Imaging of lumbar degenerative changes involving structures other than disk space

Degenerative changes in the lumbar spine involve intervertebral disks and intervertebral posterior elements at different extents. Much less attention has been directed toward degenerative changes of the posterior vertebral elements, however, when compared with intervertebral disk degeneration. These changes may involve the apophyseal joints, the bony elements of the neural arch, the intervening soft tissues, and the spinal longitudinal ligament. Roentgenographic, CT, and MR findings in these changes are depicted.     

Lumbar degenerative disk disease

The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years. Disk degeneration involves structural disruption and cell-mediated changes in composition. Mechanical, traumatic, nutritional, and genetic factors all may play a role in the cascade of disk degeneration, albeit to variable degree in different individuals. The presence of degenerative change is by no means an indicator of symptoms, and there is a very high prevalence in asymptomatic individuals. The etiology of pain as the symptom of degenerative disease is complex and appears to be a combination of mechanical deformation and the presence of inflammatory mediators. The role of imaging is to provide accurate morphologic information and influence therapeutic decision making. A necessary component, which connects these two purposes, is accurate natural history data. Understanding the relationship of etiologic factors, the morphologic alterations, which can be characterized with imaging, and the mechanisms of pain production and their interactions in the production of symptoms will require more accurate and reproducible stratification of patient cohorts.     

MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease

MR studies of the lumbar spine in 41 patients were analyzed at 203 disk interspaces to assess the appearance and frequency of bone marrow signal changes in the vertebral bodies adjacent to normal and degenerated disks. Degenerative changes were found at 58 interspaces; an abnormal bone marrow signal was identified in 29 (50%) of these. On spin-echo pulse sequences with short and long repetition times (TRs) and echo times (TEs), an area of relative increased signal intensity was seen in the vertebral body adjacent to the disk in 24 cases (17 were bandlike on both sides of the disk, four were focal on one side of the disk, and three were bandlike and focal on one or both sides of the disk). In one patient decreased signal was noted on both short and long TR/TE imaging. In the other four patients decreased signal was noted on short TR/TE pulse sequences and increased signal was evident on long TR/TE. These marrow changes were not present adjacent to normal disks. The relatively high signal intensity on both short and long TR/TE pulse sequences suggests that the increased signal resulted from the conversion of normal hemopoietic bone marrow to fatty marrow. We conclude that bandlike or focal areas of high signal intensity in the bone marrow adjacent to degenerated intervertebral disks occur commonly on MR images of the spine and must not be confused with signal changes from tumors or infections involving the disk space and adjacent vertebral end plates.     

Imaging of lumbar intervertebral disk degeneration and aging, excluding disk herniations

With the advent of CT and MR imaging, physicians have been able to complement their clinical diagnosis of the cause of low back pain with a detailed in vivo image of the structure and soft tissues of the spine. At the same time, there has been an increasing realization that information about morphology alone is not enough to make a definitive diagnosis. Proponents of diskography claim that, through pain provocation, it can provide the specificity missing from the purely morphologic information that CT and MR imaging provide. The specificity of diskography, however, is far from clear.     

Differential diagnosis of infective spondylodiscitis and erosive degenerative disk disease

PURPOSE: To assess the value of imaging in the differential diagnosis of erosive intervertebral osteochondrosis (EIVO) versus infectious discitis (ID). MATERIALS AND METHODS: Twelve cases of EIVO and 30 cases of ID were reviewed to define the usefull signs for differential diagnosis on plain films, CT, and MR. RESULTS: No single sign is sufficient, but the association of several signs is suggestive of EIVO: discal vacuum phenomenom, well-defined sclerosis and erosions of vertebral endplates, high signal strip surrounding low signal of vertebral endplates on T1-weighted images. CONCLUSION: Imaging is helpful in difficult differential diagnosis of EIVO versus ID.     

