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Athertya JS, Statum S, Chen X, Du K, Shin SH, Jerban S, Chung CB, Chang EY, Ma Y. Evaluation of spine disorders using high contrast imaging of the cartilaginous endplate. Front Physiol 2024; 15:1394189. [PMID: 38860112 PMCID: PMC11163041 DOI: 10.3389/fphys.2024.1394189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction: Many spine disorders are caused by disc degeneration or endplate defects. Because nutrients entering the avascular disc are channeled through the cartilaginous endplate (CEP), structural and compositional changes in the CEP may block this solute channel, thereby hindering disc cell function. Therefore, imaging the CEP region is important to improve the diagnostic accuracy of spine disorders. Methods: A clinically available T1-weighted and fat-suppressed spoiled gradient recalled-echo (FS-SPGR) sequence was optimized for high-contrast CEP imaging, which utilizes the short T1 property of the CEP. The FS-SPGR scans with and without breath-hold were performed for comparison on healthy subjects. Then, the FS-SPGR sequence which produced optimal image quality was employed for patient scans. In this study, seven asymptomatic volunteers and eight patients with lower back pain were recruited and scanned on a 3T whole-body MRI scanner. Clinical T2-weighted fast spin-echo (T2w-FSE) and T1-weighted FSE (T1w-FSE) sequences were also scanned for comparison. Results: For the asymptomatic volunteers, the FS-SPGR scans under free breathing conditions with NEX = 4 showed much higher contrast-to-noise ratio values between the CEP and bone marrow fat (BMF) (CNRCEP-BMF) (i.e., 7.8 ± 1.6) and between the CEP and nucleus pulposus (NP) (CNRCEP-NP) (i.e., 6.1 ± 1.2) compared to free breathing with NEX = 1 (CNRCEP-BMF: 4.0 ± 1.1 and CNRCEP-NP: 2.5 ± 0.9) and breath-hold condition with NEX = 1 (CNRCEP-BMF: 4.2 ± 1.3 and CNRCEP-NP: 2.8 ± 1.3). The CEP regions showed bright linear signals with high contrast in the T1-weighted FS-SPGR images in the controls, while irregularities of the CEP were found in the patients. Discussion: We have developed a T1-weighted 3D FS-SPGR sequence to image the CEP that is readily translatable to clinical settings. The proposed sequence can be used to highlight the CEP region and shows promise for the detection of intervertebral disc abnormalities.
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Affiliation(s)
- Jiyo S. Athertya
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Sheronda Statum
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Xiaojun Chen
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Kevin Du
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Soo Hyun Shin
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
| | - Christine B. Chung
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, United States
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
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Athertya JS, Lo J, Chen X, Shin SH, Malhi BS, Jerban S, Ji Y, Sedaghat S, Yoshioka H, Du J, Guma M, Chang EY, Ma Y. High contrast cartilaginous endplate imaging in spine using three dimensional dual-inversion recovery prepared ultrashort echo time (3D DIR-UTE) sequence. Skeletal Radiol 2024; 53:881-890. [PMID: 37935923 PMCID: PMC10973042 DOI: 10.1007/s00256-023-04503-4] [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: 07/17/2023] [Revised: 10/14/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To investigate the feasibility and application of a novel imaging technique, a three-dimensional dual adiabatic inversion recovery prepared ultrashort echo time (3D DIR-UTE) sequence, for high contrast assessment of cartilaginous endplate (CEP) imaging with head-to-head comparisons between other UTE imaging techniques. METHOD The DIR-UTE sequence employs two narrow-band adiabatic full passage (AFP) pulses to suppress signals from long T2 water (e.g., nucleus pulposus (NP)) and bone marrow fat (BMF) independently, followed by multispoke UTE acquisition to detect signals from the CEP with short T2 relaxation times. The DIR-UTE sequence, in addition to three other UTE sequences namely, an IR-prepared and fat-saturated UTE (IR-FS-UTE), a T1-weighted and fat-saturated UTE sequence (T1w-FS-UTE), and a fat-saturated UTE (FS-UTE) was used for MR imaging on a 3 T scanner to image six asymptomatic volunteers, six patients with low back pain, as well as a human cadaveric specimen. The contrast-to-noise ratio of the CEP relative to the adjacent structures-specifically the NP and BMF-was then compared from the acquired images across the different UTE sequences. RESULTS For asymptomatic volunteers, the DIR-UTE sequence showed significantly higher contrast-to-noise ratio values between the CEP and BMF (CNRCEP-BMF) (19.9 ± 3.0) and between the CEP and NP (CNRCEP-NP) (23.1 ± 1.7) compared to IR-FS-UTE (CNRCEP-BMF: 17.3 ± 1.2 and CNRCEP-NP: 19.1 ± 1.8), T1w-FS-UTE (CNRCEP-BMF: 9.0 ± 2.7 and CNRCEP-NP: 10.4 ± 3.5), and FS-UTE (CNRCEP-BMF: 7.7 ± 2.2 and CNRCEP-NP: 5.8 ± 2.4) for asymptomatic volunteers (all P-values < 0.001). For the spine sample and patients with low back pain, the DIR-UTE technique detected abnormalities such as irregularities and focal defects in the CEP regions. CONCLUSION The 3D DIR-UTE sequence is able to provide high-contrast volumetric CEP imaging for human spines on a clinical 3 T scanner.
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Affiliation(s)
- Jiyo S Athertya
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - James Lo
- Department of Radiology, University of California San Diego, San Diego, CA, USA
- Department of Bioengineering, University of California San Diego, San Diego, CA, USA
| | - Xiaojun Chen
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Soo Hyun Shin
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | | | - Saeed Jerban
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Yang Ji
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Sam Sedaghat
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Hiroshi Yoshioka
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, CA, USA
- Department of Bioengineering, University of California San Diego, San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Monica Guma
- Department of Medicine, University of California San Diego, San Diego, CA, USA
- Medicine Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Yajun Ma
- Department of Radiology, University of California San Diego, San Diego, CA, USA.
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Hwang K, Cha JG, Kim H, Jang H, Kim DJ, Lee S, Kim YJ. Ultrashort echo time pulse sequences for visualization of deep peripheral fasciae and epimysium in porcine models with histologic correlations. Quant Imaging Med Surg 2023; 13:8447-8461. [PMID: 38106251 PMCID: PMC10721985 DOI: 10.21037/qims-23-687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023]
Abstract
Background The deep peripheral fascia and epimysium are vital for muscle and tendon support, but their tight proton composition results in hypointense signals in conventional spin echo sequences. Ultrashort echo time (UTE) magnetic resonance imaging (MRI), using microsecond TE values, may visualize these structures. The purpose of this study was to evaluate whether UTE pulse sequence with a three-dimensional cone trajectory (3D UTE), with or without fat suppression (FS), can be used to visualize the fascia and epimysium using porcine lower legs as an example. Methods The anterior soft tissues of porcine lower legs were dissected and partially separated into distinct layers to expose the deep peripheral fascia, epimysium, and muscle. Axial 3D UTE and 3D UTE FS imaging using dual-echo acquisition and echo subtraction were performed both before and after dissection. Prior to dissection, the thickness, signal-to-noise ratios (SNRs), and contrast-to-noise ratios (CNRs) of structures believed to be deep peripheral fascia and epimysium were measured in both 3D UTE and 3D UTE FS. Post-dissection images were also analyzed to measure the SNRs and CNRs for the deep peripheral fascia and epimysium. Histological evaluations were carried out to verify the identities of the deep peripheral fascia and epimysium, as well as their thickness, and these measurements were compared to imaging findings. Results In pre-dissection images obtained with 3D UTE and 3D UTE FS, both the deep peripheral fascia and epimysium exhibited high signal intensity. In the subtraction images, the mean thickness of the deep fascia was 0.87 mm, and that of the epimysium was 0.80 mm when imaged with 3D UTE. This is compared to measurements of 0.77 and 0.22 mm in 3D UTE FS, respectively. Histological analyses confirmed the thickness of the deep peripheral fascia and epimysium as 0.65 and 0.14 mm, respectively. In the post-dissection images, the deep fascia continued to display high signal intensity when compared with adjacent soft tissues, consistent with the histological findings. Meanwhile, the epimysium showed very low CNRs. Conclusions 3D UTE and 3D UTE FS can be used to visualize the deep peripheral fascia with high signal intensity and contrast but are insufficient to show signal intensity in the epimysium.
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Affiliation(s)
- Kun Hwang
- Department of Plastic Surgery, Armed Forces Capital Hospital, Seongnam-City, Republic of Korea
- Ewha Medical Academy, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon-Si, Republic of Korea
| | - Hun Kim
- Division of Trauma Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Dae Joong Kim
- Department of Anatomy, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Seunghun Lee
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yeo Ju Kim
- Department of Radiology, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Finkenstaedt T, Siriwananrangsun P, Masuda K, Bydder GM, Chen KC, Bae WC. Ultrashort time-to-echo MR morphology of cartilaginous endplate correlates with disc degeneration in the lumbar spine. 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; 32:2358-2367. [PMID: 37195362 DOI: 10.1007/s00586-023-07739-9] [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: 11/15/2022] [Revised: 03/15/2023] [Accepted: 04/22/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE Using ultrashort echo time (UTE) MRI, we determined prevalence of abnormal cartilaginous endplate (CEP), and the relationship between CEP and disc degeneration in human lumbar spines. MATERIALS AND METHODS Lumbar spines from 71 cadavers (age 14-74 years) were imaged at 3 T using sagittal UTE and spin echo T2 map sequences. On UTE images, CEP morphology was defined as "normal" with linear high signal intensity or "abnormal" with focal signal loss and/or irregularity. On spin echo images, disc grade and T2 values of the nucleus pulposus (NP) and annulus fibrosus (AF) were determined. 547 CEPs and 284 discs were analysed. Effects of age, sex, and level on CEP morphology, disc grade, and T2 values were determined. Effects of CEP abnormality on disc grade, T2 of NP, and T2 of AF were also determined. RESULTS Overall prevalence of CEP abnormality was 33% and it tended to increase with older ages (p = 0.08) and at lower spinal levels of L5 than L2 or L3 (p = 0.001). Disc grades were higher and T2 values of the NP were lower in older spines (p < 0.001) and at lower disc level of L4-5 (p < 0.05). We found significant association between CEP and disc degeneration; discs adjacent to abnormal CEPs had high grades (p < 0.01) and lower T2 values of the NP (p < 0.05). CONCLUSION These results suggest that abnormal CEPs are frequently found, and it associates significantly with disc degeneration, suggesting an insight into pathoetiology of disc degeneration.
