Center for Imaging Research, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Eur J Pain. 2020 Feb;24(2):346-353. doi: 10.1002/ejp.1490. Epub 2019 Oct 17.
Low back pain (LBP) is a widespread problem and the leading cause of disability worldwide. While the cause of LBP is multifactorial, several studies suggested that inflammatory mediators in damaged subchondral plates of degenerating discs may lead to chemical sensitization and mechanical stimulation, eventually causing pain. The goal of this study was to explore associations between such changes and LBP-related disability using dynamic contrast-enhanced MRI.
Thirty-two patients diagnosed with nonspecific LBP and 24 healthy control subjects were studied with dynamic contrast-enhanced (DCEMRI) MRI and T1r (spin-lattice relaxation in the rotating frame) acquisitions. DCEMRI enhancement in disc endplate regions and average T1ρ measurements in the nucleus pulposus were extracted. The LBP patients were grouped based on their Oswestry Disability Index (ODI) scores and associations between MRI measurements and ODI scores were analyzed.
Significant associations were found between ODI scores and DCEMRI enhancement in the cartilaginous endplate regions of the most degenerated discs. ODI scores also correlated with T1ρ measurements in the nucleus pulposus of degenerating discs.
DCEMRI enhancement in the cartilaginous endplate regions and lower T1ρ measurements in the nucleus pulposus (NP) were associated with greater disability that is related to low back pain as reported on the ODI. This complements earlier reports suggesting a link between LBP and endplate degeneration. Further studies are needed to validate these findings.
Our findings indicated that dynamic contrast-enhanced MRI signal enhancement in the cartilaginous endplate regions were associated with greater disability related to low back pain. This signal enhancement might be an indication of inflammatory changes in disc endplate regions. Therefore, advanced quantitative imaging techniques like the ones presented in this study might be needed to complement conventional radiological evaluations to identify the subset of patients who could potentially benefit from novel therapies directed towards treating the disc endplate regions.
下腰痛（LBP）是一种广泛存在的问题，也是全球致残的主要原因。虽然 LBP 的病因是多因素的，但有几项研究表明，退变椎间盘的软骨下板损伤中的炎症介质可能导致化学致敏和机械刺激，最终导致疼痛。本研究旨在使用动态对比增强 MRI 探讨这些变化与与 LBP 相关的残疾之间的关联。
对 32 例诊断为非特异性 LBP 的患者和 24 例健康对照者进行了动态对比增强（DCEMRI）MRI 和 T1r（旋转框架中的自旋晶格弛豫）采集。提取椎间盘终板区域的 DCEMRI 增强和髓核的平均 T1ρ测量值。根据 Oswestry 残疾指数（ODI）评分对 LBP 患者进行分组，并分析 MRI 测量值与 ODI 评分之间的关系。
在最退变的椎间盘的软骨终板区域，ODI 评分与 DCEMRI 增强之间存在显著相关性。ODI 评分还与退变椎间盘髓核的 T1ρ测量值相关。
软骨终板区域的 DCEMRI 增强和髓核中的 T1ρ测量值（NP）较低与 ODI 报告的与下腰痛相关的残疾程度更大相关。这补充了先前关于 LBP 与终板退变之间存在联系的报告。需要进一步的研究来验证这些发现。
我们的研究结果表明，软骨终板区域的动态对比增强 MRI 信号增强与与下腰痛相关的残疾程度更大有关。这种信号增强可能是椎间盘终板区域炎症变化的一个迹象。因此，可能需要像本研究中提出的那样的先进定量成像技术来补充常规放射学评估，以识别可能从针对治疗椎间盘终板区域的新型疗法中受益的患者亚组。
