Quantitative assessment of the lumbar intervertebral disc via T2 shows excellent long-term reliability.

Methodologies for the quantitative assessment of the spine tissues, in particular the intervertebral disc (IVD), have not been well established in terms of long-term reliability. This is required for designing prospective studies. 1H water T2 in the IVD ("T2") has attained wider use in assessment of the lumbar intervertebral discs via magnetic resonance imaging. The reliability of IVD T2 measurements are yet to be established. IVD T2 was assessed nine times at regular intervals over 368 days on six anatomical slices centred at the lumbar spine using a spin-echo multi-echo sequence in 12 men. To assess repeatability, intra-class correlation co-efficients (ICCs), standard error of the measurement, minimal detectable difference and co-efficients of variation (CVs) were calculated along with their 95% confidence intervals. Bland-Altman analysis was also performed. ICCs were above 0.93, with the exception of nuclear T2 at L5/S1, where the ICC was 0.88. CVs of the central-slice nucleus sub-region ranged from 4.3% (average of all levels) to 10.1% for L5/S1 and between 2.2% to 3.2% for whole IVD T2 (1.8% for the average of all levels). Averaging between vertebral levels improved reliability. Reliability of measurements was least at L5/S1. ICCs of degenerated IVDs were lower. Test-retest reliability was excellent for whole IVD and good to excellent for IVD subregions. The findings help to establish the long-term repeatability of lumbar IVD T2 for the implementation of prospective studies and determination of significant changes within individuals.

Whey protein supplementation with vibration exercise ameliorates lumbar paraspinal muscle atrophy in prolonged bed rest.

Optimizing countermeasures for musculoskeletal deterioration during spaceflight is a priority for space agencies. We examined the impact of adding whey protein supplementation to resistive vibration exercise (RVE) on lumbar deconditioning during prolonged bed rest. Participants (n = 12) were enrolled in a crossover design study of 21 days of bed rest with RVE (2 days/wk, 2-4 min/session time under tension), whey protein supplementation plus RVE (NeX), and no-intervention control (CNT). After bed rest, NeX [-2.2 (7.0)%, P = 0.370], but not RVE [-5.6 (6.4)%, P = 0.0027], reduced paraspinal muscle atrophy compared with CNT [-6.1 (5.5)%, P = 0.00035]. After 3 days of bed rest, whole intervertebral disk (IVD) T2 increased in all groups [CNT: +5.3 (2.5)%, P < 0.0001; NeX: +6.3 (1.8)%, P < 0.0001; RVE: +6.3 (1.9)%, P < 0.0001] and remained at this level on day 21 of bed rest [CNT: 5.5 (2.6)%, P < 0.0001; NeX: 6.0 (1.8)%, P < 0.0001; RVE: 6.2 (2.8)%, P < 0.0001]. Increases in IVD T2 were greatest in the nucleus [10.9 (1.1)%, P < 0.0001], with reductions of T2 observed in the anterior annulus [-4.4 (1.0) %, P = 0.00001] and increases in the posterior annulus [2.1 (0.8)%, P = 0.011]. At 6 and 28 days post-bed rest, IVD T2 was similar compared with baseline for all groups. A similar pattern was seen for IVD height, although a -3.8 (4.6)% (P = 0.0052) reduction of IVD height was seen 28 days after bed rest in the CNT group. The countermeasures did not impact on the presence or intensity of back pain during or after bed rest. Participants reporting back pain on day 3 of bed rest had greater (P = 0.013) increases in intervertebral disk volume than participants who did not. Although neither countermeasure impacted IVD changes or back pain in prolonged bed rest, NeX, but not RVE alone, ameliorated paraspinal muscle atrophy.NEW & NOTEWORTHY We examined the impact of adding protein supplementation to exercise (resistive vibration exercise) as a countermeasure against changes in the spine during spaceflight simulation. We found that adding the protein supplementation reduced spine muscle atrophy more than exercise alone. Neither countermeasure approach prevented changes in the disks in the spine or impacted back pain reports.

Point spread functions and deconvolution of ultrasonic images.

