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Yaltırık CK, Yamaner EO, Ülgen M, Bigin EY, Firat Z, Ekinci G. Comparison of Pfirrmann classification and objective T2 signal intensity of cervical disc-cisterna magna ratio measurements in cervical intervertebral disc degeneration. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pohlan J, Stelbrink C, Tuttle N, Kubicka F, Kwon HJ, Jahnke P, Goehler F, Kershaw O, Gruber AD, Pumberger M, Diekhoff T. Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom. Acta Radiol 2021; 63:1118-1125. [PMID: 34219471 PMCID: PMC9272519 DOI: 10.1177/02841851211025863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Previously, dual-energy computed tomography (DECT) has been established for
imaging spinal fractures as an alternative modality to magnetic resonance
imaging (MRI). Purpose To analyze the diagnostic accuracy of DECT in visualizing intervertebral disc
(IVD) damage. Material and Methods The lumbar spine of a Great Dane dog was used as an ex vivo biophantom. DECT
was performed as sequential volume technique on a single-source CT scanner.
IVDs were imaged before and after an injection of sodium chloride solution
and after anterior discectomy in single-source sequential volume DECT
technique using 80 and 135 kVp. Chondroitin/Collagen maps (cMaps) were
reconstructed at 1 mm and compared with standard CT. Standardized regions of
interest (ROI) were placed in the anterior anulus fibrosus, nucleus
pulposus, and other sites. Three blinded readers classified all images as
intact disc, nucleus lesion, or anulus lesion. Additionally, clinical
examples from patients with IVD lesions were retrospectively identified from
the radiological database. Results Interrater reliability was almost perfect with a Fleiss kappa of 0.833 (95%
confidence interval [CI] 0.83–0.835) for DECT, compared with 0.780 (95% CI
0.778–0.782) for standard CT. For overall detection accuracy of IVD, DECT
achieved 91.0% sensitivity (95% CI 83.6–95.8) and 92.0% specificity (95% CI
80.8–97.8). Standard CT showed 91.0% sensitivity (95% CI 83.6–95.8) and
78.0% specificity (95% CI 64.0–88.5). Conclusion DECT reliably identified IVD damage in an ex vivo biophantom. Clinical
examples of patients with different lesions illustrate the accurate
depiction of IVD microstructure. These data emphasize the diagnostic
potential of DECT cMaps.
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Affiliation(s)
- Julian Pohlan
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Carsten Stelbrink
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Niklas Tuttle
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Felix Kubicka
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Ho Jung Kwon
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Paul Jahnke
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Friedemann Goehler
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Olivia Kershaw
- Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Achim D Gruber
- Department of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Matthias Pumberger
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Torsten Diekhoff
- Clinic of Radiology, Charité – Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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Zhang W, Zhu J, Xu X, Fan G. Synthetic MRI of the lumbar spine at 3.0 T: feasibility and image quality comparison with conventional MRI. Acta Radiol 2020; 61:461-470. [PMID: 31522520 DOI: 10.1177/0284185119871670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Synthetic magnetic resonance imaging (MRI), which can generate multiple morphologic MR images as well as quantitative maps from a single sequence, is not widely used in the spine at 3.0 T. Purpose To investigate the feasibility of synthetic MRI of the lumbar spine in clinical practice at 3.0 T. Material and Methods Eighty-four patients with lumbar diseases underwent conventional T1-weighted images, T2-weighted images, short-tau inversion recovery (STIR) images, and synthetic MRI of the lumbar spine at 3.0 T. The quantitative and qualitative image quality and agreement for detection of spinal lesions between conventional and synthetic MRI were compared by two radiologists. Results The signal-to-noise ratios of synthetic MRI showed an inferior image quality in the vertebrae and disc, whereas were higher for spinal canal and fat on the synthetic T1-weighted, T2-weighted, and STIR images. The contrast-to-noise ratios of the synthetic MRI was superior to conventional sequences, except for the vertebrae–disc contrast-to-noise ratio on T1-weighted imaging ( P = 0.005). Image quality assessments showed that synthetic MRI had greater STIR fat suppression ( P < 0.001) and fluid brightness ( P = 0.014), as well as higher degree of artifacts ( P < 0.001) and worse spatial resolution ( P = 0.002). The inter-method agreements for detection of spinal lesions were substantial to perfect (kappa, 0.614–0.925). Conclusion Synthetic MRI is a feasible method for lumbar spine imaging in a clinical setting at 3.0-T MR. It provides morphologic sequences with acceptable image quality, good agreement with conventional MRI for detection of spinal lesions and quantitative image maps with a slightly shorter acquisition time compared with conventional MRI.
