Din Rahman Ud, Cheng Xiaoguang, Yang Haisheng
Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China.
Department of Radiology, Jishuitan Hospital, Beijing, China.
J Magn Reson Imaging. 2022 Mar;55(3):755-771. doi: 10.1002/jmri.27858. Epub 2021 Jul 26.
Low back pain (LBP) is a common health issue worldwide with a huge economic burden on healthcare systems. In the United States alone, the cost is estimated to be $100 billion each year. Intervertebral disc degeneration is considered one of the primary causes of LBP. Moreover, the critical role of the vertebral endplates in disc degeneration and LBP is becoming apparent. Endplate abnormalities are closely correlated with disc degeneration and pain in the lumbar spine. Imaging modalities such as plain film radiography, computed tomography, and fluoroscopy are helpful but not very effective in detecting the causes behind LBP. Magnetic resonance imaging (MRI) can be used to acquire high-quality three-dimensional images of the lumbar spine without using ionizing radiation. Therefore, it is increasingly being used to diagnose spinal disorders. However, according to the American College of Radiology, current referral and justification guidelines for MRI are not sufficiently clear to guide clinical practice. This review aimed to evaluate the role of MRI in diagnosing LBP by considering the correlative contributions of vertebral endplates. The findings of the review indicate that MRI allows for fine evaluations of endplate morphology, endplate defects, diffusion and perfusion properties of the endplate, and Modic changes. Changes in these characteristics of the endplate were found to be closely correlated with disc degeneration and LBP. The collective evidence from the literature suggests that MRI may be the imaging modality of choice for patients suffering from LBP. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 3.
腰痛（LBP）是全球常见的健康问题，给医疗保健系统带来巨大经济负担。仅在美国，每年的成本估计就达1000亿美元。椎间盘退变被认为是腰痛的主要原因之一。此外，椎体终板在椎间盘退变和腰痛中的关键作用正日益显现。终板异常与腰椎间盘退变和疼痛密切相关。平片X线摄影、计算机断层扫描和荧光镜检查等成像方式虽有帮助，但在检测腰痛背后的原因方面效果不佳。磁共振成像（MRI）可用于在不使用电离辐射的情况下获取高质量的腰椎三维图像。因此，它越来越多地被用于诊断脊柱疾病。然而，根据美国放射学会的说法，目前MRI的转诊和诊断指南不够明确，无法指导临床实践。本综述旨在通过考虑椎体终板的相关作用来评估MRI在诊断腰痛中的作用。综述结果表明，MRI能够对终板形态、终板缺损、终板的扩散和灌注特性以及Modic改变进行精细评估。发现终板这些特征的变化与椎间盘退变和腰痛密切相关。文献中的综合证据表明，MRI可能是腰痛患者的首选成像方式。证据级别：1 技术效能阶段：3。