High-resolution surface-coil imaging of lumbar disk disease

Seventeen patients with lumbar disk disease were studied using a prototype magnetic resonance (MR) surface coil. The high signal-to-noise ratio achieved with the surface coil permitted increases in spatial resolution to 0.9 X 0.9 mm in-plane resolution with 5 mm slice thickness. The surface coil was also compatible with multiplanar, multiecho imaging techniques. The spatial resolution achieved in this study was nearly equivalent to that achieved by state-of-the-art computed tomographic (CT) scanners, and MR showed a superior range of soft-tissue contrast. One significant limitation of MR was its inability to demonstrate small calcifications. Nevertheless, MR imaging provided diagnostic information comparable to CT or myelography in a completely noninvasive manner. With further technical advances, MR is likely to become the initial procedure of choice for evaluating patients with suspected lumbar disk disease.     

Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging

Evidence on magnetic resonance (MR) images of disk degeneration and herniation, as well as of cord and root impingement, may be regarded either as normal, age-related changes or as causative of symptoms. Individuals referred for MR examinations of the larynx without symptoms referable to the cervical spine were studied retrospectively (35 patients) or prospectively (65 patients) over a 2-year period. With a solenoid surface coil, 5-mm-thick sections were acquired in sagittal, axial, and coronal planes with T1-weighted spin-echo pulsing sequences. Disk protrusion (herniation/bulge) was seen in five of 25 (20%) patients aged 45-54 and 24 of 42 (57%) patients older than 64 years of age. Posterolateral protrusions were seen in only nine of 100 patients and occurred with greatest frequency in patients over 64 years of age. In no patient was obliteration of the intraforaminal fat seen. Spinal cord impingement was observed in nine of 58 (16%) patients under 64 years of age, and in 11 of 42 (26%) patients over 64 years of age. Cord compression was observed in seven of 100 patients and occurred solely secondary to disk protrusion in all cases. The percentage of cord area reduction never exceeded 16% and averaged approximately 7%.     

Destructive discovertebral degenerative disease of the lumbar spine

The uncommon variant of degenerative hip joint disease, termed rapidly progressive osteoarthritis, and highlighted by severe joint space loss and osteochondral disintegration, is well established. We present a similar unusual subset in the lumbar spine termed destructive discovertebral degenerative disease (DDDD) with radiological features of vertebral malalignment, severe disc resorption, and "bone sand" formation secondary to vertebral fragmentation. Co-existing metabolic bone disease is likely to promote the development of DDDD of the lumbar spine, which presents with back pain and sciatica due to nerve root compression by the "bone sand" in the epidural space. MRI and CT play a complimentary role in making the diagnosis.     

Magnetic resonance imaging of degenerative disk disease of the spine

MRI has undergone an incredibly rapid evolution, and technical advances are continually occurring. MRI allows for high resolution imaging that can clearly demonstrate a variety of degenerative processes of the spine. High-resolution MRI that gives detailed anatomic information, coupled with the use of MR contrast agents, promises to change our diagnostic approach significantly for degenerative disk disease of the spine.     

MRI of degenerative lumbar spine disease: comparison of non-accelerated and parallel imaging

Introduction Parallel imaging techniques such as GRAPPA have been introduced to optimize image quality and acquisition time. For spinal imaging in a clinical setting no data exist on the equivalency of conventional and parallel imaging techniques. The purpose of this study was to determine whether T1- and T2-weighted GRAPPA sequences are equivalent to conventional sequences for the evaluation of degenerative lumbar spine disease in terms of image quality and artefacts. Methods In patients with clinically suspected degenerative lumbar spine disease two neuroradiologists independently compared sagittal GRAPPA (acceleration factor 2, time reduction approximately 50%) and non-GRAPPA images (25 patients) and transverse GRAPPA (acceleration factor 2, time reduction approximately 50%) and non-GRAPPA images (23 lumbar segments in six patients). Comparative analyses included the minimal diameter of the spinal canal, disc abnormalities, foraminal stenosis, facet joint degeneration, lateral recess, nerve root compression and osteochondrotic vertebral and endplate changes. Image inhomogeneity was evaluated by comparing the nonuniformity in the two techniques. Image quality was assessed by grading the delineation of pathoanatomical structures. Motion and aliasing artefacts were classified from grade 1 (severe) to grade 5 (absent). Results There was no significant difference between GRAPPA and non-accelerated MRI in the evaluation of degenerative lumbar spine disease (P > 0.05), and there was no difference in the delineation of pathoanatomical structures. For inhomogeneity there was a trend in favour of the conventional sequences. No significant artefacts were observed with either technique. Conclusion The GRAPPA technique can be used effectively to reduce scanning time in patients with degenerative lumbar spine disease while preserving image quality.     

