Correlation between diffusion in lumbar intervertebral disks and lumbar artery status: Evaluation with fresh blood imaging technique

Abstract

Purpose:To evaluate the correlation of the lumbar artery status with the diffusion values in lumbar vertebral disks in patients with low back problems using a fresh blood imaging (FBI) technique. Materials and Methods:First, both digital subtraction angiography (DSA) and MR angiography (MRA) was performed, and the weighted kappa value between DSA and MR angiography in evaluating the status of lumbar arteries was calculated. Then, The sagittal diffusion-weighted MR images in 260 intervertebral disks (L1-2 to L4-5) and MR angiographic images using FBI technique in the corresponding 260 lumbar artery pairs (total of 520 arteries) of the 65 patients with low back problems were separately evaluated by two radiologists. Results:The weighted kappa value between DSA and MRA in evaluating the status of lumbar arteries in both observes indicated good agreement. There were significant correlations between the status of lumbar arteries and the ADC values of the lumbar disks in all orthogonal directions (x, y, and z) at all intervertebral levels except L4-5 by both observers (P Ͻ 0.001). Conclusion:There is a strong association between the diminished flow in lumbar arteries and the decreased diffusion of lumbar intervertebral disks at all intervertebral levels except at L4-5.

Current Understanding of Lumbar Intervertebral Disc Degeneration: A Review With Emphasis Upon Etiology, Pathophysiology, and Lumbar Magnetic Resonance Imaging Findings

“…16,34,35 In the normal IVD the sensory nerve fibers 16,35,88 and their accompanying blood vessels 112 are most dense posteriorly and anterior-laterally but are generally observed only to a depth of 3.5 mm from the periphery of the annulus. Interestingly, sensory information from these nerves travels in the sinuvertebral nerve to the spinal cord via 2 possible routes: segmentally through the adjacent dorsal root or extrasegmentally through the paravertebral sympathetic chain.…”

Association of lumbar artery narrowing, degenerative changes in disc and endplate and apparent diffusion in disc on postcontrast enhancement of lumbar intervertebral disc

“…Narrowing of the lumbar arteries has been shown to associate with degenerative changes in the disc [6][7][8], which may indicate that reduced blood flow due to atherosclerotic changes is interfering nutrient supply. Likewise, a previous study showed that enhancement of disc is modified by defects in the endplate [3] suggesting that the endplate has an important role in regulating the flow of nutrients into the disc.…”

Diffusion-Weighted Magnetic Resonance Imaging of the Musculoskeletal System: An Emerging Technology With Potential to Impact Clinical Decision Making

“…2,8,31,63 Diffusion pathways are also strongly influenced by the presence, density, and orientation of tissue barriers such as membranes, collagen fibers, or solid tissues. 30,67,69 Because musculoskeletal tissues have substantial differences in their composition, such as the density of collagen fibers, the location of membranes, and the concentration of blood vessels, there is a wide variation in the diffusion of water between and within these tissues. 8,74 For example, subcutaneous fat cells are tightly packed and have low quantities of free water.…”

“…3,17,38,39 Over the course of a lifetime, the intervertebral discs often undergo substantial destructive changes, leading to a loss of water within their nuclear and annular components. 3,67,69 This condition, known as degenerative disc disease, is generally believed to be directly or indirectly involved in the generation of spinal pain for many patients; however, the mechanisms by which pain is generated remain unclear. 3,10,20,44,65 Recent studies using DWI to study the relationship of diffusion within normal and degenerative discs yield some interesting observations.…”