Abstract
In recent years, various quantitative and functional magnetic resonance imaging (MRI) sequences have been developed and used in clinical practice for the diagnosis of patients with low back pain (LBP). Until now, T2-weighted imaging (T2WI), a visual qualitative evaluation method, has been used to diagnose intervertebral disc (IVD) degeneration. However, this method has limitations in terms of reproducibility and inter-observer agreement. Moreover, T2WI observations do not directly relate with LBP. Therefore, new sequences such as T2 mapping, T1ρ mapping, and MR spectroscopy have been developed as alternative quantitative evaluation methods. These new quantitative MRIs can evaluate the anatomical and physiological changes of IVD degeneration in more detail than conventional T2WI. However, the values obtained from these quantitative MRIs still do not directly correlate with LBP, and there is a need for more widespread use of techniques that are more specific to clinical symptoms such as pain. In this paper, we review the state-of-the-art methodologies and future challenges of quantitative MRI as an imaging diagnostic tool for IVD degeneration and painful discs.
Highlights
The number of patients with low back pain (LBP) in daily medical practice is extremely high, and it is estimated that 70–85% of people will experience LBP at some point in their lives [1]
The high-intensity zone (HIZ) is a hyperintense area in the posterior annulus fibrosus (AF) of lumbar Intervertebral disc (IVD) on magnetic resonance imaging (MRI) T2-weighted imaging (T2WI), which is thought to reflect secondary inflammatory changes caused by fissures in the AF and nucleus pulposus (NP) tissue protruding into the fissures [42]
We described MRI techniques that enable quantitative analyses as a new alternative to the qualitative evaluation of IVD degeneration by commonly applied T2WI (Table 1)
Summary
The number of patients with low back pain (LBP) in daily medical practice is extremely high, and it is estimated that 70–85% of people will experience LBP at some point in their lives [1]. The Pfirrmann classification on T2-weighted imaging (T2WI) is the most widely used method for evaluating IVD degeneration by MRI [11]. This method is a qualitative evaluation method based on the examiner’s visual interpretation, and it has limitations in terms of reproducibility, inter-observer agreement, and correlation with clinical symptoms [12]. The purpose of this paper was to describe these contemporary quantitative MRI techniques, i.e., T2 mapping, diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping, T1ρ mapping, sodium MRI, q-space imaging (QSI), chemical exchange saturation transfer (CEST), and magnetic resonance spectroscopy (MRS), and to discuss their potential and limitations toward the evaluation of IVD degeneration and painful discs. The CEP is connected to the vertebral body, sandwiching the top and bottom of the IVD, and it is responsible for most of the nutrient supply to the IVD by diffusion, making the IVD the largest avascular structure in the human body [20,21]
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