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Affiliation(s)
- Tim Finkenstaedt
- Department of Radiology, University of California, 9427 Health Sciences Drive, La Jolla, CA, 92093-0997, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Palanan Siriwananrangsun
- Department of Radiology, University of California, 9427 Health Sciences Drive, La Jolla, CA, 92093-0997, USA
- Department of Radiology, Siriraj Hospital, Bangkok, Thailand
| | - Koichi Masuda
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Graeme M Bydder
- Department of Radiology, University of California, 9427 Health Sciences Drive, La Jolla, CA, 92093-0997, USA
| | - Karen C Chen
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Won C Bae
- Department of Radiology, University of California, 9427 Health Sciences Drive, La Jolla, CA, 92093-0997, USA.
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA.
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Ma Y, Jang H, Jerban S, Chang EY, Chung CB, Bydder GM, Du J. Making the invisible visible-ultrashort echo time magnetic resonance imaging: Technical developments and applications. APPLIED PHYSICS REVIEWS 2022; 9:041303. [PMID: 36467869 PMCID: PMC9677812 DOI: 10.1063/5.0086459] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/12/2022] [Indexed: 05/25/2023]
Abstract
Magnetic resonance imaging (MRI) uses a large magnetic field and radio waves to generate images of tissues in the body. Conventional MRI techniques have been developed to image and quantify tissues and fluids with long transverse relaxation times (T2s), such as muscle, cartilage, liver, white matter, gray matter, spinal cord, and cerebrospinal fluid. However, the body also contains many tissues and tissue components such as the osteochondral junction, menisci, ligaments, tendons, bone, lung parenchyma, and myelin, which have short or ultrashort T2s. After radio frequency excitation, their transverse magnetizations typically decay to zero or near zero before the receiving mode is enabled for spatial encoding with conventional MR imaging. As a result, these tissues appear dark, and their MR properties are inaccessible. However, when ultrashort echo times (UTEs) are used, signals can be detected from these tissues before they decay to zero. This review summarizes recent technical developments in UTE MRI of tissues with short and ultrashort T2 relaxation times. A series of UTE MRI techniques for high-resolution morphological and quantitative imaging of these short-T2 tissues are discussed. Applications of UTE imaging in the musculoskeletal, nervous, respiratory, gastrointestinal, and cardiovascular systems of the body are included.
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Affiliation(s)
- Yajun Ma
- Department of Radiology, University of California, San Diego, California 92037, USA
| | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, California 92037, USA
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, California 92037, USA
| | | | | | - Graeme M Bydder
- Department of Radiology, University of California, San Diego, California 92037, USA
| | - Jiang Du
- Author to whom correspondence should be addressed:. Tel.: (858) 246-2248, Fax: (858) 246-2221
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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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Xuan A, Ruan D, Wang C, He Q, Wang D, Hou L, Zhang C, Li C, Ji W, Wen T, Xu C, Zhu Z. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:490-503. [PMID: 35427416 PMCID: PMC9154349 DOI: 10.1093/stcltm/szac013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
The treatment of intervertebral disc degeneration (IVDD) is still a huge challenge for clinical updated surgical techniques and basic strategies of intervertebral disc regeneration. Few studies have ever tried to combine surgery and cell therapy to bridge the gap between clinical and basic research. A prospective clinical study with a 72-month follow-up was conducted to assess the safety and feasibility of autologous discogenic cells transplantation combined with discectomy in the treatment of lumbar disc herniation (LDH) and to evaluate the regenerative ability of discogenic cells in IVDD. Forty patients with LDH who were scheduled to have discectomy enrolled in our study and were divided into the observed group (transplantation of autologous discogenic cells after discectomy) and control group (only-discectomy). Serial MRI and X-ray were used to evaluate the degenerative extent of index discs, and clinical scores were used to determine the symptomatic improvement. No adverse events were observed in the observed group, and seven patients in the control group underwent revisions. Both groups had significant improvement of all functional scores post-operatively, with the observed group improving more considerably at 36-month and 72-month follow-up. The height and water content of discs in both groups decreased significantly since 36 months post-op with the control group decreased more obviously. Discectomy combined with autologous discogenic cells transplantation is safe and feasible in the treatment of LDH. Radiological analysis demonstrated that discogenic cells transplantation could slow down the further degeneration of index discs and decrease the complications of discectomy.
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Affiliation(s)
- Anwu Xuan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
- Corresponding author: Dike Ruan, MD, The Second School of Clinical Medicine, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou 510515, People’s Republic of China, and the Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing 100048, People’s Republic of China.
| | - Chaofeng Wang
- Department of Orthopedics, Xi’an Honghui Hospital, Xi’an, People’s Republic of China
| | - Qing He
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Deli Wang
- Department of Orthopedics, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Lisheng Hou
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Chao Zhang
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Chao Li
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Wei Ji
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Tianyong Wen
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Cheng Xu
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
| | - Zhenbiao Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China
- Department of Orthopedics, The Sixth Medical Center of PLA General Hospital, Beijing, People’s Republic of China
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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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Williams RJ, Tryfonidou MA, Snuggs JW, Le Maitre CL. Cell sources proposed for nucleus pulposus regeneration. JOR Spine 2021; 4:e1175. [PMID: 35005441 PMCID: PMC8717099 DOI: 10.1002/jsp2.1175] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022] Open
Abstract
Lower back pain (LBP) occurs in 80% of adults in their lifetime; resulting in LBP being one of the biggest causes of disability worldwide. Chronic LBP has been linked to the degeneration of the intervertebral disc (IVD). The current treatments for chronic back pain only provide alleviation of symptoms through pain relief, tissue removal, or spinal fusion; none of which target regenerating the degenerate IVD. As nucleus pulposus (NP) degeneration is thought to represent a key initiation site of IVD degeneration, cell therapy that specifically targets the restoration of the NP has been reviewed here. A literature search to quantitatively assess all cell types used in NP regeneration was undertaken. With key cell sources: NP cells; annulus fibrosus cells; notochordal cells; chondrocytes; bone marrow mesenchymal stromal cells; adipose-derived stromal cells; and induced pluripotent stem cells extensively analyzed for their regenerative potential of the NP. This review highlights: accessibility; expansion capability in vitro; cell survival in an IVD environment; regenerative potential; and safety for these key potential cell sources. In conclusion, while several potential cell sources have been proposed, iPSC may provide the most promising regenerative potential.
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Affiliation(s)
- Rebecca J. Williams
- Biomedical Research Centre, BiosciencesSheffield Hallam UniversitySheffieldUK
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
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10
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Lombardi AF, Wei Z, Wong J, Carl M, Lee RR, Wallace M, Masuda K, Chang EY, Du J, Ma YJ. High contrast cartilaginous endplate imaging using a 3D adiabatic inversion-recovery-prepared fat-saturated ultrashort echo time (3D IR-FS-UTE) sequence. NMR IN BIOMEDICINE 2021; 34:e4579. [PMID: 34219287 PMCID: PMC8944187 DOI: 10.1002/nbm.4579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 05/08/2023]
Abstract
Ultrashort echo time (UTE) sequences can image tissues with transverse T 2 /T 2 * relaxations too short to be efficiently observed on routine clinical MRI sequences, such as the vertebral body cartilaginous endplate (CEP). Here, we describe a 3D adiabatic inversion-recovery-prepared fat-saturated ultrashort echo time (3D IR-FS-UTE) sequence to highlight the CEP of vertebral bodies in comparison to the intervertebral disc (IVD) and bone marrow fat (BF) at 3 T. The IR-FS-UTE sequence used a 3D UTE sequence combined with an adiabatic IR preparation pulse centered in the middle of the water and fat peaks, while a fat saturation module was used to suppress the signal from fat. A slab-selective half pulse was used for signal excitation, and a 3D center-out cones trajectory was used for more efficient data sampling. The 3D IR-FS-UTE sequence was applied to an ex vivo human spine sample, as well as the spines of six healthy volunteers and of three patients with back pain. Bright continuous lines representing signal from CEP were found in healthy IVDs. The measured contrast-to-noise ratio was 18.5 ± 4.9 between the CEP and BF, and 20.3 ± 4.15 between the CEP and IVD for the six volunteers. Abnormal IVDs showed CEP discontinuity or irregularity in the sample and patient studies. In conclusion, the proposed 3D IR-FS-UTE sequence is feasible for imaging the vertebral body's CEP in vivo with high contrast.
