Study Design
Prospective MRI study of LBP patients requiring discography as part of their routine clinical diagnoses and asymptomatic age-matched volunteers.
Objective
To determine whether T1ρ MRI and discography opening pressure are quantitative biomarkers of disc degeneration in LBP patients and in asymptomatic volunteers.
Summary of Background Data
Disc degenerative disease (DDD), a common cause of low back pain (LBP), is related to the patient’s prognosis and serves as a target for therapeutic interventions. However, there are few quantitative measures in the clinical setting. Discography opening pressure (OP) and T1ρ MRI are potential biomarkers of DDD related to biochemical composition the intervertebral disc (IVD).
Methods
The Institutional Review Board approved all experiments and informed consent was provided by each subject. Patients being treated for LBP (n=17, 68 levels, mean age 44±6 years, range 30–53) and control (CTL) subjects (n=11, 44 levels, mean age 43±17, range 22–76) underwent T1ρ and T2 MRI on a Siemens 3T Tim Trio clinical scanner. The LBP patients also received multi-level provocative discography before their MRI. Opening Pressure (OP) was recorded as the pressure when fluid first enters the nucleus of the IVD.
Results
T1ρ was significantly lower in the painful discs (55.3ms±3.0 ms, mean ± std. error) from control (92.0±4.9 ms, p<0.001) and non-painful discs (83.6±3.2 ms, p<0.001). Mean OP for the painful discs (11.8±1.0 psi, mean ± std. error) was significantly lower than non-painful discs (19.1±0.7 psi, p<0.001). Both T1ρ and OP correlated moderately with Pfirrmann degenerative grade. ROC area under the curve was 0.91 for T1ρ MRI and 0.84 for OP for predicting painful discs.
Conclusions
T1ρ and OP are quantitative measures of degeneration that are consistent across both control subjects and LBP patients. A significant and strong correlation exists between T1ρ values and in vivo OP measurements obtained by discography in LBP patients.
Magnetic resonance (MR) imaging in patients with persistent low back pain and sciatica effectively demonstrates spine anatomy and the relationship of nerve roots and intervertebral disks. Except in cases with nerve root compression, disk extrusion, or central stenosis, conventional anatomic MR images do not help distinguish effectively between painful and nonpainful degenerating disks. Hypoxia, inflammation, innervation, accelerated catabolism, and reduced water and glycosaminoglycan content characterize degenerated disks, the extent of which may distinguish nonpainful from painful ones. Applied to the spine, "functional" imaging techniques such as MR spectroscopy, T1ρ calculation, T2 relaxation time measurement, diffusion quantitative imaging, and radio nucleotide imaging provide measurements of some of these degenerative features. Novel minimally invasive therapies, with injected growth factors or genetic materials, target these processes in the disk and effectively reverse degeneration in controlled laboratory conditions. Functional imaging has applications in clinical trials to evaluate the efficacy of these therapies and eventually to select patients for treatment. This report summarizes the biochemical processes in disk degeneration, the application of advanced disk imaging techniques, and the novel biologic therapies that presently have the most clinical promise.
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