Value of magnetic resonance T 2 mapping in the diagnosis of early cervical disc degeneration in adolescents / 中国基层医药

Objective:To analyze the value of magnetic resonance T 2 mapping in the diagnosis of early cervical disc degeneration in adolescents. Methods Patients who underwent cervical MRI examination and magnetic resonance T 2 mapping in Wenzhou Hospital of Traditional Chinese Medicine between November 2019 and September 2020 were included in this study. They were divided into observation and control groups ( n = 50 per group) according to the time of lowering their heads (≥ 2 hours) every day. The T 2 values corresponding to the nucleus pulposus of cervical intervertebral disc in each segment was compared between the two groups. Cervical disk degeneration was graded using the Pfirrmann classification. T 2 value was compared between different Pfirrmann disc grades. The efficacy of T 2 value in the diagnosis of early cervical disc degeneration in adolescents was evaluated using the receiver operating characteristic curve. The specificity and sensitivity of T 2 value in the diagnosis of early cervical disc degeneration in adolescents and the area under the receiver operating characteristic curve were calculated. Results:T 2 value measured in each cervical intervertebral disc segment in the observation group was significantly greater than that in the control group ( t = 5.06, 4.47, 3.57, 2.93, 4.98 for C2-3, C3-4, C4-5, C5-6, C6-7 segments, all P < 0.05). In the observation group, the number of patients with Pfirrmann grade II cervical intervertebral disc degeneration was highest, accounting for 42% (21/50). There was a significant difference in cervical intervertebral disc segment T 2 value between different Pfirrmann disc grades ( t = 2.62, P = 0.018, vs. Pfirrmann disc grade I ; t = 2.12, P = 0.045, vs. Pfirrmann disc grade II; t = 2.24, P = 0.049, vs. Pfirrmann disc grade III). The higher Pfirrmann grade, the lower T 2 value of cervical intervertebral disc nucleus pulposus. The receiver operating characteristic curve showed that the sensitivity and specificity of T 2 value in the diagnosis of early cervical disc degeneration and the area under the receiver operating characteristic curve were 81.2%, 79.8% and 0.756, respectively. Conclusion:T 2 mapping imaging technology can predict early cervical intervertebral disc degeneration in adolescents by quantitatively analyzing the T 2 value of cervical intervertebral disc nucleus pulposus and has a high value in the diagnosis of cervical intervertebral disc degeneration. This achievement is of innovation and science.

Intravoxel incoherent motion MR imaging in the quantitative evaluation of lumbar disc degeneration / 西安交通大学学报(医学版)

Objective: To quantitatively evaluate the changes of diffusional and perfusion of degenerative water molecules in lumbar inervertebral disc by multiple b-value voxel incoherent motion imaging. Methods: We selected 60 patients (34 males and 26 females) with low back pain or sciatica from The First Affiliated Hospital of Xi'an Jiaotong University. The subjects underwent lumbar MRI sagittal T2WI and median sagittal multiple b-value weighted imaging. We graded the L1-S1 disc according to the Pfirrmann grading standards, and measured the ADCslow, ADCfast, f values of the nucleus pulla, and the anterior and posterior edges of the annulus fibrosus. We compared the mean values of ADCslow, ADCfast, f at the anterior and posterior edges of nucleus pulposus and annulus fibrosus and analyzed the correlation analysis between them and the grade of degeneration. Single factor analysis of variance combined with SNK test was used in the statistics. Results: A total of 300 discs were measured and the statistical results showed that: ① The mean value of the ADC of the nucleus pulposus of each grade of the lumbar disc decreased with the increase of the grade. Although there was no significant difference between grade and grade Ⅱ, grade and grade , there were statistically significant differences between the other grades (P0.05). Conclusion: The quantitative measurement of nucleus pulposus ADCslow based on IVIM is a potential and more sensitive quantitative magnetic resonance method for evaluating early degeneration of lumbar disc.

