Quantifying Bone Marrow Edema Adjacent to the Lumbar Vertebral Endplate on Magnetic Resonance Imaging: A Cross-Sectional Study of Patients with Degenerative Lumbar Disease

Abstract

We aimed to quantitatively assess bone marrow edema (BME) on magnetic resonance imaging (MRI) for patients with degenerative lumbar diseases. Overview of Literature: BME adjacent to a sclerotic endplate of the lumbar spine, detected using T2-weighted fat-saturated MRI, is closely associated with low back pain in patients with degenerative lumbar diseases. However, currently, there no quantitative evaluation methods for BME adjacent to the vertebral endplate. Methods: Patients with degenerative lumbar diseases, whose MRIs detected BME, were enrolled. On a T2-weighted fat-saturated MRI, BME appeared as a high-intensity region adjacent to the vertebral endplate. We calculated the contrast ratios (CRs) of BME and normal bone marrow using the signal intensities of BME, normal bone marrow, and the spinal cord. On computed tomography, we calculated Hounsfield unit (HU) values in the same area as BME, the sclerotic endplate, and normal bone marrow to assess bone density. Results: There were 16 men and 14 women, with an average age of 73.5 years. The mean CRs of BME and normal bone marrow were −0.015±0.056 and −0.407±0.023, respectively. BME's CR was significantly higher than that of normal bone marrow (p<0.01). The HU values in the same area as BME, the sclerotic endplate, and normal bone marrow were 251.9±24.6, 828.3±35.6, and 98.1±9.3, respectively; these values were significantly different from each other (p<0.01). Conclusions: The CR on MRI is a useful quantitative assessment tool for BME in patients with degenerative lumbar diseases.

Lumbar Spinal Stenosis: Review Update 2022

“…MRI can be used to detect LSS and measure the size of the spinal canal and the degree of degenerative changes [1,23,[32][33][34][35]. It should be emphasized that the correlation between the severity of morphologically stenotic lesions on an MRI and clinical symptoms is small.…”

“…Standing in flexion and extension while having restricted sight on the MRI is required for this test, which records moving pictures from the lateral side [20,33]. In addition, CT can actually provide the information required for decompression surgery because it offers more information about bone architecture, such as osteophytes and disk calcifications, than MRI [35]. Patients with pacemakers who are unable to undergo MRI diagnostic examinations have a great alternative imaging option in CT scan.…”