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Affiliation(s)
- Weilan Zhang
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Jingyi Zhu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Xiaohan Xu
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, PR China
| | - Guoguang Fan
- Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, PR China
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Novel Application of the Pfirrmann Disc Degeneration Grading System to 9.4T MRI: Higher Reliability Compared to 3T MRI. Spine (Phila Pa 1976) 2019; 44:E766-E773. [PMID: 31205169 DOI: 10.1097/brs.0000000000002967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Reliability study. OBJECTIVE To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI. SUMMARY OF BACKGROUND DATA MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques. METHODS Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation. RESULTS Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI. CONCLUSION 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications. LEVEL OF EVIDENCE 3.
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Feasibility of T2 Mapping and Magnetic Transfer Ratio for Diagnosis of Intervertebral Disc Degeneration at the Cervicothoracic Junction: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6396073. [PMID: 31187047 PMCID: PMC6521330 DOI: 10.1155/2019/6396073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/09/2019] [Indexed: 11/18/2022]
Abstract
Background Intervertebral disc degeneration (IDD) at the cervicothoracic junction of spine is clinically relevant, however, little attention had been paid. T2 mapping and magnetic transfer ratio (MTR) are useful magnetic resonance imaging (MRI) techniques to quantitatively evaluate IDD, revealing the biochemical changes within the intervertebral disc. To compare T2 mapping with MTR imaging regarding their accuracy to quantitatively diagnose intervertebral disc degeneration at the cervicothoracic junction, influences of anatomical level, gender, age, and Pfirrmann grade of T2 relaxation time values and MTR values were evaluated. Methods Sixty-seven patients with neck and upper back pain were included and examined with both T2 mapping and MTR imaging. The Pfirrmann grade, T2 relaxation time values, and MTR value of each disc between C7 and T3 were measured. Differences were investigated among different segmental levels, genders, age ranges, and Pfirrmann grades. The diagnostic accuracy of both MRI techniques was compared using the receiver operating characteristic (ROC) curves. Results No significant difference was detected comparing T2 relaxation time values or MTR values among different anatomical levels, genders, and segmental levels. And we generally found that T2 relaxation time values decreased, while MTR value increased with increasing age. Importantly, we demonstrated the significant correlation between either T2 relaxation time values or MTR value and Pfirrmann grade. Conclusion We proved the better accuracy of T2 mapping over MTR imaging to quantitatively evaluate the intervertebral disc degeneration of the cervicothoracic junction.
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Nouh MR. Imaging of the spine: Where do we stand? World J Radiol 2019; 11:55-61. [PMID: 31110605 PMCID: PMC6503457 DOI: 10.4329/wjr.v11.i4.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/11/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
The number of patients presenting with spine-related problems has globally increased, with an enormous growing demand for the use of medical imaging to address this problem. The last three decades witnessed great leaps for diagnostic imaging modalities, including those exploited for imaging the spine. These developments improved our diagnostic capabilities in different spinal pathologies, especially with multi-detector computed tomography and magnetic resonance imaging, via both hardware and software improvisations. Nowadays, imaging may depict subtle spinal instability caused by various osseous and ligamentous failures, and could elucidate dynamic instabilities. Consequently, recent diagnostic modalities can discern clinically relevant spinal canal stenosis. Likewise, improvement in diagnostic imaging capabilities revolutionized our understanding of spinal degenerative diseases via quantitative biomarkers rather than mere subjective perspectives. Furthermore, prognostication of spinal cord injury has become feasible, and this is expected to be translated into better effective patient tailoring to management plans with better clinical outcomes. Meanwhile, our confidence in diagnosing spinal infections and assessing the different spinal instrumentation has greatly improved over the past few last decades. Overall, revolutions in diagnostic imaging over the past few decades have upgraded spinal imaging from simple subjective and qualitative indices into a more sophisticated yet precise era of objective metrics via deploying quantitative imaging biomarkers.
