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Sood A, Mishra GV, Suryadevara M, Parihar P, Khandelwal S, Manuja N, Saboo K, Shelar SS, Ahuja A, Batra N. Role of Apparent Diffusion Coefficient in Evaluating Degeneration of the Intervertebral Disc: A Narrative Review. Cureus 2023; 15:e43340. [PMID: 37700953 PMCID: PMC10493165 DOI: 10.7759/cureus.43340] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Degeneration of the lumbar intervertebral disc is the most common cause of lower back pain. It is directly related to daily activities, mechanical stress, and other biological factors. We use imaging modalities to assess the degree of disc degeneration, out of which magnetic resonance imaging (MRI) is the most popular non-invasive modality. It is believed that early changes in disc degeneration are due to the biochemical events in the disc and can be evaluated by sequences in MRI involving the diffusion of water molecules. The apparent diffusion coefficient (ADC) is one such sequence that captures the signals based on the diffusion of water molecules. Ten articles were chosen from PubMed and Google Scholar using the MeSH terms 'lumbar spine degeneration' and 'apparent diffusion coefficient'. This review article has summarized various studies intending to gain a better understanding of the biochemical events leading to the development of disc degeneration. This study has also gathered the role of various sequences in MRI that can quantitatively assess disc degeneration.
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Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Manasa Suryadevara
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Pratap Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Shreya Khandelwal
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Nishtha Manuja
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Keyur Saboo
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sheetal S Shelar
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Abhinav Ahuja
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
| | - Nitish Batra
- Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Wardha, IND
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Hamaguchi H, Kitagawa M, Sakamoto D, Katscher U, Sudo H, Yamada K, Kudo K, Tha KK. Quantitative Assessment of Intervertebral Disc Composition by MRI: Sensitivity to Diurnal Variation. Tomography 2023; 9:1029-1040. [PMID: 37218944 DOI: 10.3390/tomography9030084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
Whether diurnal variation exists in quantitative MRI indices such as the T1rho relaxation time (T1ρ) of the intervertebral disc (IVD) is yet to be explored. This prospective study aimed to evaluate the diurnal variation in T1ρ, apparent diffusion coefficient (ADC), and electrical conductivity (σ) of lumbar IVD and its relationship with other MRI or clinical indices. Lumbar spine MRI, including T1ρ imaging, diffusion-weighted imaging (DWI), and electric properties tomography (EPT), was conducted on 17 sedentary workers twice (morning and evening) on the same day. The T1ρ, ADC, and σ of IVD were compared between the time points. Their diurnal variation, if any, was tested for correlation with age, body mass index (BMI), IVD level, Pfirrmann grade, scan interval, and diurnal variation in IVD height index. The results showed a significant decrease in T1ρ and ADC and a significant increase in the σ of IVD in the evening. T1ρ variation had a weak correlation with age and scan interval, and ADC variation with scan interval. Diurnal variation exists for the T1ρ, ADC, and σ of lumbar IVD, which should be accounted for in image interpretation. This variation is thought to be due to diurnal variations in intradiscal water, proteoglycan, and sodium ion concentration.
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Affiliation(s)
- Hiroyuki Hamaguchi
- Laboratory for Biomarker Imaging Science, Graduate School of Biomedical Science and Engineering, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan
| | - Maho Kitagawa
- Laboratory for Biomarker Imaging Science, Graduate School of Biomedical Science and Engineering, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan
| | - Daiki Sakamoto
- Laboratory for Biomarker Imaging Science, Graduate School of Biomedical Science and Engineering, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan
| | - Ulrich Katscher
- Philips Research Laboratories, Roentgenstrasse 24-26, 22335 Hamburg, Germany
| | - Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo 060-8648, Japan
| | - Katsuhisa Yamada
- Department of Orthopaedic Surgery, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo 060-8648, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Hospital, N14 W5, Kita-ku, Sapporo 060-8648, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan
| | - Khin Khin Tha
- Laboratory for Biomarker Imaging Science, Graduate School of Biomedical Science and Engineering, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo 060-8638, Japan
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Khan AN, Jacobsen HE, Khan J, Filippi CG, Levine M, Lehman RA, Riew KD, Lenke LG, Chahine NO. Inflammatory biomarkers of low back pain and disc degeneration: a review. Ann N Y Acad Sci 2018; 1410:68-84. [PMID: 29265416 DOI: 10.1111/nyas.13551] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/12/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022]
Abstract
Biomarkers are biological characteristics that can be used to indicate health or disease. This paper reviews studies on biomarkers of low back pain (LBP) in human subjects. LBP is the leading cause of disability, caused by various spine-related disorders, including intervertebral disc degeneration, disc herniation, spinal stenosis, and facet arthritis. The focus of these studies is inflammatory mediators, because inflammation contributes to the pathogenesis of disc degeneration and associated pain mechanisms. Increasingly, studies suggest that the presence of inflammatory mediators can be measured systemically in the blood. These biomarkers may serve as novel tools for directing patient care. Currently, patient response to treatment is unpredictable with a significant rate of recurrence, and, while surgical treatments may provide anatomical correction and pain relief, they are invasive and costly. The review covers studies performed on populations with specific diagnoses and undefined origins of LBP. Since the natural history of LBP is progressive, the temporal nature of studies is categorized by duration of symptomology/disease. Related studies on changes in biomarkers with treatment are also reviewed. Ultimately, diagnostic biomarkers of LBP and spinal degeneration have the potential to shepherd an era of individualized spine medicine for personalized therapeutics in the treatment of LBP.
