Axial loading during MRI reveals deviant characteristics within posterior IVD regions between low back pain patients and controls
To investigate differences in functional intervertebral disk (IVD) characteristics between low back pain (LBP) patients and controls using T2-mapping with axial loading during MRI (alMRI).
In total, 120 IVDs in 24 LBP patients (mean age 39 years, range 25–69) were examined with T2-mapping without loading of the spine (uMRI) and with alMRI (DynaWell® loading device) and compared with 60 IVDs in 12 controls (mean age 38 years, range 25–63). The IVD T2-value was acquired after 20-min loading in five regions of interests (ROI), ROI1-5 from anterior to posterior. T2-values were compared between loading states and cohorts with adjustment for Pfirrmann grade.
In LBP patients, mean T2-value of the entire IVD was 64 ms for uMRI and 66 ms for alMRI (p = 0.03) and, in controls, 65 ms and 65 ms (p = 0.5). Load-induced T2-differences (alMRI–uMRI) were seen in all ROIs in both patients (0.001 > p < 0.005) and controls (0.0001 > p < 0.03). In patients, alMRI induced an increase in T2-value for ROI1-3 (23%, 18% and 5%) and a decrease for ROI4 (3%) and ROI5 (24%). More pronounced load-induced decrease was detected in ROI4 in controls (9%/p = 0.03), while a higher absolute T2-value was found for ROI5 during alMRI in patients (38 ms) compared to controls (33 ms) (p = 0.04).
The alMRI-induced differences in T2-value in ROI4 and ROI5 between patients and controls most probably indicate biomechanical impairment in the posterior IVD regions. Hence, alMRI combined with T2-mapping offers an objective and clinical feasible tool for biomechanical IVD characterization that may deepen the knowledge regarding how LBP is related to altered IVD matrix composition.
KeywordsIntervertebral disk T2-mapping Low back pain MRI Axial loading during MRI
The authors acknowledge support from C4I center, Sahlgrenska University Hospital, Konrad Helfrid Johansson’s Foundation, Felix Neubergh Foundation, ALF Grant Västra Götaland Region and Grant AFA Insurance Company.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Oral and written informed consent was obtained from all individual participants included in the study.
- 8.Mwale F, Demers CN, Michalek AJ, Beaudoin G, Goswami T, Beckman L, Iatridis JC, Antoniou J (2008) Evaluation of quantitative magnetic resonance imaging, biochemical and mechanical properties of trypsin-treated intervertebral discs under physiological compression loading. J Magn Reson Imaging 27(3):563–573. https://doi.org/10.1002/jmri.21242 CrossRefPubMedCentralPubMedGoogle Scholar
- 11.Messner A, Stelzeneder D, Trattnig S, Welsch GH, Schinhan M, Apprich S, Brix M, Windhager R, Trattnig S (2017) Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3.0 Tesla magnetic resonance study. Eur Spine J 26(3):877–883CrossRefGoogle Scholar
- 14.Abdollah V (2017) The effects of axial loading on the disc and motion segments relative to disc degeneration and pain using novel MRI biomarkers. University of Alberta. https://era.library.ualberta.ca/files/cnz805z93w/Abdollah_Vahid_201701_PhD.pdf
- 15.Stelzeneder D, Kovacs BK, Goed S, Welsch GH, Hirschfeld C, Paternostro-Sluga T, Friedrich KM, Mamisch TC, Trattnig S (2012) Effect of short-term unloading on T2 relaxation time in the lumbar intervertebral disc—in vivo magnetic resonance imaging study at 3.0 tesla. Spine J 12(3):257–264. https://doi.org/10.1016/j.spinee.2012.02.001 CrossRefPubMedCentralPubMedGoogle Scholar
- 22.Aprill C, Bogduk N (1992) High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br JRadiol 65(773):361–369Google Scholar
- 25.Maquer G, Brandejsky V, Benneker LM, Watanabe A, Vermathen P, Zysset PK (2014) Human intervertebral disc stiffness correlates better with the Otsu threshold computed from axial T2 map of its posterior annulus fibrosus than with clinical classifications. Med Eng Phys 36(2):219–225. https://doi.org/10.1016/j.medengphy.2013.11.008 CrossRefGoogle Scholar
- 29.Mok GS, Zhang D, Chen S-Z, Yuan J, Griffith JF, Wang YXJ (2016) Comparison of three approaches for defining nucleus pulposus and annulus fibrosus on sagittal magnetic resonance images of the lumbar spine. J Orthop Transl 6:34–41Google Scholar