Axial loading during MRI influences T2-mapping values of lumbar discs: a feasibility study on patients with low back pain

Nilsson, Martin; Lagerstrand, Kerstin; Kasperska, I.; Brisby, Helena; Hebelka, Hanna

doi:10.1007/s00586-016-4670-6

Cited by 26 publications

(36 citation statements)

References 30 publications

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“…An evaluation covering a larger IVD volume, without increasing the image slice thickness, could potentially more accurately describe the regional heterogeneity also in lateral regions. It is known that the spine is a dynamic structure which is influenced by axial load or recumbency [27,28]. As all imaging was done with the patients in a supine position without axial load, the IVD morphological state might have deviated from upright standing conditions.…”

Section: Discussionmentioning

confidence: 99%

MRI histogram analysis enables objective and continuous classification of intervertebral disc degeneration

et al. 2017

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Purpose Magnetic resonance imaging (MRI) is the best diagnostic imaging method for low back pain. However, the technique is currently not utilized in its full capacity, often failing to depict painful intervertebral discs (IVDs), potentially due to the rough degeneration classification system used clinically today. MR image histograms, which reflect the IVD heterogeneity, may offer sensitive imaging biomarkers for IVD degeneration classification. This study investigates the feasibility of using histogram analysis as means of objective and continuous grading of IVD degeneration. Methods Forty-nine IVDs in ten low back pain patients (six males, 25-69 years) were examined with MRI (T2-weighted images and T2-maps). Each IVD was semi-automatically segmented on three mid-sagittal slices. Histogram features of the IVD were extracted from the defined regions of interest and correlated to Pfirrmann grade. Results Both T2-weighted images and T2-maps displayed similar histogram features. Histograms of well-hydrated IVDs displayed two separate peaks, representing annulus fibrosus and nucleus pulposus. Degenerated IVDs displayed decreased peak separation, where the separation was shown to correlate strongly with Pfirrmann grade (P \ 0.05). In addition, some degenerated IVDs within the same Pfirrmann grade displayed diametrically different histogram appearances. Conclusions Histogram features correlated well with IVD degeneration, suggesting that IVD histogram analysis is a suitable tool for objective and continuous IVD degeneration classification. As histogram analysis revealed IVD heterogeneity, it may be a clinical tool for characterization of regional IVD degeneration effects. To elucidate the usefulness of histogram analysis in patient management, IVD histogram features between asymptomatic and symptomatic individuals needs to be compared.

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Section: Discussionmentioning

confidence: 99%

MRI histogram analysis enables objective and continuous classification of intervertebral disc degeneration

et al. 2017

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“…The alMRI measurements were performed with a Dynawell compression device (Dynawell diagnostics AB, Las Vegas, NV, USA) with load, corresponding to 50% of the body weight [8].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…Axial loading of the spine has been shown to affect the IVD, where differences in the MRI signal between unloaded and loaded spine have been shown to display dynamic functionality [8][9][10][11][12][13]. 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).…”

Section: Introductionmentioning

confidence: 99%

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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“…Consequently, we recommend a standardized protocol with uniform measurement timings. Notably, as shown in the study by Nilsson et al the immediate regional impact of axial loading during MRI can be significant in particular in IVDs with less pronounced degeneration. Thus, in the latter study, which included T2 mapping on 11 patients with chronic LBP (54 lumbar discs) during unloaded MRI and subsequent axial loading MRI, T2 values increased significantly in various parts of the disc with an increase in the anterior AF (8 ms in Pfirrmann I and II graded IVDs, ~0.4 ms decrease in IVDs with further degeneration), the interface anterior AF‐NP (corresponds to the NP anterior in our study; ~13 ms in Pfirrmann I and II graded IVDs, ~4 ms in IVDs with further degeneration) and the NP (~11 ms in Pfirrmann I and II graded IVDs, ~1 ms in IVDs with further degeneration).…”

Section: Discussionmentioning

confidence: 78%

T2* Mapping of the Adult Intervertebral Lumbar Disc: Normative Data and Analysis of Diurnal Effects

Kolf¹,

Konieczny²,

Hesper³

et al. 2019

Journal Orthopaedic Research

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In this prospective study, we sought to establish normative data for T2* analysis of lumbar intervertebral discs (IVDs). Further, potential diurnal effects regarding T2* relaxometry of the lower spine were examined. Lumbar IVDs of young, healthy, adult men (n = 20) and women (n = 20; mean age = 24.5 ± 2.9 years) were assessed. Magnetic resonance imaging including T2* mapping was performed on a 3-T scanner. Mid-sagittal T2* values were obtained in five regions: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP , and posterior AF. Zonal and segmental differences, as well as diurnal variations between the T2* analysis in the morning and the evening and effects of unloading, were analyzed. Discs with signs of degeneration on morphological images or imaging artifacts were excluded. We noted a zonal and segmental T2* distribution with high values in the NP, low T2* values in the AF and a T2* increase towards the caudal NP. We observed no diurnal differences between the mean T2* values in the morning and in the evening (p = 0.748). The effect of unloading the spine was low (maximum T2* difference between four measurements = 13.6 ms; significant difference noted only between the 0 and 15-min measurement). The T2* values obtained in this study will serve as normative values for future T2* measurements. There are no diurnal influences, and we suggest that unloading of the spine has no demonstrable effect after 30 min on the T2* results.

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Axial loading during MRI influences T2-mapping values of lumbar discs: a feasibility study on patients with low back pain

Abstract: alMRI instantaneously induces T2-value changes in lumbar discs and is, thus, a feasible method to reveal dynamic, biochemical disc features in patients with chronic LBP.

Cited by 26 publications

References 30 publications

MRI histogram analysis enables objective and continuous classification of intervertebral disc degeneration

MRI histogram analysis enables objective and continuous classification of intervertebral disc degeneration

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

T2* Mapping of the Adult Intervertebral Lumbar Disc: Normative Data and Analysis of Diurnal Effects

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