Is Adjacent Segment Disease More Frequent in Proximal Levels in Comparison with Distal Levels? Based on Radiological Data of at Least 2 Years Follow Up with More than 2 Level Thoracolumbar Fusions

OBJECTIVE: The purpose of this retrospective study was to determine which of the proximal adjacent segment disease (ASD) and distal ASD was more prevalent and what parameters is more related to ASD in proximal levels and distal levels after more than 2 levels fusions. METHODS: The medical records were reviewed retrospectively for 856 cases. A total of 66 cases of ASD were enrolled. On pre-op magnetic resonance imaging, disc degeneration was measured at the upper and lower parts of surgically treated levels and confirmed by the commonly used Pfirrmann grade. Segmental flexibility in sagittal plane was embodied in segment range of motion (ROM) obtained through flexion and extension X-ray before surgery. Coronal angle was recorded as methods Cobb’s angle including fusion levels preoperatively. For the comparison of categorical variables between two independent groups, the chi-square test and Fisher exact test were performed. RESULTS: Proximal ASD and distal ASD were 37/856 (4.32%) and 29/856 (3.39%), respectively. The incidence of proximal ASD was relatively high but insignificant differences. In comparison between ASD group and non ASD group, proximal Pfirmman was higher in proximal ASD and distal Pfirmman was higher in distal ASD group (p=0.005, p<0.008, respectively). However, in the ROM, proximal ROM was higher in proximal ASD, but distal ROM was not different between the two groups (p<0.0001, p=0.995, respectively). Coronal angle was not quite different in both groups (p=0.846). CONCLUSION: In spite of higher frequency in ASD in proximal level in spinal fusion, it is not clear that incidence of ASD in proximal level is not higher than that of distal ASD group in more than 2 level thoracolumbar fusions. Not only Pfirrmann grade but also proximal segmental ROM is risk factor for predicting the occurrence of ASD in patients more than 2 level of thoracolumbar spine fusion operation excluding L5S1.

Is Adjacent Segment Disease More Frequent in Proximal Levels in Comparison with Distal Levels? Based on Radiological Data of at Least 2 Years Follow Up with More than 2 Level Thoracolumbar Fusions

OBJECTIVE: The purpose of this retrospective study was to determine which of the proximal adjacent segment disease (ASD) and distal ASD was more prevalent and what parameters is more related to ASD in proximal levels and distal levels after more than 2 levels fusions.METHODS: The medical records were reviewed retrospectively for 856 cases. A total of 66 cases of ASD were enrolled. On pre-op magnetic resonance imaging, disc degeneration was measured at the upper and lower parts of surgically treated levels and confirmed by the commonly used Pfirrmann grade. Segmental flexibility in sagittal plane was embodied in segment range of motion (ROM) obtained through flexion and extension X-ray before surgery. Coronal angle was recorded as methods Cobb’s angle including fusion levels preoperatively. For the comparison of categorical variables between two independent groups, the chi-square test and Fisher exact test were performed.RESULTS: Proximal ASD and distal ASD were 37/856 (4.32%) and 29/856 (3.39%), respectively. The incidence of proximal ASD was relatively high but insignificant differences. In comparison between ASD group and non ASD group, proximal Pfirmman was higher in proximal ASD and distal Pfirmman was higher in distal ASD group (p=0.005, p<0.008, respectively). However, in the ROM, proximal ROM was higher in proximal ASD, but distal ROM was not different between the two groups (p<0.0001, p=0.995, respectively). Coronal angle was not quite different in both groups (p=0.846).CONCLUSION: In spite of higher frequency in ASD in proximal level in spinal fusion, it is not clear that incidence of ASD in proximal level is not higher than that of distal ASD group in more than 2 level thoracolumbar fusions. Not only Pfirrmann grade but also proximal segmental ROM is risk factor for predicting the occurrence of ASD in patients more than 2 level of thoracolumbar spine fusion operation excluding L5S1.

Reproducibility of intravoxel incoherent motion in body DWI technique for normal lumbar disc scanning / 实用放射学杂志

