Axial loading during MRI induces significant T2 value changes in vertebral endplates—a feasibility study on patients with low back pain

Hebelka, Hanna; Miron, Andreia; Kasperska, I.; Brisby, Helena; Lagerstrand, Kerstin

doi:10.1186/s13018-018-0727-z

Cited by 22 publications

(25 citation statements)

References 35 publications

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“…Importantly, the difference in T2-value between groups may indicate that EPs and vertebrae in LBP patients have altered biodynamical characteristics compared to controls. Additionally, present findings support our previous study that displayed load-induced T2-effects in EPs and difference in T2-value between superior and inferior EPs [14]. Hence, alMRI may reveal functional differences in EPs between patients and controls.…”

Section: Discussionsupporting

confidence: 91%

“…Also, new functional properties of the EPs and vertebrae may be displayed when the spine is loaded during MRI (alMRI), compared to conventional MRI that is performed with the spine unloaded (uMRI). In a small cohort study, we have shown that alMRI affects EPs in patients differently than in controls [14]. At present, no work has previously studied the dynamic behaviour of Modic changes.…”

Section: Introductionmentioning

confidence: 90%

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Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping

2018

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Purpose The aim was to (1) verify our previous finding that endplates (EPs) display load-induced T2-changes, (2) investigate whether vertebrae display load-induced T2-changes and (3) investigate whether EPs and vertebrae in LBP patients and controls display T2-differences during conventional unloaded MRI and axial loaded MRI (alMRI). Methods Twenty-seven patients (mean 39 years) and 12 (mean 38 years) controls were examined with T2-mapping on a 1.5 T scanner during conventional unloaded MRI and subsequently during alMRI (Dynawell ® loading device), separated by approximately 20 min. For determination of EP and vertebral T2-values, volumetric regions of interest were manually segmented. Each vertebra was then divided into half to obtain superior and inferior units. The presence of EP changes (visual inhomogeneity in the EP zone), Schmorl's nodules and Modic changes were registered. Results For conventional unloaded MRI, the T2-values in the superior and inferior vertebral units and the EPs were significantly higher in the patients compared with controls (p < 0.03, p < 0.006) even when adjusted for the presence of Modic changes, Schmorl's nodules and EP signal changes. alMRI induced significant changes in the superior EPs of the patients (p < 0.001). Additionally, the T2-value differed significantly between the superior and inferior EP, as well as between the superior and inferior vertebra with higher values in the inferior units (p < 0.001). Conclusion This study demonstrated significantly higher EP and vertebral T2-values in LBP patients in comparison with controls. In addition, alMRI induced significant T2-changes in the superior EPs for patients but not for controls. Importantly, the T2-differences between the groups may indicate that EPs and vertebrae in LBP patients have altered biodynamical characteristics compared to controls and the higher T2-values measured in patients may represent early inflammation or impaired nutritional transport.Graphical abstract These slides can be retrieved from electronic supplementary material.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 90%

Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping

2018

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“…Subsequently, the substance transport through intervertebral discs is prevented, thus reducing the synthesis of the intervertebral disc matrix and the water content of the nucleus pulposus. This vicious cycle ultimately leads to the degeneration of intervertebral discs and varies in accordance with biomechanical functions 43 . This study showed that the T2 values of the endplates in the Pm grade I-II and III, I-II and IV-V, and III and IV-V were statistically significant.…”

Section: Relationship Between the Degree Of Disc Degeneration And T2 mentioning

confidence: 99%

Significant Association between the T2 Values of Vertebral Cartilage Endplates and Pfirrmann Grading

