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超短回波时间磁共振成像评估慢性腰痛患者软骨终板损伤及其与椎间盘退变的关系。

Ultra-short echo time MR imaging in assessing cartilage endplate damage and relationship between its lesion and disc degeneration for chronic low back pain patients.

机构信息

Department of Radiology, Tianjin Hospital, Jiefangnan Road, Hexi District, Tianjin, 300211, P.R. China.

Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, P.R. China.

出版信息

BMC Med Imaging. 2023 Apr 20;23(1):60. doi: 10.1186/s12880-023-01014-5.

DOI:10.1186/s12880-023-01014-5
PMID:37081427
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10120173/
Abstract

OBJECTIVE: To investigate the feasibility of ultra-short echo time (UTE) magnetic resonance imaging (MRI) in the assessment of cartilage endplate (CEP) damage and further evaluate the relationship between total endplate score (TEPS) and lumbar intervertebral disc (IVD) degeneration for chronic low back pain patients. MATERIALS AND METHODS: IVD were measured in 35 patients using UTE imaging at 3T MR. Subtracted UTE images between short and long TEs were obtained to depict anatomy of CEP. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated to assess the image quality quantitatively. A new grading criterion for endplate damage evaluation was developed based on Rajasekaran.S grading system in this study. Two radiologists were employed to evaluate CEP and bony vertebral endplates (VEP) using this new grading criterion and assess TEPS, independently. Cohen's kappa analysis was applied to evaluate the inter-observer agreement of endplate damage assessment between two radiologists, and the Kendall's TAU-B analysis was employed to determine the relationship between TEPS and IVD degeneration evaluated with Pfirrmann grading. RESULTS: Well structural CEP was depicted on subtracted UTE images and confirmed by high SNR (33.06±2.92) and CNR values (9.4±2.08). Qualified subtracted UTE images were used by two radiologists to evaluate the degree of CEP and VEP damage. Excellent inter-observer agreement was confirmed by high value in Cohen's kappa test (0.839, P < 0.001). Ensured by this, 138 endplates from 69 IVDs of 35 patients were classified into six grades based on the new grading criterion and TEPS of each endplate was calculated. In addition, the degeneration degree of IVDs were classified into five grades. Finally, using Kendall's TAU-B analysis, significant relationship was obtained between endplate damage related TEPS and IVD degeneration (r = 0.864, P < 0.001). CONCLUSION: Ensured by high image quality, UTE imaging might be considered an effective tool to assess CEP damage. Additionally, further calculated TEPS has shown strong positive association with IVD degeneration, suggesting that the severity of endplate damage is highly linked with the degree of IVD degeneration.

摘要

目的：探讨超短回波时间（UTE）磁共振成像（MRI）在评估软骨终板（CEP）损伤中的可行性，并进一步评估总终板评分（TEPS）与慢性下腰痛患者腰椎间盘（IVD）退变之间的关系。

材料与方法：在 3T MRI 上对 35 例患者的 IVD 进行 UTE 成像测量。通过获得短 TE 和长 TE 之间的减去 UTE 图像来描绘 CEP 的解剖结构。计算信噪比（SNR）和对比噪声比（CNR）以定量评估图像质量。本研究基于 Rajasekaran.S 分级系统，制定了一种新的终板损伤评估分级标准。两名放射科医生使用新的分级标准评估 CEP 和骨性椎体终板（VEP），并独立评估 TEPS。采用 Cohen's kappa 分析评估两位放射科医生对终板损伤评估的观察者间一致性，采用 Kendall's TAU-B 分析评估基于 Pfirrmann 分级的 TEPS 与 IVD 退变之间的关系。

结果：减去 UTE 图像上显示出结构良好的 CEP，并具有较高的 SNR（33.06±2.92）和 CNR 值（9.4±2.08）得到证实。两位放射科医生使用合格的减去 UTE 图像评估 CEP 和 VEP 损伤程度。Cohen's kappa 检验的高值证实了极好的观察者间一致性（0.839，P < 0.001）。基于此，根据新的分级标准对 35 例患者的 69 个 IVD 中的 138 个终板进行分类，并计算每个终板的 TEPS。此外，将 IVD 的退变程度分为五度。最后，通过 Kendall's TAU-B 分析，在终板损伤相关的 TEPS 与 IVD 退变之间获得了显著的相关性（r = 0.864，P < 0.001）。

结论：高质量的图像证实，UTE 成像可能是评估 CEP 损伤的有效工具。此外，进一步计算的 TEPS 与 IVD 退变呈强正相关，表明终板损伤的严重程度与 IVD 退变程度密切相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8067/10120173/b34db25ef8cc/12880_2023_1014_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8067/10120173/ec36d1e9cd0a/12880_2023_1014_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8067/10120173/3dbdf6bc16ff/12880_2023_1014_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8067/10120173/b34db25ef8cc/12880_2023_1014_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8067/10120173/ec36d1e9cd0a/12880_2023_1014_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8067/10120173/3dbdf6bc16ff/12880_2023_1014_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8067/10120173/b34db25ef8cc/12880_2023_1014_Fig3_HTML.jpg

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[7]
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本文引用的文献

[1]
3D Ultrashort TE MRI for Evaluation of Cartilaginous Endplate of Cervical Disk In Vivo: Feasibility and Correlation With Disk Degeneration in T2-Weighted Spin-Echo Sequence.

AJR Am J Roentgenol. 2018-4-9

[2]
Cartilage Endplate Thickness Variation Measured by Ultrashort Echo-Time MRI Is Associated With Adjacent Disc Degeneration.

Spine (Phila Pa 1976). 2018-5-15

[3]
Vertebral Endplate Defect as Initiating Factor in Intervertebral Disc Degeneration: Strong Association Between Endplate Defect and Disc Degeneration in the General Population.

Spine (Phila Pa 1976). 2018-3-15

[4]
Evaluation of the disco-vertebral junction using ultrashort time-to-echo magnetic resonance imaging: inter-reader agreement and association with vertebral endplate lesions.

Skeletal Radiol. 2016-9

[5]
Cartilaginous end plates: Quantitative MR imaging with very short echo times-orientation dependence and correlation with biochemical composition.

Radiology. 2015-2

[6]
UTE MRI of the Osteochondral Junction.

Curr Radiol Rep. 2014-2-1

[7]
Significance of cartilage endplate within herniated disc tissue.

Eur Spine J. 2014-9

[8]
Ultrashort time-to-echo MRI of the cartilaginous endplate: technique and association with intervertebral disc degeneration.

J Med Imaging Radiat Oncol. 2013-8

[9]
Intervertebral disc decompression following endplate damage: implications for disc degeneration depend on spinal level and age.

Spine (Phila Pa 1976). 2013-8-1

[10]
Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?

Eur Spine J. 2013-2-10

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