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Affiliation(s)
- Alecio F. Lombardi
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | - Zhao Wei
- Department of Radiology, University of California San Diego, CA, United States
| | - Jonathan Wong
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | | | - Roland R. Lee
- Department of Radiology, University of California San Diego, CA, United States
| | - Mark Wallace
- Department of Anesthesiology, University of California San Diego, CA, United States
| | - Koichi Masuda
- Department of Orthopedic Surgery, University of California San Diego, CA, United States
| | - Eric Y. Chang
- Department of Radiology, University of California San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, CA, United States
| | - Jiang Du
- Department of Radiology, University of California San Diego, CA, United States
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, CA, United States
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11
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Wang L, Han M, Wong J, Zheng P, Lazar AA, Krug R, Fields AJ. Evaluation of human cartilage endplate composition using MRI: Spatial variation, association with adjacent disc degeneration, and in vivo repeatability. J Orthop Res 2021; 39:1470-1478. [PMID: 32592504 PMCID: PMC7765737 DOI: 10.1002/jor.24787] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 02/04/2023]
Abstract
Cartilage endplate (CEP) biochemical composition may influence disc degeneration and regeneration. However, evaluating CEP composition in patients remains a challenge. We used T2* mapping from ultrashort echo-time (UTE) magnetic resonance imaging (MRI), which is sensitive to CEP hydration, to investigate spatial variations in CEP T2* values and to determine how CEP T2* values correlate with adjacent disc degeneration. Thirteen human cadavers (56.4 ± 12.7 years) and seven volunteers (36.9 ± 10.9 years) underwent 3T MRI, including UTE and T1ρ mapping sequences. Spatial mappings of T2* values in L4-S1 CEPs were generated from UTE images and compared between subregions. In the abutting discs, mean T1ρ values in the nucleus pulposus were compared between CEPs with high vs low T2* values. To assess in vivo repeatability, precision errors in mean T2* values, and intraclass correlation coefficients (ICC) were measured from repeat scans. Results showed that CEP T2* values were highest centrally and lowest posteriorly. In the youngest individuals (<50 years), who had mild-to-moderately degenerated Pfirrmann grade II-III discs, low CEP T2* values associated with severer disc degeneration: T1ρ values were 26.7% lower in subjects with low CEP T2* values (P = .025). In older individuals, CEP T2* values did not associate with disc degeneration (P = .39-.62). Precision errors in T2* ranged from 1.7 to 2.6 ms, and reliability was good-to-excellent (ICC = 0.89-0.94). These findings suggest that deficits in CEP composition, as indicated by low T2* values, associate with severer disc degeneration during the mild-to-moderate stages. Measuring CEP T2* values with UTE MRI may clarify the role of CEP composition in patients with mild-to-moderate disc degeneration.
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Affiliation(s)
- Linshanshan Wang
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Misung Han
- Department of Radiology & Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Jason Wong
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Patricia Zheng
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
| | - Ann A. Lazar
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCalifornia,Department of Preventive and Restorative Dental SciencesUniversity of CaliforniaSan FranciscoCalifornia
| | - Roland Krug
- Department of Radiology & Biomedical ImagingUniversity of CaliforniaSan FranciscoCalifornia
| | - Aaron J. Fields
- Department of Orthopaedic SurgeryUniversity of CaliforniaSan FranciscoCalifornia
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12
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Three-dimensional ultrashort echo time (3D UTE) magnetic resonance imaging (MRI) of the normal and degenerative disco-vertebral complex at 4.7 T: a feasibility study with longitudinal evaluation. 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; 30:1144-1154. [PMID: 33609189 DOI: 10.1007/s00586-021-06755-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess feasibility of a three-dimensional ultrashort echo time (3D-UTE)-sequence to evaluate normal and pathological disco-vertebral complex (DVC), with assessment of its different portions in a rat model of degenerative disk disease (DDD) with histological correlation. To assess whether this sequence, in comparison with long echo time T2-weighted sequence, is able to monitor DDD with differentiation of early from chronic DVC changes in pathological mechanical conditions. METHODS Five rats were induced with DDD model by percutaneous disk trituration of the tail with an 18-G needle under US-guidance and imaged at 4.7 T. MRI protocol included fat-saturated-T2 (RARE) and 3D-UTE-sequences performed at baseline (day 0. n = 5 animals /10 DVC) and each week (W) from W1 to W10 postoperatively. Visual analysis and signal intensity measurements of SNR and CNR of all DVC portions were performed on RARE and UTE images. Following killing (baseline, n = 1/2 DVC; W2, n = 2/4 DVC; W10, n = 2/4 DVC), histological analysis was performed and compared with MRI. RESULTS In normal DVC, unlike conventional RARE-sequences, 3D-UTE allowed complete identification of DVC zonal anatomy including on visual analysis and CNR measurements. In pathological conditions, SNR and CNR measurements of the annulus fibrosus and nucleus pulposus on 3D-UTE distinguished early discitis at W1 from chronic discopathy (P < 0.001 for SNR and P < 0.001 for CNR). Neither the normal complete anatomy of the DVC nor its pathological patterns could be assessed on conventional sequences. CONCLUSIONS Unlike conventional sequences, 3D-UTE enables visualization of the complete normal DVC anatomy and enables monitoring of DDD differentiating between early DVC changes from chronic ones. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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13
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Afsahi AM, Lombardi AF, Wei Z, Carl M, Athertya J, Masuda K, Wallace M, Lee RR, Ma YJ. High-Contrast Lumbar Spinal Bone Imaging Using a 3D Slab-Selective UTE Sequence. Front Endocrinol (Lausanne) 2021; 12:800398. [PMID: 35069448 PMCID: PMC8777294 DOI: 10.3389/fendo.2021.800398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/13/2021] [Indexed: 01/11/2023] Open
Abstract
Ultra-short echo time (UTE) MRI with post-processing is a promising technique in bone imaging that produces a similar contrast to computed tomography (CT). Here, we propose a 3D slab-selective ultrashort echo time (UTE) sequence together with image post-processing to image bone structures in the lumbar spine. We also explore the intermodality agreement between the UTE and CT images. The lumbar spines of two healthy volunteers were imaged with 3D UTE using five different resolutions to determine the best imaging protocol. Then, four patients with low back pain were imaged with both the 3D UTE sequence and CT to investigate agreement between the imaging methods. Two other patients with low back pain were then imaged with the 3D UTE sequence and clinical conventional T1-weighted and T2-weighted fast spin-echo (FSE) MRI sequences for qualitative comparison. The 3D UTE sequence together with post-processing showed high contrast images of bone and high intermodality agreement with CT images. In conclusion, post-processed slab-selective UTE imaging is a feasible approach for highlighting bone structures in the lumbar spine and demonstrates significant anatomical correlation with CT images.
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Affiliation(s)
- Amir Masoud Afsahi
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Alecio F. Lombardi
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Zhao Wei
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | | | - Jiyo Athertya
- Department of Radiology, University of California San Diego, San Diego, CA, United States
| | - Koichi Masuda
- Department of Orthopedic Surgery, University of California San Diego, San Diego, CA, United States
| | - Mark Wallace
- Department of Anesthesiology, University of California San Diego, San Diego, CA, United States
| | - Roland R. Lee
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
| | - Ya-Jun Ma
- Department of Radiology, University of California San Diego, San Diego, CA, United States
- *Correspondence: Ya-Jun Ma,
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14
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Nykänen O, Leskinen HPP, Finnilä MAJ, Karhula SS, Turunen MJ, Töyräs J, Saarakkala S, Nissi MJ. Bright ultrashort echo time SWIFT MRI signal at the osteochondral junction is not located in the calcified cartilage. J Orthop Res 2020; 38:2649-2656. [PMID: 32543707 DOI: 10.1002/jor.24777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/26/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023]
Abstract
In this study, we aimed to precisely localize the hyperintense signal that is generated at the osteochondral junction when using ultrashort echo time magnetic resonance imaging (MRI) and to investigate the osteochondral junction using sweep imaging with Fourier transformation (SWIFT) MRI. Furthermore, we seek to evaluate what compositional properties of the osteochondral junction are the sources of this signal. In the study, we obtained eight samples from a tibial plateau dissected from a 68-year-old male donor, and one additional osteochondral sample of bovine origin. The samples were imaged using high-resolution ultrashort echo time SWIFT MRI and microcomputed tomography (μCT) scans. Localization of the bright signal in the osteochondral junction was performed using coregistered data sets. Potential sources of the signal feature were examined by imaging the bovine specimen with variable receiver bandwidths and by performing variable flip angle T1 relaxation time mapping. The results of the study showed that the hyperintense signal was found to be located entirely in the deep noncalcified articular cartilage. The intensity of this signal at the interface varied between the specimens. Further tests with bovine specimens indicated that the imaging bandwidth and T1 relaxation affect the properties of the signal. Based on the present results, the calcified cartilage has low signal intensity even in SWIFT imaging. Concomitantly, it appears that the bright signal seen in ultrashort echo time imaging resides within the noncalcified cartilage. Furthermore, the most likely sources of this signal are the rapid T1 relaxation of the deep cartilage and the susceptibility-induced effects arising from the calcified tissues.
