Abstract
PurposeMagnetic resonance imaging (MRI) is the best diagnostic imaging method for low back pain. However, the technique is currently not utilized in its full capacity, often failing to depict painful intervertebral discs (IVDs), potentially due to the rough degeneration classification system used clinically today. MR image histograms, which reflect the IVD heterogeneity, may offer sensitive imaging biomarkers for IVD degeneration classification. This study investigates the feasibility of using histogram analysis as means of objective and continuous grading of IVD degeneration.MethodsForty-nine IVDs in ten low back pain patients (six males, 25–69 years) were examined with MRI (T2-weighted images and T2-maps). Each IVD was semi-automatically segmented on three mid-sagittal slices. Histogram features of the IVD were extracted from the defined regions of interest and correlated to Pfirrmann grade.ResultsBoth T2-weighted images and T2-maps displayed similar histogram features. Histograms of well-hydrated IVDs displayed two separate peaks, representing annulus fibrosus and nucleus pulposus. Degenerated IVDs displayed decreased peak separation, where the separation was shown to correlate strongly with Pfirrmann grade (P < 0.05). In addition, some degenerated IVDs within the same Pfirrmann grade displayed diametrically different histogram appearances.ConclusionsHistogram features correlated well with IVD degeneration, suggesting that IVD histogram analysis is a suitable tool for objective and continuous IVD degeneration classification. As histogram analysis revealed IVD heterogeneity, it may be a clinical tool for characterization of regional IVD degeneration effects. To elucidate the usefulness of histogram analysis in patient management, IVD histogram features between asymptomatic and symptomatic individuals needs to be compared.
Highlights
The most frequent source of chronic disability for both genders in working years is low back pain (LBP) [1, 2] resulting in major consequences for both the individual as well as for the society
This study investigates the feasibility of using histogram analysis as means of objective and continuous grading of intervertebral discs (IVDs) degeneration
Histogram features of the IVD were extracted from the defined regions of interest and correlated to Pfirrmann grade
Summary
The most frequent source of chronic disability for both genders in working years is low back pain (LBP) [1, 2] resulting in major consequences for both the individual as well as for the society. The associated direct and indirect annual total costs for back pain are estimated to 1–2% of GDP [3, 4]. Degeneration of intervertebral discs (IVDs) is strongly associated with LBP and suggested to be the most common cause of LBP [5,6,7]. Magnetic resonance imaging (MRI) is sensitive to changes in cartilage structure and considered to be the best imaging method to evaluate IVD degeneration [8]. As conventional IVD degeneration measurements are qualitative and based on visual interpretation of MR images [9], the technique is currently not utilized in its full capacity.
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