Murto Niko, Lund Teija, Kautiainen Hannu, Luoma Katariina, Kerttula Liisa
Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Acta Radiol Open. 2025 Sep 25;14(9):20584601251379482. doi: 10.1177/20584601251379482. eCollection 2025 Sep.
Lumbar disc degeneration (LDD) is frequently evaluated using the Pfirrmann classification. While this composite grading system provides an overview of degeneration severity, it may oversimplify LDD by overlooking variability in individual disc components, reducing its effectiveness in longitudinal studies and constraining its applicability in artificial intelligence-based image analysis.
To examine the 14-year progression of LDD using the Pfirrmann classification and its individual components, and to evaluate the potential of component-based analysis.
LDD was assessed using MRI in 19 males (95 discs) at ages 37 and 51 by two radiologists. Evaluations included Pfirrmann grading, quantitative nucleus pulposus (NP) signal intensity, and visual grading of NP inhomogeneity, annulus fibrosus (AF) border distinction, and disc height (DH). Analyses included longitudinal changes in LDD variables and correlations between Pfirrmann grading and disc components. To assess overall LDD, a summary score was calculated by summing individual disc grades.
Pfirrmann grading correlated strongly with AF border distinction, moderately with NP signal intensity, and weakly with NP inhomogeneity and DH. Pfirrmann summary score (range 5-25) increased by 3 points over time. Variability was observed in the progression of individual disc component degeneration. While mean NP signal intensity significantly decreased, some discs exhibited increase.
This longitudinal study highlights complexity of LDD and variability in disc component changes. While Pfirrmann classification captures overall degeneration, its limitations in detecting subtle variations in disc components suggest a need for more detailed assessments to enhance diagnostic precision and support the development of automated analysis tools.
腰椎间盘退变（LDD）常采用Pfirrmann分级进行评估。虽然这种综合分级系统提供了退变严重程度的概述，但它可能因忽视各个椎间盘成分的变异性而过度简化了LDD，降低了其在纵向研究中的有效性，并限制了其在基于人工智能的图像分析中的适用性。
使用Pfirrmann分级及其各个成分来研究LDD的14年进展情况，并评估基于成分分析的潜力。
由两名放射科医生对19名男性（95个椎间盘）在37岁和51岁时进行MRI检查以评估LDD。评估内容包括Pfirrmann分级、定量髓核（NP）信号强度，以及对NP不均匀性、纤维环（AF）边界清晰度和椎间盘高度（DH）的视觉分级。分析包括LDD变量的纵向变化以及Pfirrmann分级与椎间盘成分之间的相关性。为评估整体LDD，通过将各个椎间盘等级相加计算出一个总分。
Pfirrmann分级与AF边界清晰度高度相关，与NP信号强度中度相关，与NP不均匀性和DH弱相关。Pfirrmann总分（范围为5 - 25）随时间增加了3分。观察到各个椎间盘成分退变进展存在变异性。虽然平均NP信号强度显著降低，但一些椎间盘却出现了增加。
这项纵向研究突出了LDD的复杂性以及椎间盘成分变化的变异性。虽然Pfirrmann分级能够反映整体退变情况，但其在检测椎间盘成分细微变化方面的局限性表明，需要进行更详细的评估以提高诊断准确性，并支持自动化分析工具的开发。