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Affiliation(s)
- Olli Nykänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Henri P P Leskinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mikko A J Finnilä
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Sakari S Karhula
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Mikael J Turunen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,SIB Labs, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
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15
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Mai R, Tan H, Zhao Y, Jia J, Liu W, Tian Y, Yuan S, Liu X. Diagnostic value and clinical significance of magnetic resonance imaging with the FS-PD-TSE sequence in diagnosing lumbar cartilaginous endplate failure. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1121-1130. [DOI: 10.1007/s00586-020-06338-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/01/2019] [Accepted: 02/08/2020] [Indexed: 12/31/2022]
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16
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Fields AJ, Battié MC, Herzog RJ, Jarvik JG, Krug R, Link TM, Lotz JC, O'Neill CW, Sharma A. Measuring and reporting of vertebral endplate bone marrow lesions as seen on MRI (Modic changes): recommendations from the ISSLS Degenerative Spinal Phenotypes Group. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2266-2274. [PMID: 31446492 DOI: 10.1007/s00586-019-06119-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/09/2019] [Accepted: 08/17/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE The positive association between low back pain and MRI evidence of vertebral endplate bone marrow lesions, often called Modic changes (MC), offers the exciting prospect of diagnosing a specific phenotype of chronic low back pain (LBP). However, imprecision in the reporting of MC has introduced substantial challenges, as variations in both imaging equipment and scanning parameters can impact conspicuity of MC. This review discusses key methodological factors that impact MC classification and recommends guidelines for more consistent MC reporting that will allow for better integration of research into this LBP phenotype. METHODS Non-systematic literature review. RESULTS The high diagnostic specificity of MC classification for a painful level contributes to the significant association observed between MC and LBP, whereas low and variable sensitivity underlies the between- and within-study variability in observed associations. Poor sensitivity may be owing to the presence of other pain generators, to the limited MRI resolution, and to the imperfect reliability of MC classification, which lowers diagnostic sensitivity and thus influences the association between MC and LBP. Importantly, magnetic field strength and pulse sequence parameters also impact detection of MC. Advances in pulse sequences may improve reliability and prove valuable for quantifying lesion severity. CONCLUSIONS Comparison of MC data between studies can be problematic. Various methodological factors impact detection and classification of MC, and the lack of reporting guidelines hinders interpretation and comparison of findings. Thus, it is critical to adopt imaging and reporting standards that codify acceptable methodological criteria. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Aaron J Fields
- Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, Box 0514, San Francisco, CA, 94143-0514, USA.
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, University of Western Ontario, London, ON, Canada
| | - Richard J Herzog
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey G Jarvik
- Departments of Radiology, Neurosurgery and Health Services, and the Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, Box 0514, San Francisco, CA, 94143-0514, USA
| | - Conor W O'Neill
- Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, Box 0514, San Francisco, CA, 94143-0514, USA
| | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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17
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Abstract
Purpose of review The endplates form the interface between the rigid vertebral bodies and compliant intervertebral discs. Proper endplate function involves a balance between conflicting biomechanical and nutritional demands. This review summarizes recent data that highlight the importance of proper endplate function and the relationships between endplate dysfunction, adjacent disc degeneration, and axial low back pain. Recent findings Changes to endplate morphology and composition that impair its permeability associate with disc degeneration. Endplate damage also associates with disc degeneration, and the progression of degeneration may be accelerated and the chronicity of symptoms heightened when damage coincides with evidence of adjacent bone marrow lesions. Summary The endplate plays a key role in the development of disc degeneration and low back pain. Clarification of the mechanisms governing endplate degeneration and developments in clinical imaging that enable precise evaluation of endplate function and dysfunction will distinguish the correlative vs. causative nature of endplate damage and motivate new treatments that target pathologic endplate function.
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18
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Berg-Johansen B, Han M, Fields AJ, Liebenberg EC, Lim BJ, Larson PE, Gunduz-Demir C, Kazakia GJ, Krug R, Lotz JC. Cartilage Endplate Thickness Variation Measured by Ultrashort Echo-Time MRI Is Associated With Adjacent Disc Degeneration. Spine (Phila Pa 1976) 2018; 43:E592-E600. [PMID: 28984733 PMCID: PMC5882595 DOI: 10.1097/brs.0000000000002432] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A magnetic resonance imaging study of human cadaver spines. OBJECTIVE To investigate associations between cartilage endplate (CEP) thickness and disc degeneration. SUMMARY OF BACKGROUND DATA Damage to the CEP is associated with spinal injury and back pain. However, CEP morphology and its association with disc degeneration have not been well characterized. METHODS Ten lumbar motion segments with varying degrees of disc degeneration were harvested from six cadaveric spines and scanned with magnetic resonance imaging in the sagittal plane using a T2-weighted two-dimensional (2D) sequence, a three-dimensional (3D) ultrashort echo-time (UTE) imaging sequence, and a 3D T1ρ mapping sequence. CEP thicknesses were calculated from 3D UTE image data using a custom, automated algorithm, and these values were validated against histology measurements. Pfirrmann grades and T1ρ values in the disc were assessed and correlated with CEP thickness. RESULTS The mean CEP thickness calculated from UTE images was 0.74 ± 0.04 mm. Statistical comparisons between histology and UTE-derived measurements of CEP thickness showed significant agreement, with the mean difference not significantly different from zero (P = 0.32). Within-disc variation of T1ρ (standard deviation) was significantly lower for Pfirrmann grade 4 than Pfirrmann grade 3 (P < 0.05). Within-disc variation of T1ρ and adjacent CEP thickness heterogeneity (coefficient of variation) had a significant negative correlation (r = -0.65, P = 0.04). The standard deviation of T1ρand the mean CEP thickness showed a moderate positive correlation (r = 0.40, P = 0.26). CONCLUSION This study demonstrates that quantitative measurements of CEP thickness measured from UTE magnetic resonance imaging are associated with disc degeneration. Our results suggest that variability in CEP thickness and T1ρ, rather than their mean values, may serve as valuable diagnostic markers for disc degeneration. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Britta Berg-Johansen
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
| | - Misung Han
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Ellen C Liebenberg
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Brandon J Lim
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Peder Ez Larson
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Cigdem Gunduz-Demir
- Department of Computer Engineering, Bilkent University, Ankara, Turkey
- Neuroscience Graduate Program, Bilkent University, Ankara, Turkey
| | - Galateia J Kazakia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
- Department of Bioengineering, UC Berkeley/UCSF Joint Program in Bioengineering, Berkeley, CA
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19
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3D Ultrashort TE MRI for Evaluation of Cartilaginous Endplate of Cervical Disk In Vivo: Feasibility and Correlation With Disk Degeneration in T2-Weighted Spin-Echo Sequence. AJR Am J Roentgenol 2018; 210:1131-1140. [PMID: 29629793 DOI: 10.2214/ajr.17.17855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility of 3D ultrashort TE (UTE) MRI in depicting the cartilaginous endplate (CEP) and its abnormalities and to investigate the association between CEP abnormalities and disk degeneration on T2-weighted spin-echo (SE) MR images in cervical disks in vivo. SUBJECTS AND METHODS Eight healthy volunteers and 70 patients were examined using 3-T MRI with the 3D UTE cones trajectory technique (TR/TE, 16.1/0.032, 6.6). In the volunteer study, quantitative and qualitative assessments of CEP depiction were conducted for the 3D UTE and T2-weighted SE imaging. In the patient study, CEP abnormalities were analyzed. Intersequence agreement between the images obtained with the first-echo 3D UTE sequence and the images created by subtracting the second-echo from the first-echo 3D UTE sequence (subtracted 3D UTE) and the intraobserver and interobserver agreements for 3D UTE overall were also tested. The CEP abnormalities on the 3D UTE images correlated with the Miyazaki grading of the T2-weighted SE images. RESULTS In the volunteer study, the CEP was well visualized on 3D UTE images but not on T2-weighted SE images (p < 0.001). In the patient study, for evaluation of CEP abnormalities, intersequence agreements were substantial to almost perfect, intraobserver agreements were substantial to almost perfect, and interobserver agreements were moderate to substantial (p < 0.001). All of the CEP abnormalities correlated with the Miyazaki grade with statistical significance (p < 0.001). CONCLUSION Three-dimensional UTE MRI feasibly depicts the CEP and CEP abnormalities, which may be associated with the severity of disk degeneration on T2-weighted SE MRI.
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20
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Berg‐Johansen B, Fields AJ, Liebenberg EC, Li A, Lotz JC. Structure-function relationships at the human spinal disc-vertebra interface. J Orthop Res 2018; 36:192-201. [PMID: 28590060 PMCID: PMC5720932 DOI: 10.1002/jor.23627] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 05/28/2017] [Indexed: 02/04/2023]
Abstract
Damage at the intervertebral disc-vertebra interface associates with back pain and disc herniation. However, the structural and biomechanical properties of the disc-vertebra interface remain underexplored. We sought to measure mechanical properties and failure mechanisms, quantify architectural features, and assess structure-function relationships at this vulnerable location. Vertebra-disc-vertebra specimens from human cadaver thoracic spines were scanned with micro-computed tomography (μCT), surface speckle-coated, and loaded to failure in uniaxial tension. Digital image correlation (DIC) was used to calculate local surface strains. Failure surfaces were scanned using scanning electron microscopy (SEM), and adjacent sagittal slices were analyzed with histology and SEM. Seventy-one percent of specimens failed initially at the cartilage endplate-bone interface of the inner annulus region. Histology and SEM both indicated a lack of structural integration between the cartilage endplate (CEP) and bone. The interface failure strength was increased in samples with higher trabecular bone volume fraction in the vertebral endplates. Furthermore, failure strength decreased with degeneration, and in discs with thicker CEPs. Our findings indicate that poor structural connectivity between the CEP and vertebra may explain the structural weakness at this region, and provide insight into structural features that may contribute to risk for disc-vertebra interface injury. The disc-vertebra interface is the site of failure in the majority of herniation injuries. Here we show new structure-function relationships at this interface that may motivate the development of diagnostics, prevention strategies, and treatments to improve the prognosis for many low back pain patients with disc-vertebra interface injuries. © 2017 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 36:192-201, 2018.
