Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3.0 Tesla magnetic resonance study

Messner, Alina; Stelzeneder, David; Trattnig, S.; Welsch, Goetz H.; Schinhan, Martina; Apprich, Sebastian; Brix, M.; Windhager, Reinhard; Trattnig, Siegfried

doi:10.1007/s00586-016-4873-x

Cited by 18 publications

(18 citation statements)

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“…Higher T2-values can be expected in inflammatory tissues. For example, in IVDs with hernias, higher T2-values have been shown within the posterior regions, reflecting altered biochemistry, such as increased water content due to an inflammatory process [16]. The persistent higher T2-value in the patient group even after Modic correction might be due to an early inflammation process, not visible in conventional MR images due to limitations in diagnostic performance.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

2018

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“…within ROI4-5, which represents the region between nucleus pulposus and annulus fibrosus, respectively, the posterior annulus. The finding of regional IVD differences in ROI4-5 between LBP patients and controls in several T2-mapping studies highlights the importance of subregional IVD analysis in the search of pain markers [9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…It has been established that T2-relaxation times provide continuous and objective grading of degeneration, with reduced T2-relaxation times correlating well with increased grade of degeneration [6][7][8]. Recent studies, including studies imaging the spine in loaded position, indicate regional IVD differences when comparing T2-maps between low back pain (LBP) patients and controls [9][10][11][12], which is promising in the search for pain predictors.…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies regarding quantitative MRI and lumbar IVD data exist; however, the majority are based on small cohorts and include divergent methodology, such as different IVD segmentation methods and the use of either axial or sagittal sequencing [3,4,6,[8][9][10][13][14][15][16][17][18], thus limiting comparison between studies. Further, variation between different motion segments can be expected due to natural IVD size and loading angles [19].…”

Section: Introductionmentioning

confidence: 99%

“…However, these studies have been based on small cohorts, so their results should be interpreted with caution. Since several quantitative MRI studies have reported differences within posterior IVD regions between LBP patients and controls [9][10][11][12], it seems important to elucidate how quantitative MRI data depend on IVD level, regarding not only the entire IVD but also potential impact on its subregions.…”

Section: Introductionmentioning

confidence: 99%

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The importance of level stratification for quantitative MR studies of lumbar intervertebral discs: a cross-sectional analysis in 101 healthy adults

et al. 2019

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Purpose To investigate whether quantitative T2-times depend on lumbar intervertebral disc (IVD) level. Methods The lumbar spine (Th12/L1-L5/S1) of 101 participants (53.5% female, 30.0[± 3.6]years, 173.5[± 9.6]cm and 69.9[± 13.4]kg), without history of back pain, was examined on a 3T scanner with sagittal T2-mapping. All IVDs were stratified according to Pfirrmann grade and lumbar level, with mean T2-time determined for the entire IVD volume and in five subregions of interests. Results Significant level-dependent T2-time differences were detected, both for the entire IVD volume and its subregions. For the entire IVD volume, Pfirrmann grade 2 IVDs displayed 9-18% higher T2-times in Th12/L1 IVDs compared to L2/ L3-L5/S1 IVDs (0.001 > p < 0.004) and significantly different T2-times in L1/L2-L2/L3 IVDs compared to most of the IVDs in the lower lumbar spine. In Pfirrmann grades 1, 3 and 4 IVDs, no significant level-dependent T2-time differences were observed for the entire IVD. More pronounced results were observed when comparing IVD subregions, with significant level-dependent differences also within Pfirrmann grade 1 and grade 3 IVDs. For example, in posterior IVD subregions mean T2-time was 80-82% higher in Th12/L1 compared to L3/L4-L4/L5 Pfirrmann grade 1 IVDs (p < 0.05) and 10-14% higher in L5/S1 compared to L3/L4-L4/L5 Pfirrmann grade 3 IVDs (0.02 > p < 0.001). Discussion Significant level-dependent T2-time differences within several Pfirrmann grades, both for the entire IVD volume and for multiple IVD subregions, were shown in this large cohort study. The T2-time differences between levels existed in both non-degenerated and degenerated IVDs. These findings show the importance of stratifying for lumbar level when quantitative IVD studies are performed using T2-mapping.

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Insights into the role of water concentrations on nanomechanical behavior of type I collagen‐hyaluronan interfaces in annulus fibrosus: A molecular dynamics investigation

Bhattacharya

Dubey

2023

Numer Methods Biomed Eng

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Multi‐faceted deformation capabilities of Annulus Fibrosus (AF) results from an intricate mechanical design by nature. Wherein, organization and interactions between the constituents, collagen type I (CI), collagen type II (C2), hyaluronan, aggrecan, and water are instrumental. However, mechanisms by which such interactions influence AF mechanics at tissue‐scale is not well understood. This work investigates nanoscale interfacial interactions between CI and hyaluronan (CI‐H) and presents insights into their influence on tissue‐scale mechanics of AF. For this, three‐dimensional molecular dynamics (MD) simulations of tensile and compressive deformation are conducted on atomistic model of CI‐H interface at 0%, 65%, and 75% water concentrations (WC). Results show hyaluronan lowers local hydration around CI component of interface, owing to its hydrophilic nature. Analyses show that increase in WC from 65% to 75% leads to increased interchain sliding in hyaluronan, which further lowers tensile modulus of the interface from 2.1 GPa to 660 MPa, contributing to softening observed from outer to inner AF. Furthermore, increase in WC from 65% to 75%, shifts compressive deformation from buckling‐dominant to non‐buckling‐dominant which contributes towards lower radial bulge at inner AF. Findings provide deeper insights into mechanistic interactions and mechanisms at fundamental length‐scale which influence the AF structure‐mechanics at tissue‐scale.

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Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3.0 Tesla magnetic resonance study

Cited by 18 publications

References 28 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

The importance of level stratification for quantitative MR studies of lumbar intervertebral discs: a cross-sectional analysis in 101 healthy adults

Insights into the role of water concentrations on nanomechanical behavior of type I collagen‐hyaluronan interfaces in annulus fibrosus: A molecular dynamics investigation

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