23Na-magnetic resonance imaging of the human lumbar vertebral discs: in vivo measurements at 3.0 T in healthy volunteers and patients with low back pain |
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| Authors: | Stefan Haneder Melissa M.L. Ong Johannes M. Budjan René Schmidt Simon Konstandin John N. Morelli Lothar R. Schad Stefan O. Schoenberg Ulrich H. Kerl |
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| Affiliation: | 1. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;2. Department of Orthopedic and Traumatology, Alb-Fils Hospital Goeppingen, Eicherstr. 3, 73035 Goeppingen, Germany;3. Computer Assisted Clinical Medicine, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;4. The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287-0006, USA;5. Department of Neuroradiology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;1. Department of Radiology, Vanderbilt University Institute of Imaging Science (VUIIS), Nashville, TN 37232, USA;2. Huntington Medical Research Institutes, 99 North El Molino Ave, Pasadena, CA 91101, USA;3. National High Magnetic Field Laboratory (NHMFL), Florida State University, 1800 E Paul Dirac Drive, Tallahassee, FL 32310, USA;4. Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37235, USA;5. Department of Biochemistry, Vanderbilt University, Nashville, TN 37205, USA;6. Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN 37232, USA;1. The Virginia Spine Institute, 1831 Wiehle Ave., Reston, VA, USA;2. The Spinal Research Foundation, 1831 Wiehle Ave., Suite 200, Reston, VA 20190, USA;1. Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, Ontario, Canada M5T2S8;2. Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, Ontario, Canada M5T2S8 |
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| Abstract: | Background context1H magnetic resonance imaging (MRI) of the spine can rule out common causes of low back pain (LBP), such as disc protrusions or nerve root compression; however, no significant causal relation exists between morphology and the extent of symptoms. Functional MRI techniques, such as 23Na, may provide additional information, allowing indirect assessment of vertebral glycosaminoglycan concentrations, decreases in which are associated with early degenerative changes.PurposeTo evaluate 23Na-MRI of asymptomatic healthy volunteers and symptomatic patients with LPB and correlate the results to the Pfirrmann classification of MRI disc morphology.Study designRetrospective cohort study at an academic medical center.Patient sampleTwo groups were studied: (1) 55 healthy volunteers (31 men, 24 women; mean age 28.8 years) and (2) 12 patients (6 men, 6 women; mean age: 35.3 years) with a recent history of LBP.MethodsLumbar spines of the aforementioned groups were examined on a 3.0 T MRI scanner with morphological 1H and 23Na imaging. Intervertebral disc (IVD) 23Na at each level was normalized (23Nanorm). Distribution and differences between mean 23Nanorm corresponding to each Pfirrmann classification were evaluated in the two study groups (analysis of variance). Linear correlations between 23Nanorm, body mass index (BMI), and age were assessed (Pearson correlation coefficient). Gender-dependent differences were evaluated (paired t test).Outcome measuresPhysiological measure: IVD 23Nanorm as determined by 23Na-MRI.ResultsA normal distribution of 23Nanorm was confirmed for both groups (p=.072 and p=.073, respectively). The mean Pfirrmann score statistically significantly differed between them (p<.0001). 23Nanorm was statistically significantly reduced in degenerated IVDs (Pfirrmann scores 4+5) (p<.0001). No statistically significant differences were seen for the mean 23Nanorm of IVDs with the same Pfirrmann score in healthy volunteers and patients (.4692<0.202) and BMI (0.0742<0.288) showed either weak or no correlation to 23Nanorm. Mean 23Nanorm was significantly (p=.0002) greater in women relative to men.ConclusionsThe results underline the feasibility and robustness of 23Na-MRI of human IVDs and affirm, in a large cohort, decreases in 23Na IVD content seen with disc degeneration. |
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| Keywords: | Vertebral discs 3.0 T Healthy volunteers LBP Pfirrmann score |
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