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Affiliation(s)
- Britta Berg‐Johansen
- University of California513 Parnassus Avenue, S‐1157San FranciscoCalifornia94143‐0514
| | - Aaron J. Fields
- University of California513 Parnassus Avenue, S‐1157San FranciscoCalifornia94143‐0514
| | - Ellen C. Liebenberg
- University of California513 Parnassus Avenue, S‐1157San FranciscoCalifornia94143‐0514
| | - Alfred Li
- University of California513 Parnassus Avenue, S‐1157San FranciscoCalifornia94143‐0514
| | - Jeffrey C. Lotz
- University of California513 Parnassus Avenue, S‐1157San FranciscoCalifornia94143‐0514
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Jin RC, Huang YC, Luk KDK, Hu Y. A computational measurement of cartilaginous endplate structure using ultrashort time-to-echo MRI scanning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 143:49-58. [PMID: 28391818 DOI: 10.1016/j.cmpb.2017.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 12/20/2016] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Ultrashort time-to-echo (UTE) MRI scanning has been applied to observe the cartilaginous endplate (CEP) in intervertebral disc. CEP plays a critical role in IVD health and disease. Nevertheless, current measurements of CEP based on UTE MRI technique are still by manual segmentation, and observation of signal abnormality was usually time-consuming and often disturbed by subjective bias. This study hence proposed an efficient way to harvest the global parameters of CEP after UTE MRI scanning. METHODS Ex-vivo UTE-MRI scanning was performed using 12 goat lumbar spine specimens. After the UTE-MRI data were collected, the computational method for CEP segmentation and assessment was developed. Global view of CEP, e.g., surface morphology as well as distributions of thickness and signal intensity, were measured. Histological staining of the CEP as well as manual CEP segmentation was then conducted to validate the accuracy. RESULTS Segmentation of CEP by the proposed method presented a good agreement with manual measurement, with mean Jaccard index of 0.7296 and mean Cohen's Kappa coefficient of 0.8286. The processing time for CEP segmentation and property measurements was 59.2s which was much shorter than the manual measurement. CONCLUSIONS This newly-developed technique is able to qualitatively and quantitatively assess the CEP structure, which is very valuable for the clinicians and researchers to accurately evaluate the endplate health after UTE MRI scanning.
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Affiliation(s)
- Ri-Chu Jin
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, PR China
| | - Yong-Can Huang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, PR China
| | - Keith D K Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, PR China
| | - Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, PR China.
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Sahoo MM, Mahapatra SK, Kaur S, Sarangi J, Mohapatra M. Significance of Vertebral Endplate Failure in Symptomatic Lumbar Disc Herniation. Global Spine J 2017; 7:230-238. [PMID: 28660105 PMCID: PMC5476348 DOI: 10.1177/2192568217694142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE Endplate lesions though have been implicated in the genesis of lumbar disc herniation (LDH), very little is known regarding their clinical course. Thus, the present study is aimed to investigate the incidence and types of endplate failure (EPF) in LDH and its correlation with the clinical symptoms and prognosis. METHODS Clinical and magnetic resonance imaging (MRI) features of 66 patients with isolated single level LDH were studied. Three-dimensional fast spoiled gradient (3D FSPGR) MRI and computed tomography scans were used to identify the bony and cartilaginous EPF. Twenty-five patients were operated on and 41 patients were treated conservatively. Changes in the pain score, function and neurology were noted at 3, 6, 12, 24, and 36 weeks. RESULTS Endplate lesions were observed in 64 patients (96.9%), including bony endplate failure (bony failure) in 47 patients (71.2%) and isolated cartilaginous endplate lesions in 17 patients (25.7%). Bony failure group had similar pain and functional scores but more severe neurological deficit at the initial evaluation. Clinical parameters improved in all groups, but the recovery was lesser in conservatively treated bony failure patients. CONCLUSION Endplate lesions are commonly associated with symptomatic LDH. Presence of bony failure can increase neurological deficit and reduce the chance of recovery with conservative management. The 3D FSPGR sequence of MRI can be successfully used for detection of the endplate lesions in the herniated disc.
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Affiliation(s)
| | - Sudhir Kumar Mahapatra
- SCB Medical College, Cuttack, India,Sudhir Kumar Mahapatra, Department of Orthopaedics, SCB Medical College, Manglabag, Cuttack 753007, India.
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Ghannam M, Jumah F, Mansour S, Samara A, Alkhdour S, Alzuabi MA, Aker L, Adeeb N, Massengale J, Oskouian RJ, Tubbs RS. Surgical anatomy, radiological features, and molecular biology of the lumbar intervertebral discs. Clin Anat 2017; 30:251-266. [PMID: 27997062 DOI: 10.1002/ca.22822] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 12/04/2016] [Indexed: 01/07/2023]
Abstract
The intervertebral disc (IVD) is a joint unique in structure and functions. Lying between adjacent vertebrae, it provides both the primary support and the elasticity required for the spine to move stably. Various aspects of the IVD have long been studied by researchers seeking a better understanding of its dynamics, aging, and subsequent disorders. In this article, we review the surgical anatomy, imaging modalities, and molecular biology of the lumbar IVD. Clin. Anat. 30:251-266, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Malik Ghannam
- An-Najah National University Hospital, Nablus, Palestine
| | - Fareed Jumah
- An-Najah National University Hospital, Nablus, Palestine
| | - Shaden Mansour
- An-Najah National University Hospital, Nablus, Palestine
| | - Amjad Samara
- An-Najah National University Hospital, Nablus, Palestine
| | - Saja Alkhdour
- An-Najah National University Hospital, Nablus, Palestine
| | | | - Loai Aker
- An-Najah National University Hospital, Nablus, Palestine
| | - Nimer Adeeb
- Department of Neurosurgery, Boston Medical Center, Boston University, Massachusetts
| | - Justin Massengale
- Department of Neurosurgery, Boston Medical Center, Boston University, Massachusetts
| | | | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada.,Seattle Science Foundation, Seattle, Washington
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Siriwanarangsun P, Statum S, Biswas R, Bae WC, Chung CB. Ultrashort time to echo magnetic resonance techniques for the musculoskeletal system. Quant Imaging Med Surg 2016; 6:731-743. [PMID: 28090449 DOI: 10.21037/qims.2016.12.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic resonance (MR) imaging has been widely implemented as a non-invasive modality to investigate musculoskeletal (MSK) tissue disease, injury, and pathology. Advancements in MR sequences provide not only enhanced morphologic contrast for soft tissues, but also quantitative biochemical evaluation. Ultrashort time to echo (UTE) sequence, in particular, enables novel morphologic and quantitative evaluation of previously unseen MSK tissues. By using short minimum echo times (TE) below 1 msec, the UTE sequence can unveil short T2 properties of tissues including the deepest layers of the articular cartilage, cartilaginous endplate at the discovertebral junction, the meniscus, and the cortical bone. This article will discuss the application of UTE to evaluate these MSK tissues, starting with tissue structure, MR imaging appearance on standard versus short and ultrashort TE sequences, and provide the range of quantitative MR values found in literature.
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Affiliation(s)
- Palanan Siriwanarangsun
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sheronda Statum
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Reni Biswas
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Won C Bae
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
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Evaluation of the disco-vertebral junction using ultrashort time-to-echo magnetic resonance imaging: inter-reader agreement and association with vertebral endplate lesions. Skeletal Radiol 2016; 45:1249-56. [PMID: 27241121 PMCID: PMC4947562 DOI: 10.1007/s00256-016-2413-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/18/2016] [Accepted: 05/18/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate ultrashort time to echo (UTE) magnetic resonance (MR) morphology of the cartilaginous endplates (CEP) in cadaveric lumbar spines with bony vertebral endplate (VEP) lesions, to determine inter-reader agreement as well as associations between the CEP morphology and VEP lesions as well as other abnormalities. MATERIALS AND METHODS MR imaging of cadaveric lumbar spines from 10 donors was performed at 3T using a UTE MR sequence. Two musculoskeletal radiologists identified the location of vertebral endplate lesions in consensus. The morphology of the CEP overlying the lesions and in the adjacent normal regions was assessed individually. A total of 55 vertebral lesions and 55 normal regions were assessed. The presence of osteophytosis, morphological changes of the anterior and posterior longitudinal ligament, and intervertebral disc signal and morphology was also assessed. Agreement between observers was determined using Cohen's kappa analysis, and association between CEP and vertebral endplate lesions was determined using the chi square test. RESULTS Fifty-five vertebral endplate lesions were identified and the morphology of CEP evaluated by two readers was in substantial agreement with Cohen's kappa of 0.78. The presence of vertebral endplate abnormality was associated with the presence of osteophytes (39 out of 55 levels), altered morphology and signal of the anterior longitudinal ligament (23 out of 55 levels) and intervertebral discs (30 out of 55 levels). CONCLUSION UTE MRI enables evaluation of the CEP with substantial inter-reader agreement. Abnormal changes of the CEP may facilitate formation of lesions of vertebral endplate over time and are associated with degenerative changes of the lumbar spine.