Plain film evaluation of degenerative disk disease at the lumbosacral junction

 Objective. Diagnosing degenerative disk disease (DDD) at the lumbosacral junction (LSJ) on plain films is often difficult, compared with other disk levels. The purpose of this study was to determine whether criteria for diagnosis of DDD at the LSJ can be established for plain films. Design and patients. We retrospectively reviewed 100 lumbar MRI scans of patients who also had lumbar plain films. Using MRI as the reference standard, the LSJ was classified as normal (n=35) or exhibiting mild (n=45) or severe (n=20) DDD by two radiologists using accepted criteria. Measurements were performed on the plain films by two other radiologists and the average measurements were tabulated according to the three categories of DDD defined by MRI. Plain film measurements included the anterior and posterior disk heights (ADH, PDH), Farfan’s ratio, determined by adding ADH to PDH and dividing that number by the measured anteroposterior (AP) length of the inferior end plate of L5 [(ADH+PDH)/AP length of L5], and lumbosacral angle (LSA). Subsequently, five additional radiologists interpreted the radiographs by visual inspection only, for DDD at the LSJ, both before and, several weeks later, after being provided with the quantitative data for normal versus DDD. Results and conclusion. There was a statistically significant difference between normal disk and increasing severity of DDD on radiographs using the parameters of PDH and Farfan’s ratio. There was no statistically significant difference regarding ADH or LSA. Diagnostic accuracy by visual inspection was not significantly altered using the quantitative data for interpretation of DDD (68% correct before, 69.5% correct after). Analysis of results indicates that PDH is the most reliable and easily used criterion for detection of DDD at the LSJ. A PDH ≤5.4 mm on plain lateral film indicates DDD; PDH ≥7.7 mm indicates the absence of DDD on plain film.     

Gd-DTPA-enhanced 3D MR imaging of cervical degenerative disk disease: initial experience.

PURPOSE: To assess whether a single enhanced T1-weighted gradient echo volume sequence, with the appropriate reformatted images, could be equivalent to a more conventional 2D set of MR sequences for the evaluation of cervical extradural degenerative disk disease (bony canal and foraminal stenosis; disk herniation). MATERIALS AND METHODS: Sixty-one patients evaluated for extradural degenerative disease by MR were imaged with a "standard" MR examination (Sagittal T1-weighted spin echo, axial low flip angle gradient echo), were then given 0.1 mmol/kg Gd-DTPA intravenously, and reimaged with either a 3D FLASH (fast low angle shot), TR 40/TE 7/1 excitation), 40 degree flip angle, acquired as 64, 2-mm sagittal partitions, or a 3D turbo FLASH (MP RAGE-magnetization prepared rapid acquisition gradient echo) (10/4/1), 10 degree flip angle acquired as 128, 2-mm coronal partitions. The volume sequences were reconstructed in the axial plane, and right and left 45 degree oblique coronal planes. The two sets of examinations (standard vs volume) were prospectively interpreted by two neuroradiologists for quality of examination, and location, type, and severity of extradural degenerative disease in a random, blinded, independent fashion. RESULTS: There was no significant difference between the standard examination and the 3D MP RAGE for central extradural disease. The 3D FLASH examination was significantly worse than the standard examination in identification of central extradural disease, with an average of 21 herniations not identified, or underestimated in size. Neither the 3D FLASH, nor the 3D MP RAGE examinations showed any significant improvement compared to the routine 2D examination for the location and severity of foraminal disease. CONCLUSION: If extradural degenerative disk disease is being evaluated, then a single enhanced 3D T1-weighted imaging sequence taking 6 minutes can be equivalent to a routine set of mixed 2D spin echo and low flip angle gradient echo sequences.     

