Diffusion based MR measurements correlates with age-related changes in human intervertebral disks

Diffusion‐weighted imaging (DWI) is an established MRI technique that can investigate tissue microstructure at the scale of a few micrometers. Musculoskeletal tissues typically have a highly ordered structure to fulfill their functions and therefore represent an optimal application of DWI. Even more since disruption of tissue organization affects its biomechanical properties and may indicate irreversible damage. The application of DWI to the musculoskeletal system faces application‐specific challenges on data acquisition including susceptibility effects, the low T2 relaxation time of most musculoskeletal tissues (2–70 msec) and the need for sub‐millimetric resolution. Thus, musculoskeletal applications have been an area of development of new DWI methods. In this review, we provide an overview of the technical aspects of DWI acquisition including diffusion‐weighting, MRI pulse sequences and different diffusion regimes to study tissue microstructure. For each tissue type (growth plate, articular cartilage, muscle, bone marrow, intervertebral discs, ligaments, tendons, menisci, and synovium), the rationale for the use of DWI and clinical studies in support of its use as a biomarker are presented. The review describes studies showing that DTI of the growth plate has predictive value for child growth and that DTI of articular cartilage has potential to predict the radiographic progression of joint damage in early stages of osteoarthritis. DTI has been used extensively in skeletal muscle where it has shown potential to detect microstructural and functional changes in a wide range of muscle pathologies. DWI of bone marrow showed to be a valuable tool for the diagnosis of benign and malignant acute vertebral fractures and bone metastases. DTI and diffusion kurtosis have been investigated as markers of early intervertebral disc degeneration and lower back pain. Finally, promising new applications of DTI to anterior cruciate ligament grafts and synovium are presented. The review ends with an overview of the use of DWI in clinical routine.Evidence Level5Technical EfficacyStage 3

Section: Musculoskeletal Applications Of Quantitative Diffusionmentioning

confidence: 99%

Section: Skeletal Musclementioning

confidence: 99%

Applications of Diffusion‐Weighted MRI to the Musculoskeletal System

Raya

Duarte

Wang

et al. 2023

“…The diffusion of nutritional supplies from blood vessels to the disc's annulus is essential for a healthy disc. 8,63,64 The nutrient transport mechanism necessary for the transport of solutes through the disc endplate was initially investigated by radioisotopes. 65,66 Dynamic contrast-enhanced (DCE) MRI is a new approach for detecting any disruption in the nutrient transport system to the disc.…”

Section: Endplate Diffusionmentioning

confidence: 99%

“…The diffusion of nutritional supplies from blood vessels to the disc's annulus is essential for a healthy disc 8,63,64 . The nutrient transport mechanism necessary for the transport of solutes through the disc endplate was initially investigated by radioisotopes 65,66 .…”

Section: Contributions Of Endplates To Lbpmentioning

confidence: 99%

Diagnostic Role of Magnetic Resonance Imaging in Low Back Pain Caused by Vertebral Endplate Degeneration

Din

Cheng

Yang

2021

Low back pain (LBP) is a common health issue worldwide with a huge economic burden on healthcare systems. In the United States alone, the cost is estimated to be $100 billion each year. Intervertebral disc degeneration is considered one of the primary causes of LBP. Moreover, the critical role of the vertebral endplates in disc degeneration and LBP is becoming apparent. Endplate abnormalities are closely correlated with disc degeneration and pain in the lumbar spine. Imaging modalities such as plain film radiography, computed tomography, and fluoroscopy are helpful but not very effective in detecting the causes behind LBP. Magnetic resonance imaging (MRI) can be used to acquire high-quality threedimensional images of the lumbar spine without using ionizing radiation. Therefore, it is increasingly being used to diagnose spinal disorders. However, according to the American College of Radiology, current referral and justification guidelines for MRI are not sufficiently clear to guide clinical practice. This review aimed to evaluate the role of MRI in diagnosing LBP by considering the correlative contributions of vertebral endplates. The findings of the review indicate that MRI allows for fine evaluations of endplate morphology, endplate defects, diffusion and perfusion properties of the endplate, and Modic changes. Changes in these characteristics of the endplate were found to be closely correlated with disc degeneration and LBP. The collective evidence from the literature suggests that MRI may be the imaging modality of choice for patients suffering from LBP.

“…Additionally, ADC and DTI‐derived metrics of IVD have been reported to correlate with age. A cadaver study demonstrated a negative correlation between age and mean ADC of IVD, along with a positive correlation with the coefficient of variation of ADC 7 . Zhang et al found a negative correlation between age and mean diffusivity and a moderate positive correlation with fractional anisotropy of IVD in asymptomatic volunteers 8 …”

mentioning

confidence: 99%

Editorial for “Characterization of Age‐Related and Sex‐Related Differences of Relaxation Parameters in the Intervertebral Disc Using MR‐Fingerprinting”

Wang

2023

C urrently, quantitative magnetic resonance imaging (MRI) has been widely used to provide functional information about the human body by assessing tissue composition, microstructure, and metabolites. Magnetic resonance fingerprinting (MRF) is a novel framework that can simultaneously generate multiple quantitative property maps, including T1, T2, and T1ρ. The MRF acquisition process involves three steps: signal acquisition, dictionary generation, and pattern matching. During signal acquisition, scan parameters are varied to generate a unique signal evolution over time, forming a signal "fingerprint" that is matched to a known dictionary to generate tissue property maps. 1 There has been a growing interest in evaluating the application of MRF in musculoskeletal system. Cloos et al developed an MRF approach called Plug-and-Play MRF, which eliminates artifacts induced by inhomogeneous B1+ field and enables accurate quantitative PD, T1, and T2 maps near metal implants. 2 Sharafi et al found that MRF sequences can simultaneously measure the T1, T2, T1ρ, and B1+ maps of human articular cartilage and detect cartilage degradation in patients with mild osteoarthritis. 3 In this study, a 3D-MRF sequence was shown to be capable of simultaneously acquiring proton density, T1, T2, and T1ρ maps of intervertebral disc (IVD) in healthy subjects. 4 The application of MRF has also been validated in other areas such as the brain, heart, breast, prostate, and abdomen. However, there are still limitations to its widespread application, including pulse sequence optimization, computational power, and metrics for error analysis. 1 Aging is a significant risk factor for IVD degeneration. This study demonstrated a significant negative correlation between age and T1, T2, and T1ρ values of lumbar IVDs. 4 The results are similar to previous studies. Wang et al enrolled both asymptomatic subjects and patients with low back pain and found T2 and T1ρ values of lumbar IVDs were significantly negatively correlated with age. 5 Menezes-