnetic resonance imaging (MRI) has been established as one of the most valuable tools in diagnosing IDD. Innovative quantitative MRI (qMRI) techniques able to detect the earliest signs of IDD have been increasingly reported. PURPOSE To systematically review available reports on the application of novel qMRI techniques to detect early IDD changes. STUDY DESIGN Systematic literature review. METHODS A systematic search of PubMed/MEDLINE, Scopus, CINAHL, EMBASE, CENTRAL and Cochrane databases was performed through January 21, 2023. Randomized and nonrandomized studies on innovative qMRI tools able to diagnose early biochemical and architectural IDD changes in patients with or without discogenic LBP were searched. Data on study population, follow-up time (when applicable) and MRI sequence used were recorded. The QUADAS-2 tool was utilized to assess the risk of bias of included studies. RESULTS A total of 39 articles published between 2005 and 2022 resulted from the search. All novel qMRI techniques showed an increased capacity to detect early IDD changes thanks to the ability to assess subtle alterations of water content, proteoglycan and glycosaminoglycan concentration, and increased levels of catabolic biomarkers compared to conventional MRI. CONCLUSIONS Innovative qMRI techniques have proven effective in identifying premature IDD changes. Further studies are needed to validate their application in wider populations and confirm their applicability in the clinical setting.
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Affiliation(s)
- Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Eugenio Giannarelli
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo A Mallio
- Department of Diagnostic Imaging and Interventional Radiology, Research Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carlo C Quattrocchi
- Department of Diagnostic Imaging and Interventional Radiology, Research Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Takashima H, Yoshimoto M, Ogon I, Takebayashi T, Imamura R, Akatsuka Y, Yamashita T. T1rho, T2, and T2* relaxation time based on grading of intervertebral disc degeneration. Acta Radiol 2023; 64:1116-1121. [PMID: 35876305 DOI: 10.1177/02841851221113936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have explored the biochemical changes of disc degeneration and its relevance in low back pain using various quantitative magnetic resonance imaging (MRI) techniques. However, quantitative evaluation of intervertebral disc (IVD) with MRI such as T1rho, T2, and T2* have not been previously analyzed and compared directly in the same patients. PURPOSE To investigate T1rho, T2, and T2* of IVD degeneration in the same patients, reveal the correlation coefficients of these values, and evaluate which values are more sensitive to detect the degree of IVD degeneration. MATERIAL AND METHODS The participants were 55 patients who underwent MRI examinations which the investigator classified the degree of IVD degeneration according to the Pfirrmann classification. The T1rho, T2, and T2* values of IVD were analyzed for their classification and were compared. RESULTS T1rho, T2, and T2* values were 74.3 ± 7.1, 61.2 ± 6.7, and 46.5 ± 16.3 ms (grade II); 61.6 ± 11.8, 48.9 ± 8.2, and 34.1 ± 11.8 ms (grade III); 50.8 ± 10.8, 38.9 ± 9.8, and 25.4 ± 8.1 ms, (grade IV); 44.5 ± 13.3, 34.8 ± 9.5, and 11.2 ± 6.6 ms (grade V), respectively. Those values significantly decreased with increasing grades, but T1rho and T2 values for grades IV and V were not different. CONCLUSION The T1rho and T2 values were excellent for the evaluation of initial to moderate IVD degeneration with water and proteoglycan content. In contrast, the T2* value was suitable for detailed evaluation of progressive IVD, even with poor water content.
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Affiliation(s)
- Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, 13035Sapporo Medical University Hospital, Sapporo, Japan
- Department of Orthopedic Surgery, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopedic Surgery, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Izaya Ogon
- Department of Orthopedic Surgery, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Rui Imamura
- Division of Radiology and Nuclear Medicine, 13035Sapporo Medical University Hospital, Sapporo, Japan
| | - Yoshihiro Akatsuka
- Division of Radiology and Nuclear Medicine, 13035Sapporo Medical University Hospital, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, 13035Sapporo Medical University School of Medicine, Sapporo, Japan
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Benedikter C, Abrar DB, Konieczny M, Schleich C, Bittersohl B. Patterns of Intervertebral Disk Alteration in Asymptomatic Elite Rowers: A T2* MRI Mapping Study. Orthop J Sports Med 2022; 10:23259671221088572. [PMID: 35464905 PMCID: PMC9019338 DOI: 10.1177/23259671221088572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Repetitive loading of the back puts elite rowers at risk for acute and chronic back injuries. Hypothesis: That asymptomatic elite rowers would demonstrate characteristic intervertebral disk (IVD) alterations on T2* magnetic resonance imaging (MRI) mapping compared with asymptomatic nonrowers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included 20 asymptomatic elite rowers (mean age, 23.4 ± 3.03 years; 9 women, 11 men) studied at 2 different times, once before (t1) and once after (t2) the competition phase. MRI including T2* mapping was performed on a 3-T scanner. The authors derived normative T2* data from a previous study on 40 asymptomatic volunteers (20 men, 20 women) who were not competitive rowers; based on complete T2* data sets, 37 controls were included. T2* values were compared between groups in 4 lumbar IVDs, and midsagittal T2* values were compared in 5 zones: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. The Pfirrmann grade was used for morphological assessment of disk degeneration. Statistical analysis was conducted using the Mann-Whitney U test, Wilcoxon matched-pairs test, and Spearman rank correlation coefficient. Results: Lower T2* values were noted in