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Affiliation(s)
- Aysha N Khan
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Hayley E Jacobsen
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Jansher Khan
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | | | | | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - Lawrence G Lenke
- Department of Orthopedic Surgery, Columbia University, New York, New York.,New York-Presbyterian-Spine Hospital, New York, New York
| | - Nadeen O Chahine
- Department of Orthopedic Surgery, Columbia University, New York, New York.,Department of Biomedical Engineering, Columbia University, New York, New York
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Wada T, Togao O, Tokunaga C, Funatsu R, Yamashita Y, Kobayashi K, Nakamura Y, Honda H. Glycosaminoglycan chemical exchange saturation transfer in human lumbar intervertebral discs: Effect of saturation pulse and relationship with low back pain. J Magn Reson Imaging 2016; 45:863-871. [PMID: 27439061 DOI: 10.1002/jmri.25397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 07/05/2016] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the dependence of saturation pulse power and duration on glycosaminoglycan chemical exchange saturation transfer (gagCEST) imaging and assess the degeneration of human lumbar intervertebral discs (IVDs) using this method. MATERIALS AND METHODS All images were acquired on a 3T magnetic resonance imaging (MRI) scanner. The CEST effects were measured in the glycosaminoglycan (GAG) phantoms with different concentrations. In the human study, CEST effects were measured in the nucleus pulposus of IVD. We compared the CEST effects among the different saturation pulse powers (0.4, 0.8, and 1.6 μT) or durations (0.5, 1.0, and 2.0 sec) at each Pfirrmann grade (I-V). The relationship between the CEST effects and low back pain was also evaluated. RESULTS The phantom study showed high correlations between the CEST effects and GAG concentration (R2 = 0.863, P < 0.0001, linear regression). In the human study, the CEST effect obtained with the 0.8 μT power was significantly greater than those obtained with 0.4 (P < 0.01) and 1.6 μT power (P < 0.05) at Pfirrmann grade I. The CEST effect obtained with a 1.0-sec duration was significantly greater than those derived with 0.5 and 2.0 sec (P < 0.01) durations at Pfirrmann grades I and II. The CEST effects in the group with moderate low back pain were significantly lower than those in the groups without pain (P < 0.001) and with mild pain (P = 0.0216). CONCLUSION The contrast of gagCEST imaging in the lumbar IVDs varied with saturation pulse power and duration. GagCEST imaging may serve as a tool for evaluating IVD degeneration in the lumbar spine. LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:863-871.