Objective To investigate the reproducibility of magnetic resonance intravoxel incoherent motion in body diffusionG weighted imaging (IVIMGDWI)for normal lumbar disc scanning.Methods 50 healthy volunteers were enrolled with informed consent,30 males and 20 females,2 5.20±2.04 years old.Using 3.0T MR on the lumbar spine,the sagittal T1 WI,the sagittal,axial T2 WI and sagittal IVIMGDWI sequences were scanned once,then the second sagittal IVIMGDWI sequence was scanned after 4 hours.The IVIMGDWI sequence used 10 b values (0,10,20,40,60,80,100,200,400,600 s/mm2 ).The discs were graded according to the Pfirrmann grading standard.The ADCfast ,ADCslow ,and f values of each intervertebral disc were measured by two doctors at the postGprocessing workstation.Paired tGtest was used to analyze whether there was a difference between the two scans.The intraGgroup correlation coefficient (ICC)was used to analyze the consistency of the ADCfast ,ADCslow ,and f values of the two acquisitions (P＜0.05)and the consistency of the ADCfast ,ADCslow,and f values between the different doctors (P＜0.05).The IVIMGDWI imaging was evaluated to measure the repeatability of normal lumbar discs. Results Of the 50 healthy volunteers,230 intervertebral discs matched the criteria(Pfirrmann gradeⅠandⅡ).The ADCslowvalue between the two scans was significantly different (t＝2.460,P＜0.05),and the differences in ADCfast and f values were not significant (t＝－0.418,1.273,P＞0.05). The consistency of ADCfast ,ADCslow ,and f values for the two scans were generally (ICC＝0.478,0.306,0.316,P＜0.05 ).Different observers had good consistency in the measurement of interverG tebral disc ADCfast ,ADCslow,and f values (ICC＝0.929,0.909, 0.9 1 1 ,P＜0.05).Conclusion The IVIMGDWI imaging has good consistency in the measurement of normal lumbar disc between different observers.The consistency of IVIMGDWI in two scans of normal lumbar intervertebral discs is general,which may be due to the time interval between the two scans.Because ADCslow represents the diffusion of water molecules in tissues,the microenvironment in the lumbar intervertebral disc has changed,resulting in the difference of ADCslow value.As for the problem that different scanning time may lead to the change of IVIMGDWI data,we will study it further.

MRI assessment of the correlation between lumbar physiological curvature and Pfirrmann grading of lumbar intervertebral disc in young patients / 实用放射学杂志

Objective To investigate the correlation between lumbar physiological curvature and Pfirrmann grading of lumbar intervertebral disc in young patients with lower lumbar pain.Methods 1 1 1 cases with lower lumbar pain were analyzed retrospectively by lumbar MRI examination.The MRI image was reviewed by two radiologists,and the degree of lumbar physiological curvature and lumbar disc degeneration were observed.Chi square test was applied to the statistical results.Results Final analysis was performed on 300 discs in 60 cases of patients with lumbar physiological curvature straightening.Among them,209 were grade Ⅰ-Ⅱ(70%),45 grade Ⅲ(15%),35 grade Ⅳ(11%)and 11 grade Ⅴ(4%)in Pfirrmann grading.In total of 255 discs of 51 cases with normal physiological curvature of the spine,there were 212 (83%)of Pfirrmann grade Ⅰ-Ⅱ,22 of grade Ⅲ(9%),19 of grade Ⅳ(7%)and 2 of grade Ⅴ(1 %).There was statistical difference between the lumbar physiological curvature straightening and the normal lumbar physiological curvature group (P< 0.05).The proportions of degeneration of Ⅰ-Ⅱ in the lumbar physiological curvature group was lower than that in normal lumbar curvature group,while the proportions of gradeⅢ,ⅣandⅤdegeneration in the lumbar physiological curvature group were higher than that in normal lumbar curvature group.Conclusion Stratification lumbar physiologic curvature is an important factor for lumbar disc degeneration and easy to cause Pfirrmann gradeⅣ-Ⅴdegeneration in young patients.

Whole Spine Disc Degeneration Survey according to the Ages and Sex Using Pfirrmann Disc Degeneration Grades