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DeLucca JF, Peloquin JM, Smith LJ, Wright AC, Vresilovic EJ, Elliott DM. MRI quantification of human spine cartilage endplate geometry: Comparison with age, degeneration, level, and disc geometry. J Orthop Res 2016; 34:1410-7. [PMID: 27232974 PMCID: PMC5244473 DOI: 10.1002/jor.23315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/06/2016] [Indexed: 02/04/2023]
Abstract
Geometry is an important indicator of disc mechanical function and degeneration. While the geometry and associated degenerative changes in the nucleus pulposus and the annulus fibrosus are well-defined, the geometry of the cartilage endplate (CEP) and its relationship to disc degeneration are unknown. The objectives of this study were to quantify CEP geometry in three dimensions using an MRI FLASH imaging sequence and evaluate relationships between CEP geometry and age, degeneration, spinal level, and overall disc geometry. To do so, we assessed the MRI-based measurements for accuracy and repeatability. Next, we measured CEP geometry across a larger sample set and correlated CEP geometric parameters to age, disc degeneration, level, and disc geometry. The MRI-based measures resulted in thicknesses (0.3-1 mm) that are comparable to prior measurements of CEP thickness. CEP thickness was greatest at the anterior/posterior (A/P) margins and smallest in the center. The CEP A/P thickness, axial area, and lateral width decreased with age but were not related to disc degeneration. Age-related, but not degeneration-related, changes in geometry suggest that the CEP may not follow the progression of disc degeneration. Ultimately, if the CEP undergoes significant geometric changes with aging and if these can be related to low back pain, a clinically feasible translation of the FLASH MRI-based measurement of CEP geometry presented in this study may prove a useful diagnostic tool. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1410-1417, 2016.
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Affiliation(s)
- John F. DeLucca
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716
| | - John M. Peloquin
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Lachlan J. Smith
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Alexander C. Wright
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Edward J. Vresilovic
- Department of Orthopedic Surgery, Pennsylvania State University Hershey Medical Center, Hershey, Pennsylvania 17033
| | - Dawn M. Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716
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Rivers WE, Rimmalapudi V, Heit JJ. Progress in Advanced Imaging Techniques for the Lumbar Spine. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Jackman TM, DelMonaco AM, Morgan EF. Accuracy of finite element analyses of CT scans in predictions of vertebral failure patterns under axial compression and anterior flexion. J Biomech 2016; 49:267-75. [PMID: 26792288 PMCID: PMC4955561 DOI: 10.1016/j.jbiomech.2015.12.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/26/2015] [Accepted: 12/04/2015] [Indexed: 11/18/2022]
Abstract
Finite element (FE) models built from quantitative computed tomography (QCT) scans can provide patient-specific estimates of bone strength and fracture risk in the spine. While prior studies demonstrate accurate QCT-based FE predictions of vertebral stiffness and strength, the accuracy of the predicted failure patterns, i.e., the locations where failure occurs within the vertebra and the way in which the vertebra deforms as failure progresses, is less clear. This study used digital volume correlation (DVC) analyses of time-lapse micro-computed tomography (μCT) images acquired during mechanical testing (compression and anterior flexion) of thoracic spine segments (T7-T9, n=28) to measure displacements occurring throughout the T8 vertebral body at the ultimate point. These displacements were compared to those simulated by QCT-based FE analyses of T8. We hypothesized that the FE predictions would be more accurate when the boundary conditions are based on measurements of pressure distributions within intervertebral discs of similar level of disc degeneration vs. boundary conditions representing rigid platens. The FE simulations captured some of the general, qualitative features of the failure patterns; however, displacement errors ranged 12-279%. Contrary to our hypothesis, no differences in displacement errors were found when using boundary conditions representing measurements of disc pressure vs. rigid platens. The smallest displacement errors were obtained using boundary conditions that were measured directly by DVC at the T8 endplates. These findings indicate that further work is needed to develop methods of identifying physiological loading conditions for the vertebral body, for the purpose of achieving robust, patient-specific FE analyses of failure mechanisms.
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Affiliation(s)
- Timothy M Jackman
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
| | - Alex M DelMonaco
- Department of Biomedical Engineering, Boston University, Boston, MA, United States; Department of Mechanical Engineering, Boston University, Boston, MA, United States
| | - Elise F Morgan
- Department of Biomedical Engineering, Boston University, Boston, MA, United States; Department of Mechanical Engineering, Boston University, Boston, MA, United States.
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Morphological studies of cartilage endplates in subaxial cervical region. 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 2015; 25:2218-22. [PMID: 26611364 DOI: 10.1007/s00586-015-4336-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to provide morphological data of endplates for the redesign of cervical artificial disc for use in the middle and lower cervical spine (C3-C7). METHODS Reformatted CT scans of 73 individuals were analysed. The shapes of superior endplates (SEPs) and inferior endplates (IEPs) were classified as either flat or arced. The curvature radius of the IEP and sagittal disc angle were measured in the mid-sagittal plane. The maximum transverse diameter (MTD) of the SEPs and IEP was measured in the coronal plane. RESULTS The majority of SEPs were flat (79.5 % at C7 and 91.8-95.9 % at C3-C6). Almost all (98.6-100 %) IEPs were arced. The curvature radius has a gradually increasing trend from C3 to C6 (P < 0.05, mean 29.26 mm). There were significant differences at C3-C7 in the average sagittal disc angles (5.80°, 6.92°, 7.51°, and 8.82°, respectively; P < 0.05; mean 7.26°), the average MTDs of the SEPs (13.64, 14.42, 15.03, and 16.74 mm, respectively, P < 0.05; mean 14.96 mm) and the average MTD of the IEPs (16.77, 17.67, 19.15, and 21.66 mm, respectively; P < 0.05; mean 18.81 mm). CONCLUSION The majority of SEPs were flat, while almost all IEPs were curved. The curvature radius of IEPs has a gradually increasing trend from C3 to C6. The average sagittal disc angles, MTDs of the SEPs and IEPs significantly increased from C3 to C7. Based on the above, the current cervical artificial disc design does not sufficiently match the morphology of cervical endplates (CEPs). This mismatch may lead to some postoperative complications of cervical disc arthroplasty.
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Changes in perfusion and diffusion in the endplate regions of degenerating intervertebral discs: a DCE-MRI 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 2015; 24:2458-67. [PMID: 26238936 DOI: 10.1007/s00586-015-4172-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Dynamic contrast-enhanced MRI (DCE-MRI) was used to investigate the associations between intervertebral disc degeneration and changes in perfusion and diffusion in the disc endplates. METHODS 56 participants underwent MRI scans. Changes in DCE-MRI signal enhancement in the endplate regions were analyzed. Also, a group template was generated for the endplates and enhancement maps were registered to this template for group analysis. RESULTS DCE-MRI enhancement changed significantly in cranial endplates with increased degeneration. A similar trend was observed for caudal endplates, but it was not significant. Group-averaged enhancement maps revealed major changes in spatial distribution of endplate perfusion and diffusion with increasing disc degeneration especially in peripheral endplate regions. CONCLUSIONS Increased enhancement in the endplate regions of degenerating discs might be an indication of ongoing damage in these tissues. Therefore, DCE-MRI could aid in understanding the pathophysiology of disc degeneration. Moreover, it could be used in the planning of novel treatments such as stem cell therapy.
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Chen C, Jia Z, Han Z, Gu T, Li W, Li H, Tang Y, Wu J, Wang D, He Q, Ruan D. Quantitative T2 relaxation time and magnetic transfer ratio predict endplate biochemical content of intervertebral disc degeneration in a canine model. BMC Musculoskelet Disord 2015; 16:157. [PMID: 26123048 PMCID: PMC4485356 DOI: 10.1186/s12891-015-0610-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/29/2015] [Indexed: 12/24/2022] Open
Abstract
Background Direct measurement of disc biochemical content is impossible in vivo. Therefore, magnetic resonance imaging (MRI) is used to evaluate disc health. Unfortunately, current clinical imaging techniques do not adequately assess degeneration, especially in the early stage of cartilage endplate, and subchondral bone zone (CEPZ). Therefore, this study aimed to investigate the sensitivity of quantitative MRI methods, namely T2 relaxation time and Magnetic Transfer Ratio (MTR), to identify early disc degeneration, especially for the CEPZ, using an experimental canine model of intervertebral disc injury and to investigate their sensitivity in depicting biochemically and histologically controlled degenerative changes in the disc. Methods Sixteen juvenile dogs underwent iatrogenic annular disruption via stab incisions. The animals underwent repeated 3.0 T MR imaging, and were sacrificed 4, 8, and 12 weeks post-operatively. A continuous rectangle drawing method was used to select regions of interest for the intervertebral disc from the cephalic to caudal CEPZ including the vertebrae, nucleus pulposus (NP) and annulus fibrosus (AF), which resembled pixel measurement for imaging analysis. Presence of degenerative changes was controlled by biochemical and histological analyses. The correlations between histological score, biochemical content, and quantitative MRI signal intensities were also analyzed. Results Both T2 relaxation time and MTR values changed for CEPZ, NP, and AF tissues within 12 weeks. T2 relaxation time values decreased significantly in the NP, AF, and CEPZ separately at pre-operation, 4, 8, and 12 weeks when compared each time (P < 0.05). MTR values showed no significant differences for the CEPZ between 8 and 4 weeks or 12 weeks, or compared to pre-operative values; there were significant differences for the AF. Biochemical and histological analysis showed changes consistent with quantitative MRI signal intensities for early stage degeneration. Conclusions Early traumatic or degenerative changes are detectable with both T2 and MTR. T2 changes were more sensitive to the differences in disc status, especially for the CEPZ. Since T2 and MTR reflect different disc properties, performing both imaging under the same conditions would be helpful in the evaluation of disc degeneration. The continuous rectangle drawing can be a sensitive method to detect the changes of CEPZ. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0610-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chun Chen
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China. .,Department of Orthopedic Surgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
| | - Zhiwei Jia
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Zhihua Han
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Tao Gu
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Wei Li
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Hao Li
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Yong Tang
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Jianhong Wu
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Deli Wang
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Qin He
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
| | - Dike Ruan
- Department of Orthopedic Surgery, Navy General Hospital, NO. 6 Fu-cheng Road, 100048, Beijing, People's Republic of China.