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Affiliation(s)
- Tatsuhiro Wada
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Osamu Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chiaki Tokunaga
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Ryohei Funatsu
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Yasuo Yamashita
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Kouji Kobayashi
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Yasuhiko Nakamura
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Weber KT, Alipui DO, Sison CP, Bloom O, Quraishi S, Overby MC, Levine M, Chahine NO. Serum levels of the proinflammatory cytokine interleukin-6 vary based on diagnoses in individuals with lumbar intervertebral disc diseases. Arthritis Res Ther 2016; 18:3. [PMID: 26743937 PMCID: PMC4718017 DOI: 10.1186/s13075-015-0887-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/03/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Many intervertebral disc diseases cause low back pain (LBP). Proinflammatory cytokines and matrix metalloproteinases (MMPs) participate in disc pathology. In this study, we examined levels of serum cytokines and MMPs in human subjects with diagnoses of disc herniation (DH), spinal stenosis (SS), or degenerative disc disease (DDD) relative to levels in control subjects. Comparison between subjects with DH and those with other diagnoses (Other Dx, grouped from SS and DDD) was performed to elaborate a pathological mechanism based on circulating cytokine levels. METHODS Study participants were recruited from a spine neurosurgery practice (n = 80), a back pain management practice (n = 27), or a control cohort (n = 26). Serum samples were collected before treatment and were assayed by multiplex assays for levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon-γ, tumor necrosis factor-α, MMP-1, MMP-3, and MMP-9. Inflammatory and degradative mediator levels were compared for subjects with LBP and control subjects, by diagnosis and by treatment groups, controlling for effects of sex, age, and reported history of osteoarthritis. Spearman's correlation coefficient was used to examine relationships with age, body mass index (BMI), symptom duration, and smoking history. RESULTS Serum levels of IL-6 were significantly higher in subjects with LBP compared with control subjects. Participants with LBP due to Other Dx had significantly higher levels of IL-6 than DH and controls. Serum levels of MMP-1 were significantly lower in LBP subjects, specifically those with DH, than in control subjects. Positive correlations were found between IL-6 levels and BMI, symptom duration, and age. MMP-1 levels were positively correlated with age. CONCLUSIONS The findings of the present clinical study are the results of the first examination of circulating cytokine levels in DDD and SS and provide evidence for a more extensive role of IL-6 in disc diseases, where patients with DDD or SS have higher serum cytokine levels than those with DH or control subjects. These findings suggest that LBP subjects have low-grade systemic inflammation, and biochemical profiling of circulating cytokines may assist in refining personalized diagnoses of disc diseases.
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Affiliation(s)
- Kathryn T Weber
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, USA.
| | - D Olivier Alipui
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, USA.
| | - Cristina P Sison
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, USA. .,Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA. .,Department of Population Health, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
| | - Ona Bloom
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, USA. .,Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA. .,Department of Physical Medicine and Rehabilitation, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
| | - Shaheda Quraishi
- Department of Physical Medicine and Rehabilitation, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA. .,Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
| | - M Chris Overby
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
| | - Mitchell Levine
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
| | - Nadeen O Chahine
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, USA. .,Department of Molecular Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA. .,Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA. .,Department of Orthopedic Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
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Gonyea JV, Watts R, Applebee A, Andrews T, Hipko S, Nickerson JP, Thornton L, Filippi CG. In vivo quantitative whole‐brain T
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rho MRI of multiple sclerosis. J Magn Reson Imaging 2015; 42:1623-30. [DOI: 10.1002/jmri.24954] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jay V. Gonyea
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Richard Watts
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Angela Applebee
- Department of Neurological SciencesUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Trevor Andrews
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
- Philips HealthTechCleveland Ohio USA
| | - Scott Hipko
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Joshua P. Nickerson
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Lindsay Thornton
- Department of RadiologyUniversity of FloridaGainesville Florida USA
| | - Christopher G. Filippi
- Department of Neurological SciencesUniversity of Vermont College of MedicineBurlington Vermont USA
- Department of RadiologyNorth Shore University Hospital‐Long Island JewishNew York New York USA
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7
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Brink WM, Gulani V, Webb AG. Clinical applications of dual-channel transmit MRI: A review. J Magn Reson Imaging 2015; 42:855-69. [PMID: 25854179 DOI: 10.1002/jmri.24791] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 11/09/2022] Open
Abstract
This article reviews the principle of dual-channel transmit MRI and highlights current clinical applications which are performed primarily at 3 Tesla. The main benefits of dual-channel transmit compared with single-transmit systems are the increased image contrast homogeneity and the decreased scanning time due to the more accurate local specific absorption ratio estimation, meaning that less conservative safety limits are needed. The dual-transmit approach has been particularly beneficial in body imaging applications, and is also promising in terms of cardiac, spine, and fetal imaging. Future advances in transmit SENSE, the combination of dual-channel transmit with high permittivity pads, as well as the potential increase in the number of transmit channels are also discussed.
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Affiliation(s)
- Wyger M Brink
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vikas Gulani
- Department of Radiology, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Andrew G Webb
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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