退变性腰椎后滑脱症的影像学研究(附130例分析)

目的:探讨"退变性腰椎后滑脱影像学诊断。方法:以患者CR片及CT、MR检查,观察和测量病患椎体相对位置变化;并分析有无并发病变。结果:130例本病患者腰椎向后滑脱1.5～11mm,平均3.8mm。所有患者有程度不同的腰椎退变表现。结论:本病皆由腰椎退变而引起,故以"退变性腰椎后滑脱症"命名,它的发生有其解剖学基础,腰椎退变是关键,外力作用为诱因,三者共同作用促成了本病。     

Outpatient low-dose computed tomography metrizamide myelography and evaluation of lumbar disk disease

Outpatient low-dose computed tomography metrizamide myelography (CTMM) for the evaluation of lumbar disk disease is described in 55 patients. Ten individuals (group 1) were studied using 3.5 ml of 150 mg I/ml (525 mg I total) of metrizamide. Forty-five additional patients (group 2) were examined with 5 ml of 110 mg I/ml (550 mg I total) concentration of metrizamide. Group 2 experienced less post-procedure headache (6.6%) and nausea (2.2%) than did group 1 (30% and 10%, respectively). Group 2 demonstrated a lowered rate of headache (p less than .01) and showed a trend to less nausea (p less than .09) than a recently published study describing full-dose lumbar myelography. In addition, CTMM in group 2 produced more uniform mixing of metrizamide than in group 1. Overall, low-dose CTMM increased accuracy and reduced morbidity, patient cost, and inconvenience as compared with routine full-dose lumbar myelography.     

Evaluation of multiplanar reconstruction in CT recognition of lumbar disk disease

Axial computed tomographic (CT) images were compared with sagittal and coronal reformations and myelograms in 60 patients to evaluate the diagnostic usefulness of multiplanar reconstructions for the recognition of lumbar disk disease. The axial CT scans were most sensitive and specific. The sagittal scans were helpful in evaluating the neural foramina, the size of the disk bulge into the spinal canal, especially at L5-S1, and patients with spondylolisthesis. The coronal images were the least informative, although they contributed to the evaluation of lumbar nerve roots. The myelograms and the sagittal images were equally useful in the detection of herniated disk, but axial scans were superior to either. It was concluded that reformatted sagittal and coronal images are not required if all axial images are normal. However, when uncertainty exists or complex anatomy is being evaluated, reformatted images may be helpful, particularly for reassurance.     

腰椎间盘突出症中医证型的影像分析

腰椎间盘突出症是在纤维环退变的基础上,髓核冲破纤维环,引起神经根、马尾受压产生的综合征,症状实际是来自纤维环的压迫,故又称为纤维环破裂症[1]。在中医属筋断,为损伤性腰痛,俗称闪腰,是骨伤科、推拿科常见病之一。中医学对任何疾病都要先辨证,也就是进行证的诊断。笔者结合     

Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound

This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degenerative) lesions. Moreover, it reviews the effectiveness of ultrasound in relation to magnetic resonance (MR) imaging. Most authors report that full-thickness tears of the supraspinatus can reliably be diagnosed by ultrasound. However, the simple diagnosis of a full-thickness rotator cuff tear is no longer sufficient for surgical management. The precise localization and size of rotator cuff tears as well as the extent of muscle degeneration is important for surgical planning. For this aspect and for partial-thickness tears of the supraspinatus, for subscapularis lesions as well as for lesions of the long biceps tendons there is no consensus regarding the diagnostic value of ultrasound. To the present, ultrasound (contrary to MR imaging) has failed to demonstrate that it consistently influences the clinician's degree of confidence in the clinical diagnosis or the treatment plan. Therefore, some orthopedic surgeons prefer MR imaging to ultrasound in the evaluation of rotator cuff tears and other abnormalities of the glenohumeral joint. Moreover, MR imaging, especially when combined with arthrography, represents a one-step investigation, which not only allows for assessment of rotator cuff lesion but also of lesions of the labrum (Bankart lesions, SLAP lesions), the joint capsule and the biceps tendon. It also demonstrates muscle atrophy, which represents an important predictor of surgical outcome in rotator cuff repair.