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Herniation of Cartilaginous Endplates in the Lumbar Spine: MRI Findings. AJR Am J Roentgenol 2015; 204:1075-81. [DOI: 10.2214/ajr.14.13319] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Farshad-Amacker NA, Farshad M, Winklehner A, Andreisek G. MR imaging of degenerative disc disease. Eur J Radiol 2015; 84:1768-76. [PMID: 26094867 DOI: 10.1016/j.ejrad.2015.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/02/2015] [Accepted: 04/04/2015] [Indexed: 11/29/2022]
Abstract
Magnet resonance imaging (MRI) is the most commonly used imaging modality for diagnosis of degenerative disc disease (DDD). Lack of precise observations and documentation of aspects within the complex entity of DDD might partially be the cause of poor correlation of radiographic findings to clinical symptoms. This literature review summarizes the current knowledge on MRI in DDD and outlines the diagnostic limitations. The review further sensitizes the reader toward awareness of potentially untended aspects of DDD and the interaction of DDD and endplate changes. A summary of the available classifications for DDD is provided.
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Affiliation(s)
- Nadja A Farshad-Amacker
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland.
| | - Mazda Farshad
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Anna Winklehner
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
| | - Gustav Andreisek
- Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
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Fields AJ, Han M, Krug R, Lotz JC. Cartilaginous end plates: Quantitative MR imaging with very short echo times-orientation dependence and correlation with biochemical composition. Radiology 2014; 274:482-9. [PMID: 25302832 DOI: 10.1148/radiol.14141082] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To measure the T2* of the human cartilaginous end plate by using magnetic resonance (MR) imaging with very short echo times and to determine the effect of the orientation of the end plate on T2* and on relationships between T2* and biochemical composition. MATERIALS AND METHODS This study was exempt from institutional review board approval, and informed consent was not required. Thirty-four samples of three cadaveric lumbar spines (from subjects who died at ages 51, 57, and 66 years) containing cartilaginous end plates and subchondral bone were prepared. Samples were imaged with a 3-T imager for T2* quantification by using a three-dimensional very short echo time sequence (repetition time msec/echo times msec, 30/0.075, 2, 5, 12, 18). Samples were imaged with the end plate at three orientations with respect to the constant magnetic induction field: 0°, 54.7°, and 90°. After imaging, the cartilage was assayed for its water, glycosaminoglycan, and collagen content. Pearson correlations were used to investigate the effect of orientation on the relationships between T2* and biochemical composition. RESULTS T2* was significantly longer when measured at an orientation of 54.7° (21.8 msec ± 2.8 [± standard error of the mean]) than at 0° (10.0 msec ± 0.7, P < .001) or 90° (9.9 msec ± 0.4, P < .001). At 54.7°, T2* was highly correlated with glycosaminoglycan content (r = 0.85, P < .001), the collagen-to-glycosaminoglycan ratio (r = -0.79, P < .001), and water content (r = 0.62, P = .02); at 0° and 90°, there were no significant differences in these relationships, with a minimum P value of .19. CONCLUSION T2* evaluation can allow noninvasive estimation of the degeneration of the cartilaginous end plate; however, the accuracy of T2*-based estimates of biochemical composition depends on the orientation of the end plate.
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Affiliation(s)
- Aaron J Fields
- From the Department of Orthopaedic Surgery (A.J.F., R.K., J.C.L.) and Department of Radiology and Biomedical Imaging (M.H., R.K.), University of California-San Francisco, 513 Parnassus Ave, Room S-1161, San Francisco, CA 94143-0514
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Boyde A, Davis GR, Mills D, Zikmund T, Cox TM, Adams VL, Niker A, Wilson PJ, Dillon JP, Ranganath LR, Jeffery N, Jarvis JC, Gallagher JA. On fragmenting, densely mineralised acellular protrusions into articular cartilage and their possible role in osteoarthritis. J Anat 2014; 225:436-46. [PMID: 25132002 DOI: 10.1111/joa.12226] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 12/11/2022] Open
Abstract
High density mineralised protrusions (HDMP) from the tidemark mineralising front into hyaline articular cartilage (HAC) were first described in Thoroughbred racehorse fetlock joints and later in Icelandic horse hock joints. We now report them in human material. Whole femoral heads removed at operation for joint replacement or from dissection room cadavers were imaged using magnetic resonance imaging (MRI) dual echo steady state at 0.23 mm resolution, then 26-μm resolution high contrast X-ray microtomography, sectioned and embedded in polymethylmethacrylate, blocks cut and polished and re-imaged with 6-μm resolution X-ray microtomography. Tissue mineralisation density was imaged using backscattered electron SEM (BSE SEM) at 20 kV with uncoated samples. HAC histology was studied by BSE SEM after staining block faces with ammonium triiodide solution. HDMP arise via the extrusion of an unknown mineralisable matrix into clefts in HAC, a process of acellular dystrophic calcification. Their formation may be an extension of a crack self-healing mechanism found in bone and articular calcified cartilage. Mineral concentration exceeds that of articular calcified cartilage and is not uniform. It is probable that they have not been reported previously because they are removed by decalcification with standard protocols. Mineral phase morphology frequently shows the agglomeration of many fine particles into larger concretions. HDMP are surrounded by HAC, are brittle, and show fault lines within them. Dense fragments found within damaged HAC could make a significant contribution to joint destruction. At least larger HDMP can be detected with the best MRI imaging ex vivo.
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Affiliation(s)
- A Boyde
- Biophysics, Oral Growth and Development, Barts and The London School of Medicine and Dentistry, QMUL, London, UK
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Chang EY, Du J, Chung CB. UTE imaging in the musculoskeletal system. J Magn Reson Imaging 2014; 41:870-83. [PMID: 25045018 DOI: 10.1002/jmri.24713] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 07/08/2014] [Accepted: 07/03/2014] [Indexed: 12/12/2022] Open
Abstract
Tissues, such as bone, tendon, and ligaments, contain a high fraction of components with "short" and "ultrashort" transverse relaxation times and therefore have short mean transverse relaxation times. With conventional magnetic resonance imaging (MRI) sequences that employ relatively long echo times (TEs), there is no opportunity to encode the decaying signal of short and ultrashort T2 /T2 * tissues before it has reached zero or near zero. The clinically compatible ultrashort TE (UTE) sequence has been increasingly used to study the musculoskeletal system. This article reviews the UTE sequence as well as various modifications that have been implemented since its introduction. These modifications have been used to improve efficiency or contrast as well as provide quantitative analysis. This article reviews several clinical musculoskeletal applications of UTE.
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Affiliation(s)
- Eric Y Chang
- Department of Radiology, VA San Diego Healthcare System, San Diego, California, USA; Department of Radiology, University of California, San Diego Medical Center, San Diego, California, USA
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Fields AJ, Liebenberg EC, Lotz JC. Innervation of pathologies in the lumbar vertebral end plate and intervertebral disc. Spine J 2014; 14:513-21. [PMID: 24139753 PMCID: PMC3945018 DOI: 10.1016/j.spinee.2013.06.075] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 05/21/2013] [Accepted: 06/24/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Magnetic resonance imaging (MRI) has limited diagnostic value for chronic low back pain because of the unclear relationship between any anatomic abnormalities on MRI and pain reported by the patient. Assessing the innervation of end plate and disc pathologies-and determining the relationship between these pathologies and any abnormalities seen on MRI-could clarify the sources of back pain and help identify abnormalities with enhanced diagnostic value. PURPOSE To quantify innervation in the vertebral end plate and intervertebral disc and to relate variation in innervation to the presence of pathologic features observed by histology and conventional MRI. STUDY DESIGN/SETTING A cross-sectional histology and imaging study of vertebral end plates and intervertebral discs harvested from human cadaver spines. METHODS We collected 92 end plates and 46 intervertebral discs from seven cadaver spines (ages 51-67 years). Before dissection, the spines were scanned with MRI to grade for Modic changes and high-intensity zones (HIZ). Standard immunohistochemical techniques were used to localize the general nerve marker protein gene product 9.5. We quantified innervation in the following pathologies: fibrovascular end-plate marrow, fatty end-plate marrow, end-plate defects, and annular tears. RESULTS Nerves were present in the majority of end plates with fibrovascular marrow, fatty marrow, and defects. Nerve density was significantly higher in fibrovascular end-plate marrow than in normal end-plate marrow (p<.001). Of the end plates with fibrovascular and fatty marrow, less than 40% were Modic on MRI. Innervated marrow pathologies collocated with more than 75% of the end plate defects; hence, innervation was significantly higher in end plate defects than in normal end plates (p<.0001). In the disc, nerves were observed in only 35% of the annular tears; in particular, innervation in radial tears tended to be higher than in normal discs (p=.07). Of the discs with radial tears, less than 13% had HIZ on T2 MRI. Innervation was significantly less in radial tears than in fibrovascular end-plate marrow (p=.05) and end-plate defects (p=.02). CONCLUSIONS These findings indicate that vertebral end-plate pathologies are more innervated than intervertebral disc pathologies and that many innervated end-plate pathologies are not detectable on MRI. Taken together, these findings suggest that improved visualization of end-plate pathologies could enhance the diagnostic value of MRI for chronic low back pain.