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Affiliation(s)
- Mohamed R Nouh
- Faculty of Medicine, Alexandria University, Alexandria 21521, Egypt
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Ying J, Han Z, Zeng Y, Du Y, Pei S, Su L, Ruan D, Chen C. Evaluation of intervertebral disc regeneration with injection of mesenchymal stem cells encapsulated in PEGDA-microcryogel delivery system using quantitative T2 mapping: a study in canines. Am J Transl Res 2019; 11:2028-2041. [PMID: 31105815 PMCID: PMC6511749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Intervertebral disc degeneration (IDD), the primary cause of low back pain, is still a great challenge to spinal surgeons and clinicians. T2 mapping, a biochemical magnetic resonance imaging (MRI) technique to calculate relaxation time, has the potential to offer a quantitative assessment of IDD. The aim of the study was to evaluate the regenerative effects of adipose-derived mesenchymal stem cells (MSCs) encapsulated in PEGDA-microcryogels (PMs) reinforced alginate hydrogel (AH) on the degenerative intervertebral disc (IVD) in a canine model using T2 mapping. Four degeneration-induced IVDs (L3-L4 to L6-L7) of 12 adult beagle dogs were injected with phosphate-buffered saline (PBS), MSCs, AH-PMs, and MSCs-laden AH-PMs, respectively. The intact IVD L7-S1 served as the normal control. IVD height change on plain radiograph, Pfirrmann grade and T2 relaxation time on MRI, histological change, and extracellular matrix (ECM)-associated proteins were evaluated during the 24-week follow-up period. Injection of MSCs-laden AH-PMs had the most satisfactory effects, having less decrease of IVD height, lower Pfirrmann grade, milder histological change, and longer T2 relaxation time (P < 0.05). T2 relaxation time was positively correlated with ECM content (proteoglycan: r = 0.85, P < 0.001; collagen II: r = 0.79, P < 0.001) and IVD height (r = 0.81, P < 0.001), but negatively correlated with Pfirrmann grade and histological grade (rho = -0.86, P < 0.001; rho = -0.95, P < 0.001). These results suggest that T2 mapping has the potential to quantitatively evaluate the repairing effects of cell-based engineering treatments on IDD for a long-term follow-up.
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Affiliation(s)
- Jinwei Ying
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou 510515, China
- Department of Orthopedic Surgery, Navy General HospitalBeijing 100048, China
- Department of Orthopedic Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000, China
| | - Zhihua Han
- Department of Trauma and Orthopedics, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
- Experimental Trauma and Orthopedic Surgery, JW Goethe-UniversityFrankfurt am Main, Germany
| | - Yang Zeng
- Department of Cancer Biology, Dana Farber Cancer Institute/Harvard Medical School360 Longwood Ave, Room 3316K, Boston, MA
| | - Yanan Du
- Department of Biomedical Engineering, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, School of Medicine, Tsinghua UniversityBeijing 100084, China
| | - Shishen Pei
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou 510515, China
- Department of Orthopedic Surgery, Navy General HospitalBeijing 100048, China
| | - Linghao Su
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou 510515, China
- Department of Orthopedic Surgery, Navy General HospitalBeijing 100048, China
| | - Dike Ruan
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou 510515, China
- Department of Orthopedic Surgery, Navy General HospitalBeijing 100048, China
| | - Chun Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000, China
- Engineering Research Center of Clinical Functional Materials and Diagnosis and Treatment Devices of Zhejiang Province, Wenzhou Institute of Biomaterials and EngineeringWenzhou 325011, China
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Peterson P, Olsson E, Svensson J. T
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relaxation time bias in gagCEST at 3T and 7T: comparison of saturation schemes. Magn Reson Med 2018; 81:1044-1051. [DOI: 10.1002/mrm.27465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/08/2018] [Accepted: 07/05/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Pernilla Peterson
- Medical Radiation Physics, Malmö, Department of Translational Medicine Lund University Sweden
- Radiation Physics Skåne University Hospital Malmö Sweden
| | - Emma Olsson
- Medical Radiation Physics, Malmö, Department of Translational Medicine Lund University Sweden
| | - Jonas Svensson
- Medical Radiation Physics, Malmö, Department of Translational Medicine Lund University Sweden