OBJECTIVE: Pfirrmann disc grade is a useful scoring tool for evaluating disc degeneration, but normal values according to aging process has not been elucidated. This study was conducted to identify the prevalence and pattern of whole spine disc degeneration according to ages and gender differences. METHODS: Total 653 patients (336 male and 317 female patients, 48.1±58.7 years old) who took whole spine magnetic resonance images were enrolled in this study. There were 19 cases in their 2nd decades and 74 cases in 3rd decades, 141 cases in 4th decades, 129 cases in 5th decades, 139 cases in 6th decades, and 93 cases in 7th decades, 58 cases in over 8th decades. Pfirrmann disc grades were measured according to sex and ages by 2 neurosurgeons that were blind to this study. RESULTS: All spinal disc degeneration grades were correlated with ageing. The Pfirrmann disc grades of degeneration in all spine levels showed the statistically significant difference according to the ages (p < 0.001). The common Pfirrmann disc grades according to the ages were grade 3 among 2nd to 5th decades, and grade 4 was more common than 6th decades. The lower cervical level (C2–3 to C4–5) and lumbar level (L1–2 to L5–S1) were happened relatively early severe disc degeneration compared to other levels. The intersexual differences were increased after 6th decades. CONCLUSION: Disc degeneration is natural course after one’s 2nd decades. And its incidence and grade were increased with age, and more affected by sexual difference after 6th decades.

Classificação semi-automática da degeneração de discos intervertebrais em imagens imagens de ressonância magnética / Semi-automatic classification of disc degeneration intervertebraises in magnetic resonance images

Este trabalho descreve o desenvolvimento de um método que classifica de forma semi-automática a degeneração de discos intervertebrais lombares em imagens de ressonância magnética ponderadas em T2. O conjunto de imagens consiste de 210 discos extraídos de exames de 94 indivíduos (20 a 80 anos). A classificação é feita por uma rede neural do tipo perceptron multicamada com 6 entradas, 15 neurônios na camada intermediária e 1 saída. Os resultados obtidos mostraram uma taxa média de acerto de 81,42%, com erro padrão de 9,11%.

This article describes the development of a method that classifies semi-automatic degeneration of lumbar intervertebral discs in magnetic resonance T2-weighted images. The dataset consists of images of 210 discs obtained from94 individuals (20 to 80 year old). An artificial neural network of the multilayer perceptron with 6 inputs, 15 neuronsin the hidden layer and 1 output, was used to check the efficiency of this study. Obtained an average rate of sucess of81.42%, with a standard error of 9.11%.

The preliminary research of T2 mapping at 3.0T MR in lumbar intervertebral disc degeneration / 实用放射学杂志

Objective The purpose of our research was to quantitative study the degeneration of lumbar intervertebral discs by using T2 mapping technology at 3.0T MR and research the correlation of biomechanics and lumbar disc degeneration.Methods 34 patients with low back pain or sciatica were enrolled.The correlation of T2 values of lumbar intervertebral discs and Pfirrmann grading,disc location,patient ages were analyzed.T2 values before and after loading were also analyzed.Results T2 values of nucleus pulposus were correlation with Pfirrmann scoring,disc location and,patient ages.Conclusion (1 )T2 mapping provides a non-invasive and quantitative way to diagnose lumbar discs degeneration.(2)The change of external pressure load can affect the T2 values of the intervertebral disc.

Lumbosacral Transition Vertebra: Prevalence and Its Significance

STUDY DESIGN: Retrospective analysis of radiological images. PURPOSE: To determine the prevalence of lumbosacral transition vertebra (LSTV) and to study its significance with respect to clinically significant spinal symptoms, disc degeneration and herniation. OVERVIEW OF LITERATURE: LSTV is the most common congenital anomaly of the lumbosacral spine. The prevalence has been debated to vary between 7% and 30%, and its relationship to back pain, disc degeneration and herniation has also not been established. METHODS: The study involved examining the radiological images of 3 groups of patients. Group A consisted of kidney urinary bladder (KUB) X-rays of patients attending urology outpatient clinic. Group B consisted of X-rays with or without magnetic resonance images (MRIs) of patients at-tending a spine outpatient clinic, and group C consisted of X-rays and MRI of patients who had undergone surgery for lumbar disc herniation. One thousand patients meeting the inclusion criteria were selected to be in each group. LSTV was classified by Castellvi's classification and disc degeneration was assessed by Pfirrmann's grading on MRI scans. RESULTS: The prevalence of LSTV among urology outpatients, spine outpatients and discectomy patients was 8.1%, 14%, and 16.9% respectively. LSTV patients showed a higher Pfirrmann's grade of degeneration of the last mobile disc. Results were found to be significant statistically. CONCLUSIONS: The prevalence of LSTV in spinal outpatients and discectomy patients was significantly higher as compared to those attending the urology outpatient clinic. There was a definite causal relationship between the transitional vertebra and the degeneration of the disc immediately cephalad to it.