Diagnostic Role of Magnetic Resonance Imaging in Low Back Pain Caused by Vertebral Endplate Degeneration

Din, Rahman Ud; Cheng, Xiaoguang; Yang, Haisheng

doi:10.1002/jmri.27858

Cited by 22 publications

(13 citation statements)

References 129 publications

(412 reference statements)

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“…Zhou et al Journal of Orthopaedic Surgery and Research (2023) 18:293 Modic changes refer to abnormal signal changes of vertebral endplate and bone under endplate in MRI examination of spine [5]. According to the signal changes of endplate on MRI, it can be divided into three types [6,7]: Modic I changes: low signal on T1WI and high signal on T2WI; Modic II changes: hyperintense on T1WI, isointense or slightly hyperintense on T2WI; Modic III changes: both T1WI and T2WI showed low signal intensity. Previous studies have shown that spinal Modic changes are closely related to the mechanical state of the spine [8,9].…”

Section: Introductionmentioning

confidence: 99%

K-line tilt as a novel potential risk factor for cervical Modic change: a retrospective study

et al. 2023

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Background Cervical sagittal parameters are important parameters that reflect the mechanical stress in the sagittal plane of the cervical spine and are an important basis for predicting the clinical status and prognosis of patients. Although it has been confirmed that there is a significant correlation between cervical Modic changes and some sagittal parameters. However, as a newly discovered sagittal parameter, there is no report on the relationship between the K-line tilt and the Modic changes of cervical spine. Methods A retrospective analysis was performed for 240 patients who underwent cervical magnetic resonance imaging scan for neck and shoulder pain. Among them, 120 patients with Modic changes, namely the MC(+) group, were evenly divided into three subgroups of 40 patients in each group according to different subtypes, namely MCI subgroup, MCII subgroup and MCIII subgroup. One hundred twenty patients without Modic changes were included in MC(−) group. We measured and compared the sagittal parameters of cervical spine among different groups, including K-line tilt, C2–C7 sagittal axial vertical distance (C2–C7 SVA), T1 slope and C2–7 lordosis. Logistic regression was used to analyse the risk factors of cervical Modic changes. Results The K-line tilt and C2–7 lordosis were significantly different between MC(+) group and MC(−) group (P < 0.05). The K-line tilt greater than 6.72° is a risk factor for Modic changes in cervical spine (P < 0.05). At the same time, the receiver operating characteristic curve showed that this change had moderate diagnostic value when the area under the curve was 0.77. Conclusion This study shows that the K-line tilt greater than 6.72° is a potential risk factor for Modic changes in cervical spine. When the K-line tilt is greater than 6.72°, we should be alert to the occurrence of Modic changes. Trial registration number: 2022ER023-1.

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Section: Introductionmentioning

confidence: 99%

K-line tilt as a novel potential risk factor for cervical Modic change: a retrospective study

et al. 2023

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“…8 Despite its prevalence, the association of MCs with LBP is inconsistent. 5,[9][10][11] Hypothesized to cause LBP through structural and inflammatory changes in the bony structures of the spine, [12][13][14] MCs are defined as signal variations seen in the combined assessment of T 1 -weighted and T 2 -weighted magnetic resonance imaging (MRI). 8 Bone marrow edema-like changes or fibrovascular changes appear distinctly hypointense on T 1 -weighted images and hyperintense on T 2 -weighted images (Modic type 1).…”

Section: Introductionmentioning

confidence: 99%

“…Modic changes (MCs) are the most commonly used classification system for describing changes in endplate‐adjacent vertebral bone marrow 8 . Despite its prevalence, the association of MCs with LBP is inconsistent 5,9–11 …”