- Medical Imaging and Physiology Skåne University Hospital Lund Sweden
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Han Z, Gao L, Shi Q, Chen L, Chen C. Quantitative magnetic resonance imaging for diagnosis of intervertebral disc degeneration of the cervico-thoracic junction: a pilot study. Am J Transl Res 2018; 10:925-935. [PMID: 29636882 PMCID: PMC5883133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/14/2018] [Indexed: 06/08/2023]
Abstract
This study aimed to appraise two quantitative magnetic resonance imaging techniques, T2* imaging and diffusion-weighted imaging (DWI), for the diagnosis of the intervertebral disc degeneration of the cervico-thoracic junction. Influence of specific factors and diagnostic accuracy of both techniques were particularly explored. Sixty-one volunteers with neck and upper back pain were recruited and evaluated with both T2* imaging and DWI. The Pfirrmann grade, T2* relaxation time and apparent diffusion coefficient (ADC) value of each disc between C7 and T3 were recorded. Stratified analyses were performed for different anatomic levels, genders, age ranges and Pfirrmann grades. The diagnostic accuracy of both techniques was investigated using the receiver operating characteristic (ROC) curves. No statistically significant difference of either T2* relaxation time or ADC value was detected between males and females. Both parameters decreased with the increasing age and Pfirrmann grade. The ROC curves showed the higher sensitivity and specificity for T2* imaging than DWI to quantitatively identify the disc degeneration. Particularly, T2* imaging allowed for a quantitative distinguishing the normal, mild and moderate disc degeneration from the severe degeneration, which was unable to accomplish with DWI. In conclusion, we demonstrated that T2* imaging possess a better accuracy than DWI to quantitatively diagnose the intervertebral disc degeneration at the cervico-thoracic junction.
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Affiliation(s)
- Zhihua Han
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000, PR China
- Frankfurt Initiative for Regenerative Medicine, JW Goethe-UniversityFrankfurt am Main 60528, Germany
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland UniversityHomburg/Saar 66421, Germany
| | - Qinglei Shi
- Siemens Ltd., China Healthcare Sector MR Business GroupBeijing 100102, PR China
| | - Lei Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000, PR China
| | - Chun Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000, PR China
- Engineering Research Center of Clinical Functional Materials and Diagnosis & Treatment Devices of Zhejiang Province, Wenzhou Institute of Biomaterials and EngineeringWenzhou 325001, PR China
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Apparent Diffusion Coefficient of Diffusion-Weighted Imaging in Evaluation of Cervical Intervertebral Disc Degeneration: An Observational Study with 3.0 T Magnetic Resonance Imaging. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6843053. [PMID: 29670903 PMCID: PMC5835286 DOI: 10.1155/2018/6843053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/09/2017] [Accepted: 01/03/2018] [Indexed: 12/03/2022]
Abstract
Aims To investigate the correlation between the apparent diffusion coefficient (ADC) value and cervical intervertebral disc degeneration in adult symptomatic patients. Methods A total of 52 symptomatic and 40 healthy volunteers were included. DWI and routine MRI examinations were performed to their cervical spines. The cervical discs (from C2-C3 to C6-C7) were graded according to the Pfirrmann grading system, and ADC values of the nucleus pulposus (NP) were measured. Differences of the ADC values between different genders and anatomic levels were analyzed; the correlation between the ADC value and the Pfirrmann grade was investigated. The cut-off ADC values of each Pfirrmann grade were calculated. Results The mean ADC value of the NP decreased with increasing Pfirrmann grade (I–V) upon both patients and asymptotic volunteers. The ADC value decreased descendingly from C2-C3 to C5-C6 (P < 0.05) and then increased at C6-C7 (P < 0.05). Additionally, the comparison of the ADC values between different genders achieved statistical significance at each anatomical level (P < 0.05), except at C6-C7 (P > 0.05). Significant negative correlations between the ADC value and either age or Pfirrmann grade were observed. Conclusions Our preliminary findings suggest that the ADC value obtained by DWI can provide a reliable indicator to evaluate the cervical disc degeneration.
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