This article investigates the restoration of ultrasonic pulse-echo C-scan images by means of deconvolution with a point spread function (PSF). The deconvolution concept from linear system theory (LST) is linked to the wave equation formulation of the imaging process, and an analytic formula for the PSF of planar transducers is derived. For this analytic expression, different numerical and analytic approximation schemes for evaluating the PSF are presented. By comparing simulated images with measured C-scan images, we demonstrate that the assumptions of LST in combination with our formula for the PSF are a good model for the pulse-echo imaging process. To reconstruct the object from a C-scan image, we compare different deconvolution schemes: the Wiener filter, the ForWaRD algorithm, and the Richardson-Lucy algorithm. The best results are obtained with the Richardson-Lucy algorithm with total variation regularization. For distances greater or equal twice the near field distance, our experiments show that the numerically computed PSF can be replaced with a simple closed analytic term based on a far field approximation.

Muscular forces affect the glycosaminoglycan content of joint cartilage: unloading in human volunteers with the HEPHAISTOS lower leg orthosis.

BACKGROUND AND PURPOSE: Unloading alters the thickness of joint cartilage. It is unknown, however, to what extent unloading leads to a loss of glycosaminoglycans (GAGs) in the cartilage tissue. We hypothesized that muscle forces, in addition to axial loading, are necessary to maintain the joint cartilage GAG content of the knee and the upper and lower ankle. PATIENTS AND METHODS: The HEPHAISTOS orthosis was worn unilaterally by 11 men (mean age 31 (23-50) years old) for 56 days. The orthosis reduces activation and force production of the calf muscles while it permits full gravitational loading of the lower leg. MRI measurements of the knee and ankle were taken before the intervention, during the intervention (on day 49), and 14 days after the end of the intervention. Cartilage segmentation was conducted semiautomatically for the knee joint (4 segments) and for the upper (tibio-talar) and lower (subtalar) ankle joints (2 segments each). Linear mixed-effects (LME) models were used for statistical analysis. RESULTS: 8 volunteers completed the MRI experiment. In the lower ankle joint, differences in ΔT1 were found between the end of the intervention and 14 days after (p = 0.004), indicating a decrease in GAG content after reloading. There were no statistically significant differences in ΔT1 values in the knee and upper ankle joints. INTERPRETATION: Our findings suggest that in addition to gravitational load, muscular forces affect cartilage composition depending on the local distribution of forces in the joints affected by muscle contraction.

Assessment of lumbar intervertebral disc glycosaminoglycan content by gadolinium-enhanced MRI before and after 21-days of head-down-tilt bedrest.

During spaceflight, it has been shown that intervertebral discs (IVDs) increase in height, causing elongation of the spine up to several centimeters. Astronauts frequently report dull lower back pain that is most likely of discogenic origin and may result from IVD expansion. It is unknown whether disc volume solely increases by water influx, or if the content of glycosaminoglycans also changes in microgravity. Aim of this pilot study was to investigate effects of the spaceflight analog of bedrest on the glycosaminoglycan content of human lumbar IVDs. Five healthy, non-smoking, male human subjects of European descent were immobilized in 6° head-down-tilt bedrest for 21 days. Subjects remained in bed 24 h a day with at least one shoulder on the mattress. Magnetic Resonance Imaging (MRI) scans were taken according to the delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) protocol before and after bedrest. The outcome measures were T1 and ΔT1. Scans were performed before and after administration of the contrast agent Gd-DOTA, and differences between T1-values of both scans (ΔT1) were computed. ΔT1 is the longitudinal relaxation time in the tissue and inversely related to the glycosaminoglycan-content. For data analysis, IVDs L1/2 to L4/5 were semi-automatically segmented. Zones were defined and analyzed separately. Results show a highly significant decrease in ΔT1 (p<0.001) after bedrest in all IVDs, and in all areas of the IVDs. The ΔT1-decrease was most prominent in the nucleus pulposus and in L4/5, and was expressed slightly more in the posterior than anterior IVD. Unexpected negative ΔT1-values were found in Pfirrmann-grade 2-discs after bedrest. Significantly lower T1 before contrast agent application was found after bedrest compared to before bedrest. According to the dGEMRIC-literature, the decrease in ΔT1 may be interpreted as an increase in glycosaminoglycans in healthy IVDs during bedrest. This interpretation seems contradictory to previous findings in IVD unloading.