Abstract
Low back pain (LBP) is often a result of a degenerative process in the intervertebral disc. The precise origin of discogenic pain is diagnosed by the invasive procedure of provocative discography (PD). Previously, we developed quantitative chemical exchange saturation transfer (qCEST) magnetic resonance imaging (MRI) to detect pH as a biomarker for discogenic pain. Based on these findings we initiated a clinical study with the goal to evaluate the correlation between qCEST values and PD results in LBP patients. Twenty five volunteers with chronic low back pain were subjected to T2-weighted (T2w) and qCEST MRI scans followed by PD. A total of 72 discs were analyzed. The average qCEST signal value of painful discs was significantly higher than non-painful discs (p = 0.012). The ratio between qCEST and normalized T2w was found to be significantly higher in painful discs compared to non-painful discs (p = 0.0022). A receiver operating characteristics (ROC) analysis indicated that qCEST/T2w ratio could be used to differentiate between painful and non-painful discs with 78% sensitivity and 81% specificity. The results of the study suggest that qCEST could be used for the diagnosis of discogenic pain, in conjunction with the commonly used T2w scan.
Highlights
Low back pain (LBP) is one of the most common causes of surgical procedures and one of the most frequent reasons for doctors’ visits and hospital a dmissions[1,2]
Analysis of pain scores based on Defense and Veterans Pain Rating Scale (DVPRS) questionnaires and numeric pain scales showed that pain levels were similar prior to and post magnetic resonance imaging (MRI) scans
Our results showed that painful intervertebral disc (IVD) had significantly higher quantitative chemical exchange saturation transfer (qCEST) scores than non-painful IVDs
Summary
Low back pain (LBP) is one of the most common causes of surgical procedures and one of the most frequent reasons for doctors’ visits and hospital a dmissions[1,2]. PD involves X-ray findings of disc defects, the injection of contrast agent into the IVD under X-ray guidance, and a positive elicitation of pain, suggesting a diagnosis of LBP originating from disc damage or degeneration Pain associated with this procedure can last for over a year in some patients[8], which prompted the development of anesthetic discography, whereby a local anesthetic is injected into the disc, and relief of pain is considered a positive result for discogenic back pain. Several studies have suggested that anesthetic discography may have the potential to replace the diagnostic role of P D9,10, current guidelines by the North American Spine Society conclude there is insufficient evidence to make a recommendation for or against anesthetic d iscography[11] These same guidelines suggest that PD currently remains the most accurate diagnostic modality for identifying discogenic pain, citing high-level evidence that PD correlates with other robust diagnostic modalities such as pain reproduction in the presence of disc degeneration on MRI/CT discography and the presence of vertebral endplate abnormalities on MRI imaging[11]. Despite remaining the gold standard diagnostic test for discogenic LBP, the popularity of PD has declined in recent years, likely due to the invasiveness of the procedure, concerns about the potential to cause IVD injury[12], and unclear value in predicting surgery o utcomes[13,14]
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