Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Orthop Res. 2021 Dec;39(12):2703-2710. doi: 10.1002/jor.25024. Epub 2021 Mar 19.
The purpose was to investigate if high intensity zones (HIZ), Modic (MC), and endplate changes (EPC) display different behaviors measured with quantitative magnetic resonance imaging (MRI) with and without loading of the spine and if there is a simultaneous presence of these features in the same motion segment. 130 motion segments in patients with chronic low back pain (n = 26, 25-69 year, mean 38 year, 11 males) were examined. HIZs, MCs, and EPCs (i.e., structural findings, reflecting calcifications, erosions, and fissures) were determined with standardized MRI. Different T2-values with and without loading for these features were then determined with the quantitative MRI method T2-mapping. Significantly different behaviors were found in the spinal tissues with associated HIZs, MC, and EPC (p < 0.004). HIZ (62% of patients, 1-2/patient) was associated with EPC (100% of patients, 1-7/patient) (p = 0.0003 and 0.0004 for upper and lower EPs), with an occurrence of 91% for upper and 71% for lower endplates adjacent to discs with HIZ. MC (81% of patients, 1-3/patient) were associated with EPC (p < 0.0001) with an occurrence of 87% for endplates adjacent to vertebrae with MC. The occurrence of both HIZ and MC was 43% (p = 0.0001) for upper and 29% (p = 0.003) for lower vertebrae. HIZ was associated with simultaneous presence of both MC and EPC in the same motion segment. T2-mapping was found to objectively reflect changes in the spinal tissues associated with HIZs, MC, and EPC.
目的在于探究高强度区（HIZ）、Modic 改变（MC）和终板改变（EPC）在脊柱加载与未加载时，通过定量磁共振成像（MRI）测量是否表现出不同的行为，以及在同一运动节段是否同时存在这些特征。共检查了 26 例慢性下腰痛患者（25-69 岁，平均 38 岁，男性 11 例）的 130 个运动节段。通过标准 MRI 确定 HIZ、MC 和 EPC（即反映钙化、侵蚀和裂隙的结构改变）。然后用定量 MRI 方法 T2 映射来确定这些特征在加载与未加载时的不同 T2 值。与 HIZ、MC 和 EPC 相关的脊柱组织表现出明显不同的行为（p<0.004）。HIZ（62%的患者，1-2/患者）与 EPC（100%的患者，1-7/患者）相关（上、下终板，p=0.0003 和 0.0004），与 HIZ 相邻的上、下终板的发生率分别为 91%和 71%。MC（81%的患者，1-3/患者）与 EPC 相关（p<0.0001），与 MC 相邻的椎体终板的发生率为 87%。HIZ 和 MC 同时存在于上、下椎体的发生率分别为 43%（p=0.0001）和 29%（p=0.003）。HIZ 与同一运动节段同时存在 MC 和 EPC 相关。T2 映射被发现客观地反映了与 HIZ、MC 和 EPC 相关的脊柱组织的变化。
