Abstract
The drop in the MRI signal intensity, analysed without any normalisation, was found related to the intervertebral disc degeneration, but its association with low back pain remains controversial. The authors developed the analysis of MR signal intensity distribution (AMRSID) method that analyzes the 3D distribution of the normalized T2-weighted MR signal intensity within the intervertebral disc using descriptive statistics of histograms and weighted centers. In this study, we hypothesized that the distribution of the normalized MRI signal intensity within T2- weighted images of the intervertebral disc is a bio-marker of low back pain (LBP) independently of age and disc degenerescence. The aims were to: 1) characterize intervertebral disc degeneration in vertebral fracture from MR T1-weighted and T2-weighted images; 2) evaluate the sensitivity of the normalized MRI signal distribution to the presence of LBP, discs height loss and aging. We prospectively studied 22 patients who underwent an MRI acquisition within 48h after an accidental lumbar vertebral fracture. The presence of prefracture low back pain, spinal stenosis, annular disruption, intervertebral disc height loss was noted from each patient’s medical record. The presence of Modic changes, High-Intensity Zones (HIZs) and vertebral endplate perforations was recorded from MRI. The descriptive statistics of the normalized T2-weighted signal were compared using one-way ANOVAs and a principal component analysis was proposed. MRI, associated to normalisation of the signal intensity and principal component analysis, offers a remarkable potential for in-vivo imaging and analysis of vertebral fractures and adjacent tissues for the patient’s follow-up. The mean normalized MRI signal intensity of the adjacent intervertebral disc to the vertebral fracture was found to be a bio-marker of pain, independently of age and disc degeneration. However, the parameters describing the distribution of the normalized signal intensity were found to be not sensitive to the presence of low back pain, discs height loss and aging. Further studies need to be performed to detect small abnormalities that may explain the presence of LBP.
Highlights
Vertebral endplate damage and annular tears trigger an important intervertebral disc degeneration mechanism characterized by a loss of cellularity and the degradation of the extracellular matrix that entail morphological changes and alteration of the biomechanical properties [1,2,3,4,5,6]
We hypothesized that the distribution of the normalized Magnetic resonance imaging (MRI) signal intensity within T2weighted images of the intervertebral disc is a biomarker of low back pain (LBP) independently of age and disc degenerescence
The parameters describing the distribution of the normalized signal intensity were found to be not sensitive to the presence of low back pain, discs height loss and aging
Summary
Vertebral endplate damage and annular tears trigger an important intervertebral disc degeneration mechanism characterized by a loss of cellularity and the degradation of the extracellular matrix that entail morphological changes and alteration of the biomechanical properties [1,2,3,4,5,6]. Secondary changes occurring from the redistribution of the tissue stresses within the intervertebral disc include fibrocartilage production, with a disorganization of the annular architecture and an increase in type-II collagen. Magnetic resonance imaging (MRI) offers an important potential for detecting vertebral endplate damage from T1- and T2-weighted images using the Modic changes classification technique [7,8,9]. Despite the signal intensity changes observed after a successful spinal fusion [10], the significance of Modic changes following a surgical treatment remains unclear
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