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Fields AJ, Rodriguez D, Gary KN, Liebenberg EC, Lotz JC. Influence of biochemical composition on endplate cartilage tensile properties in the human lumbar spine. J Orthop Res 2014; 32:245-52. [PMID: 24273192 PMCID: PMC4039641 DOI: 10.1002/jor.22516] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 10/14/2013] [Indexed: 02/04/2023]
Abstract
Endplate cartilage integrity is critical to spine health and is presumably impaired by deterioration in biochemical composition. Yet, quantitative relationships between endplate biochemical composition and biomechanical properties are unavailable. Using endplate cartilage harvested from human lumbar spines (six donors, ages 51-67 years) we showed that endplate biochemical composition has a significant influence on its equilibrium tensile properties and that the presence of endplate damage associates with a diminished composition-function relationship. We found that the equilibrium tensile modulus (5.9 ± 5.7 MPa) correlated significantly with collagen content (559 ± 147 µg/mg dry weight, r(2) = 0.35) and with the collagen/GAG ratio (6.0 ± 2.1, r(2) = 0.58). Accounting for the damage status of the adjacent cartilage improved the latter correlation (r(2) = 0.77) and indicated that samples with adjacent damage such as fissures and avulsions had a diminished modulus-collagen/GAG relationship (p = 0.02). Quasi-linear viscoelastic relaxation properties (C, t1 , and t2 ) did not correlate with biochemical composition. We conclude that reduced matrix quantity decreases the equilibrium tensile modulus of human endplate cartilage and that characteristics of biochemical composition that are independent of matrix quantity, that is, characteristics related to matrix quality, may also be important.
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Affiliation(s)
- Aaron J. Fields
- Orthopaedic Bioengineering Laboratory; Department of Orthopaedic Surgery; University of California; 513 Parnassus Avenue S-1157 San Francisco California 94143-0514
| | - David Rodriguez
- Orthopaedic Bioengineering Laboratory; Department of Orthopaedic Surgery; University of California; 513 Parnassus Avenue S-1157 San Francisco California 94143-0514
| | - Kaitlyn N. Gary
- Orthopaedic Bioengineering Laboratory; Department of Orthopaedic Surgery; University of California; 513 Parnassus Avenue S-1157 San Francisco California 94143-0514
| | - Ellen C. Liebenberg
- Orthopaedic Bioengineering Laboratory; Department of Orthopaedic Surgery; University of California; 513 Parnassus Avenue S-1157 San Francisco California 94143-0514
| | - Jeffrey C. Lotz
- Orthopaedic Bioengineering Laboratory; Department of Orthopaedic Surgery; University of California; 513 Parnassus Avenue S-1157 San Francisco California 94143-0514
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Serai SD, Laor T, Dwek JR, Zbojniewicz AM, Carl M. Feasibility of ultrashort TE (UTE) imaging of children at 1.5 T. Pediatr Radiol 2014; 44:103-8. [PMID: 23907186 DOI: 10.1007/s00247-013-2758-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/05/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
Ultrashort TE (UTE) is a relatively new MRI technique that allows for the visualization of tissue structures with short T2 components that show little or no signal on all conventional MR imaging sequences. This technique, to the best of our knowledge, has been described only in adults and uses a half excitation pulse and radial k-space data acquisition to produce echo times of less than 100 microseconds with no need for additional hardware modifications. We describe the feasibility of using a 2-D UTE sequence in vivo on a routine 1.5 T clinical MR scanner to depict various musculoskeletal structures in children.
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Affiliation(s)
- Suraj D Serai
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA
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Chang EY, Pallante-Kichura AL, Bae WC, Du J, Statum S, Wolfson T, Gamst AC, Cory E, Amiel D, Bugbee WD, Sah RL, Chung CB. Development of a Comprehensive Osteochondral Allograft MRI Scoring System (OCAMRISS) with Histopathologic, Micro-Computed Tomography, and Biomechanical Validation. Cartilage 2014; 5:16-27. [PMID: 24489999 PMCID: PMC3904392 DOI: 10.1177/1947603513514436] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To describe and apply a semi-quantitative MRI scoring system for multi-feature analysis of cartilage defect repair in the knee by osteochondral allografts, and to correlate this scoring system with histopathologic, micro-computed tomography (μCT), and biomechanical reference standards using a goat repair model. DESIGN Fourteen adult goats had two osteochondral allografts implanted into each knee: one in the medial femoral condyle (MFC) and one in the lateral trochlea (LT). At 12 months, goats were euthanized and MRI was performed. Two blinded radiologists independently rated nine primary features for each graft, including cartilage signal, fill, edge integration, surface congruity, calcified cartilage integrity, subchondral bone plate congruity, subchondral bone marrow signal, osseous integration, and presence of cystic changes. Four ancillary features of the joint were also evaluated, including opposing cartilage, meniscal tears, synovitis, and fat-pad scarring. Comparison was made with histological and μCT reference standards as well as biomechanical measures. Interobserver agreement and agreement with reference standards was assessed. Cohen's kappa, Spearman's correlation, and Kruskal-Wallis tests were used as appropriate. RESULTS There was substantial agreement (κ>0.6, p<0.001) for each MRI feature and with comparison against reference standards, except for cartilage edge integration (κ=0.6). There was a strong positive correlation between MRI and reference standard scores (ρ=0.86, p<0.01). OCAMRISS was sensitive to differences in outcomes between the types of allografts. CONCLUSIONS We have described a comprehensive MRI scoring system for osteochondral allografts and have validated this scoring system with histopathologic and μCT reference standards as well as biomechanical indentation testing.
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Affiliation(s)
- Eric Y. Chang
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA,Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | | | - Won C. Bae
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Sheronda Statum
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Tanya Wolfson
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Anthony C. Gamst
- Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
| | - Esther Cory
- Department of Bioengineering, University of California, San Diego, CA, USA
| | - David Amiel
- Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - William D. Bugbee
- Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, CA, USA,Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Robert L. Sah
- Department of Bioengineering, University of California, San Diego, CA, USA,Department of Orthopaedic Surgery, University of California, San Diego School of Medicine, La Jolla, CA, USA
| | - Christine B. Chung
- Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA,Department of Radiology, University of California, San Diego Medical Center, La Jolla, CA, USA
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Abstract
The osteochondral junction is composed of numerous tissue components and serves important functions relating to structural stability and proper nutrition in joints such as the knee and spine. Conventional MR techniques have been inadequate at imaging the tissues of the osteochondral junction primarily because of the intrinsically short T2 nature of these tissues, rendering them "invisible" with the standard acquisitions. Ultrashort time to echo (UTE) MR techniques acquire sufficient MR signal of osteochondral tissues, thereby allowing direct evaluation. This article reviews the anatomy of the osteochondral junction of the knee and the spine, technical aspects of UTE MRI, and the application of UTE MRI for evaluation of the osteochondral junction.
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Affiliation(s)
- Won C Bae
- Department of Radiology, University of California, San Diego, 408 Dickinson St., San Diego, CA 92103-8226, USA
| | - Reni Biswas
- Department of Radiology, University of California, San Diego, 408 Dickinson St., San Diego, CA 92103-8226, USA
| | - Karen Chen
- Department of Radiology, University of California, San Diego, 408 Dickinson St., San Diego, CA 92103-8226, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, 408 Dickinson St., San Diego, CA 92103-8226, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, 408 Dickinson St., San Diego, CA 92103-8226, USA
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Moon SM, Yoder JH, Wright AC, Smith LJ, Vresilovic EJ, Elliott DM. Evaluation of intervertebral disc cartilaginous endplate structure using magnetic resonance 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 2013; 22:1820-8. [PMID: 23674162 DOI: 10.1007/s00586-013-2798-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 03/01/2013] [Accepted: 04/25/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The cartilaginous endplate (CEP) is a thin layer of hyaline cartilage positioned between the vertebral endplate and nucleus pulposus (NP) that functions both as a mechanical barrier and as a gateway for nutrient transport into the disc. Despite its critical role in disc nutrition and degeneration, the morphology of the CEP has not been well characterized. The objective of this study was to visualize and report observations of the CEP three-dimensional morphology, and quantify CEP thickness using an MRI FLASH (fast low-angle shot) pulse sequence. METHODS MR imaging of ex vivo human cadaveric lumbar spine segments (N = 17) was performed in a 7T MRI scanner with sequence parameters that were selected by utilizing high-resolution T1 mapping, and an analytical MRI signal model to optimize image contrast between CEP and NP. The CEP thickness at five locations along the mid-sagittal AP direction (center, 5 mm, 10 mm off-center towards anterior and posterior) was measured, and analyzed using two-way ANOVA and a post hoc Bonferonni test. For further investigation, six in vivo volunteers were imaged with a similar sequence in a 3T MRI scanner. In addition, decalcified and undecalcified histology was performed, which confirmed that the FLASH sequence successfully detected the CEP. RESULTS CEP thickness determined by MRI in the mid-sagittal plane across all lumbar disc levels and locations was 0.77 ± 0.24 mm ex vivo. The CEP thickness was not different across disc levels, but was thinner toward the center of the disc. CONCLUSIONS This study demonstrates the potential of MRI FLASH imaging for structural quantification of the CEP geometry, which may be developed as a technique to evaluate changes in the CEP with disc degeneration in future applications.
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Affiliation(s)
- Sung M Moon
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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