the rower group compared with the controls (37.08 ± 33.63 vs 45.59 ± 35.73 ms, respectively; P < .001). The intersegmental comparison revealed lower mean T2* values among rowers (P ≤ .027 for all). The interzonal comparison indicated significantly lower mean T2* values for the rowers in all zones except for the anterior NP (P ≤ .008 for all). Lower mean T2* values were observed for the rowers at t1 versus t2 (39.25 ± 36.19 vs 43.97 ± 38.67 ms, respectively; P = .008). The authors noted a higher level of IVD damage according to Pfirrmann assessment in the rower cohort (P < .001); the Pfirrmann grade distributions of rowers versus controls, respectively, were as follows: 51.3% versus 73.7% (grade 1), 20.5% versus 19.5% (grade 2), 21.8% versus 6.8% (grade 3), 5.1% versus 0% (grade 4), and 1.3% versus 0% (grade 5). The authors also noted a correlation between low T2* and high Pfirrmann grade at t1 (r =–0.48; P < .001) and t2 (r =–0.71; P < .001). Conclusion: The cohort of elite rowers revealed more degenerative IVD changes compared with controls. The T2* values suggest that repetitive loading of the spine has demonstrable short-term and possibly permanent effects on the lumbar IVD.
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Affiliation(s)
- Chiara Benedikter
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Markus Konieczny
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
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Wegener LC, Werner F, Kleyer A, Simon D, Uder M, Janka R, Trattnig S, Welsch GH, Pachowsky ML. Changes in T2 Relaxation Time Mapping of Intervertebral Discs Adjacent to Vertebrae after Kyphoplasty Correlate with the Physical Clinical Outcome of Patients. Diagnostics (Basel) 2022; 12:diagnostics12030605. [PMID: 35328158 PMCID: PMC8946901 DOI: 10.3390/diagnostics12030605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/20/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
(1) Background: To assess whether clinical outcomes correlate with tissue changes in the intervertebral discs (IVDs) after kyphoplasty as treatment for vertebral fractures, quantitative MRI was applied. (2) Methods: Quantitative T2 mapping acquired in a 3 T MRI scanner of the thoracolumbar spine was performed in 20 patients two years after kyphoplasty. The IVDs adjacent and nonadjacent to the treated vertebrae were divided into six regions of interest (ROI), which were further categorised into inner (ROI 2–5) and outer (ROI 1 and 6) parts of the IVDs, and the T2 values were analysed. T2 values of adjacent discs were correlated with the items of questionnaires evaluating the clinical outcome (i.e., 36-Item Short Form Survey). (3) Results: Lower T2 values in adjacent IVDs correlated with poorer physical outcome two years after kyphoplasty. The inner part of the IVDs adjacent to treated vertebrae showed statistically significant lower T2 values in segments L2/L3 and L3/L4 compared to nonadjacent ones. Patients with lower T2 values showed more pain and physical limitations in everyday life. (4) Conclusions: Quantitative T2 mapping can detect IVD degeneration in patients after kyphoplasty and correlates with the physical outcome. This technique could help to gain better insights into alterations in tissue composition following kyphoplasty and the consequences for the patients’ quality of life.
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Affiliation(s)
- Lisa C. Wegener
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
- Johanna-Etienne Hospital, 41462 Neuss, Germany
| | - Felix Werner
- Department of Internal Medicine 4–Nephrology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Arnd Kleyer
- Department of Internal Medicine 3–Rheumatology and Immunology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.K.); (D.S.)
| | - David Simon
- Department of Internal Medicine 3–Rheumatology and Immunology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.K.); (D.S.)
| | - Michael Uder
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.U.); (R.J.)
| | - Rolf Janka
- Institute of Radiology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (M.U.); (R.J.)
| | - Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria;
| | - Goetz H. Welsch
- UKE Athleticum, Department of Trauma and Orthopedic Surgery, University Hospital Hamburg-Eppendorf, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Milena L. Pachowsky
- Department of Internal Medicine 3–Rheumatology and Immunology, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.K.); (D.S.)
- Department of Internal Medicine 3–Rheumatology and Immunology, Department of Trauma and Orthopaedic Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Correspondence:
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Novel Magnetic Resonance Imaging Tools for the Diagnosis of Degenerative Disc Disease: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12020420. [PMID: 35204509 PMCID: PMC8870820 DOI: 10.3390/diagnostics12020420] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 01/27/2023] Open
Abstract
Low back pain (LBP) is one of the leading causes of disability worldwide, with a significant socioeconomic burden on healthcare systems. It is mainly caused by degenerative disc disease (DDD), a progressive, chronic, and age-related process. With its capacity to accurately characterize intervertebral disc (IVD) and spinal morphology, magnetic resonance imaging (MRI) has been established as one of the most valuable tools in diagnosing DDD. However, existing technology cannot detect subtle changes in IVD tissue composition and cell metabolism. In this review, we summarized the state of the art regarding innovative quantitative MRI modalities that have shown the capacity to discriminate and quantify changes in matrix composition and integrity, as well as biomechanical changes in the early stages of DDD. Validation and implementation of this new technology in the clinical setting will allow for an early diagnosis of DDD and ideally guide conservative and regenerative treatments that may prevent the progression of the degenerative process rather than intervene at the latest stages of the disease.