Cao

Guo²,

Wan

2020

Orthopaedic Surgery

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Objective The T2 value of lumbar cartilage endplates was measured using the T2 mapping imaging technique, aiming to explore the correlation between the T2 value and Pfirrmann grading of intervertebral discs. Methods A total of 130 patients with lumbar spine MR examination due to persistent low back pain were enrolled, including 71 men and 59 women (age: 21–63 years). Lumbar Modic changes and Schmorl nodules were recognized by conventional T1WI and T2WI images in 49 patients, and these patients were excluded from the study. A total of 81 patients were enrolled in this study, including 45 men (45.16 ± 12.20 years) and 36 women (43.33 ± 11.27 years). Pfirrmann (Pm) grading of each lumbar disc was performed based on conventional T2WI median sagittal images and the position of cartilage endplates (CEP) was determined by IDEAL‐SPGR images. Meanwhile, the T2 mapping technique was used to obtain T2 values of cartilage endplates. The T2 values of CEP corresponding to different Pm grade discs were compared, and the correlation between the T2 value and the Pm grade of intervertebral discs was analyzed. Results The T2 values of cephalic and caudal CEP of L1–2 in Pm grades I–II, Pm grades III, and Pm grades IV–V were 61.96 ± 5.89 ms, 54.45 ± 3.29 ms, 42.47 ± 3.69 ms and 64.35 ± 5.93 ms, 55.28 ± 3.97 ms, 44.75 ± 2.12 ms, respectively. For cephalic and caudal CEP of L2–3, the T2 values in Pm grades I–II, Pm grades III, and Pm grades IV–V were 62.96 ± 6.93 ms, 55.19 ± 4.02 ms, 48.67 ± 4.56 ms and 65.51 ± 6.49 ms, 57.16 ± 5.55 ms, 52.05 ± 4.20 ms, respectively. The T2 values of cephalic and caudal CEP from L3–4 to L5–S1 in Pm grades I–II, Pm grades III, and Pm grades IV–V were (63.72 ± 5.76 ms, 53.96 ± 6.52 ms, 48.05 ± 5.00 ms), (65.46 ± 6.37 ms, 55.70 ± 7.50 ms, 48.10 ± 3.27 ms); (66.34 ± 7.68 ms, 56.76 ± 9.48 ms, 47.80 ± 4.33 ms), (64.44 ± 4.65 ms, 59.30 ± 8.80 ms, 47.30 ± 5.78 ms), (65.32 ± 5.11 ms, 55.33 ± 6.65 ms, 48.18 ± 5.37 ms), and (63.47 ± 4.92 ms, 50.32 ± 8.86 ms, 44.77 ± 4.69 ms), respectively. There were significant differences in T2 values of cartilage endplates between the Pm grades I–II, III, and IV–V of intervertebral discs (P = 0.000). T2 values corresponding to Pm I–II grades were higher than those in Pm III grade, while T2 values in Pm grades IV–V were lowest. The T2 value of the L4–5, L5–S1 segment endplates was highly correlated with the Pm grades (r = −0.711, −0.721, −0.796, −0.745; P = 0.000) and that of L1–2, L2–3 endplates were moderately correlated (r = −0.542, −0.562, −0.637, −0.612; P = 0.000). Conclusion The T2 values of cartilage endplates revealed varying degrees of degeneration of intervertebral discs, and more severe degeneration corresponded to lower T2 values. Measurement of changes in the T2 value through cartilage endplates can be useful for the diagnosis of early intervertebral disc degeneration and the prevention of disc degeneration.

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“…Intervertebral discs, as the largest avascular organs in humans, mainly obtain nutrition by two pathways, including the endplate nutritional pathway and the annulus fibrous nutritional pathway [8]. As the most main nutritional pathway of the discs, the endplate nutritional pathway also plays important role in the degeneration of intervertebral disc [9, 10]. However, the effect of blocking the endplate nutritional pathway on the IDD was still unclear and controversial [5, 6].…”

Section: Discussionmentioning

confidence: 99%

Inhibition of both endplate nutritional pathways results in intervertebral disc degeneration in a goat model

Yin

Zhao

et al. 2019

J Orthop Surg Res

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Background The vertebral endplate route was demonstrated to be the main pathway for nutrition to the intervertebral disc. However, it is still a controversial issue on whether the blocking of the endplate nutritional pathway could result in intervertebral disc degeneration (IDD) in animal models. The aim was therefore to investigate the effect of the inhibition of both endplate nutritional pathways by bone cement injection on the IDD in a goat model. Methods Two lumbar intervertebral discs (L2–3 and L3–4) in eight 24-month-old goats were blocked in both endplate nutritional pathways by cement injection, and the other two lumbar intervertebral discs (L1–2 and L4–5) remained intact as normal controls. Effective blocking area percentage in nucleus pulposus (NP) was calculated, and X-rays, magnetic resonance imaging (MRI), and histology studies were performed at 4, 12, 24, and 48 weeks after operation. Results The mean effective blocking area percentage was 60.7 ± 5.3%. Imaging examinations at the time of 48 weeks after blocking the endplate nutritional pathways showed obvious IDD, with larger disc height reduction and higher degrees of disc degeneration grading compared with the normal controls. Histological examinations including HE, Masson’s trichrome, Sirius Red, and proteoglycan stainings also confirmed the degenerative changes of the blocked discs. Conclusions The endplate nutritional route could be inhibited by blocking both endplate pathways with cement injection in a goat model. The severe inhibition in the endplate nutritional pathways may result in IDD.

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Axial loading during MRI induces significant T2 value changes in vertebral endplates—a feasibility study on patients with low back pain

Cited by 22 publications

References 35 publications

Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping

Low back pain patients and controls display functional differences in endplates and vertebrae measured with T2-mapping

Significant Association between the T2 Values of Vertebral Cartilage Endplates and Pfirrmann Grading

Inhibition of both endplate nutritional pathways results in intervertebral disc degeneration in a goat model

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