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7
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Evaluating the effect of a post-processing algorithm in detection of annular fissure on MR imaging. 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 2021; 30:2150-2156. [PMID: 33683440 DOI: 10.1007/s00586-021-06793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE Visualization of annular fissures on MRI is becoming increasingly important but remains challenging. Our purpose was to test whether an image processing algorithm could improve detection of annular fissures. MATERIALS AND METHODS In this retrospective study, two neuroradiologists identified 56 IVDs with annular fissures and 97 IVDs with normal annulus fibrosus in lumbar spine MRIs of 101 patients (58 M, 43 F; age ± SD 15.1 ± 3.0 years). Signal intensities of diseased and normal annulus fibrosus, and contrast-to-noise ratio between them on sagittal T2-weighted images were calculated before and after processing with a proprietary software. Effect of processing on detection of annular fissures by two masked neuroradiologists was also studied for IVDs with Pfirrmann grades of ≤ 2 and > 2. RESULTS Mean (SD) signal baseline intensities of diseased and normal annulus fibrosus were 57.6 (23.3) and 24.4 (7.8), respectively (p < 0.001). Processing increased (p < 0.001) the mean (SD) intensity of diseased annulus to 110.6 (47.9), without affecting the signal intensity of normal annulus (p = 0.14). Mean (SD) CNR between the diseased and normal annulus increased (p < 0.001) from 11.8 (14.1) to 29.6 (29.1). Both masked readers detected more annular fissures after processing in IVDs with Pfirrmann grade of ≤ 2 and > 2, with an apparent increased sensitivity and decreased specificity using predefined image-based human categorization as a reference standard. CONCLUSIONS Image processing improved CNR of annular fissures and detection rate of annular fissures. However, further studies with a more stringent reference standard are needed to assess its effect on sensitivity and specificity.
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Takashima H, Yoshimoto M, Ogon I, Terashima Y, Imamura R, Akatsuka Y, Iesato N, Oshigiri T, Morita T, Takebayashi T, Emori M, Teramoto A, Yamashita T. Lumbar disc degeneration assessment using T2* relaxation time with ultra-short TE. Magn Reson Imaging 2020; 73:11-14. [PMID: 32673744 DOI: 10.1016/j.mri.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hiroyuki Takashima
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan; Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan.
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Rui Imamura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Yoshihiro Akatsuka
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Noriyuki Iesato
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Tsutomu Oshigiri
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Tomonori Morita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | | | - Makoto Emori
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Japan
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Kolf AK, Konieczny M, Hesper T, Hosalkar H, Schleich C, Antoch G, Krauspe R, Bittersohl B. T2* Mapping of the Adult Intervertebral Lumbar Disc: Normative Data and Analysis of Diurnal Effects. J Orthop Res 2019; 37:1956-1962. [PMID: 31042306 DOI: 10.1002/jor.24327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 04/04/2019] [Indexed: 02/04/2023]
Abstract
In this prospective study, we sought to establish normative data for T2* analysis of lumbar intervertebral discs (IVDs). Further, potential diurnal effects regarding T2* relaxometry of the lower spine were examined. Lumbar IVDs of young, healthy, adult men (n = 20) and women (n = 20; mean age = 24.5 ± 2.9 years) were assessed. Magnetic resonance imaging including T2* mapping was performed on a 3-T scanner. Mid-sagittal T2* values were obtained in five regions: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. Zonal and segmental differences, as well as diurnal variations between the T2* analysis in the morning and the evening and effects of unloading, were analyzed. Discs with signs of degeneration on morphological images or imaging artifacts were excluded. We noted a zonal and segmental T2* distribution with high values in the NP, low T2* values in the AF and a T2* increase towards the caudal NP. We observed no diurnal differences between the mean T2* values in the morning and in the evening (p = 0.748). The effect of unloading the spine was low (maximum T2* difference between four measurements = 13.6 ms; significant difference noted only between the 0 and 15-min measurement). The T2* values obtained in this study will serve as normative values for future T2* measurements. There are no diurnal influences, and we suggest that unloading of the spine has no demonstrable effect after 30 min on the T2* results. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1956-1962, 2019.
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Affiliation(s)
- Anna-Katharina Kolf
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Markus Konieczny
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Tobias Hesper
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - HarishS Hosalkar
- Center for Hip Preservation and Children's Orthopedics, & The Hosalkar Institute for Joint Preservation and Injury Care, San Diego, California
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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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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