Section: Introductionmentioning

confidence: 99%

Automatic detection and voxel‐wise mapping of lumbar spine Modic changes with deep learning

et al. 2022

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Background: Modic changes (MCs) are the most prevalent classification system for describing magnetic resonance imaging (MRI) signal intensity changes in the vertebrae. However, there is a growing need for novel quantitative and standardized methods of characterizing these anomalies, particularly for lesions of transitional or mixed nature, due to the lack of conclusive evidence of their associations with low back pain. This retrospective imaging study aims to develop an interpretable deep learning-based detection tool for voxel-wise mapping of MCs.Methods: Seventy-five lumbar spine MRI exams that presented with acute-tochronic low back pain, radiculopathy, and other symptoms of the lumbar spine were enrolled. The pipeline consists of two deep convolutional neural networks to generate an interpretable voxel-wise Modic map. First, an autoencoder was trained to segment vertebral bodies from T 1 -weighted sagittal lumbar spine images. Next, two radiologists segmented and labeled MCs from a combined T 1 -and T 2 -weighted assessment to serve as ground truth for training a second autoencoder that performs segmentation of MCs. The voxels in the detected regions were then categorized to the appropriate Modic type using a rule-based signal intensity algorithm. Post hoc, three radiologists independently graded a second dataset with the aid of the model predictions in an artificial (AI)-assisted experiment. Results:The model successfully identified the presence of changes in 85.7% of samples in the unseen test set with a sensitivity of 0.71 (±0.072), specificity of 0.95 (±0.022), and Cohen's kappa score of 0.63. In the AI-assisted experiment, the agreement between the junior radiologist and the senior neuroradiologist significantly improved from Cohen's kappa score of 0.52 to 0.58 (p < 0.05).Conclusions: This deep learning-based approach demonstrates substantial agreement with radiologists and may serve as a tool to improve inter-rater reliability in the assessment of MCs.Kenneth T. Gao and Radhika Tibrewala contributed equally to this study.

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“…While the underlying cause of MCs are not fully elucidated, they are theorized to have one of the following etiologies: degenerative disc disease, infection, trauma and/or inflammation. 14 Moreover, the three primary subtypes of Modic changes appear to represent different phases of disease process. MC-I are evoked by inflammatory changes wherein vertebral endplates are disrupted and edematous changes are apparent in the bone.…”

Section: Introductionmentioning

confidence: 99%

Modic Changes of the Cervical and Lumbar Spine and Their Effect on Neck and Back Pain: A Systematic Review and Meta-Analysis

Lambrechts

Issa

Toci

et al. 2022

Global Spine Journal

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Study Design Systematic Review. Objectives To systematically review the current literature and perform a meta-analysis on patients with cervical or lumbar spine Modic changes to determine if their baseline axial back pain and disability are comparable to patients without Modic changes. Methods A systematic review of the PubMed database was conducted in accordance with PRISMA guidelines. A meta-analysis was performed to compare the mean differences in back pain, leg pain, and disability based on the presence of cervical or lumbar spine Modic changes. A subgroup analysis of the different types of Modic changes was conducted to determine if Modic type affected back pain or disability. Results – After review of 259 articles, 17 studies were included for meta-analysis and ten studies were included for qualitative synthesis. In the lumbar spine, 10 high-quality studies analyzed Visual Analog Scale (VAS) back pain, 10 evaluated VAS leg pain, and 8 analyzed Oswestry Disability Index. VAS back pain (mean difference (MD), −.38; 95% CI, -.61 – .16) and Oswestry disability index (MD −2.52; 95% CI, −3.93 – −1.12) were significantly lower in patients without Modic changes. Modic change subtype was not associated with differences in patient-reported outcomes. Patients with cervical spine Modic changes did not experience more severe pain than those without MC. Conclusions Modic changes in the lumbar spine are not associated with clinically significant axial low back pain severity or patient disability. Similar to the lumbar spine, Modic changes in the cervical spine are not associated with symptom severity, but they are associated with pain duration.

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Diagnostic Role of Magnetic Resonance Imaging in Low Back Pain Caused by Vertebral Endplate Degeneration

Cited by 22 publications

References 129 publications

K-line tilt as a novel potential risk factor for cervical Modic change: a retrospective study

K-line tilt as a novel potential risk factor for cervical Modic change: a retrospective study

Automatic detection and voxel‐wise mapping of lumbar spine Modic changes with deep learning

Modic Changes of the Cervical and Lumbar Spine and Their Effect on Neck and Back Pain: A Systematic Review and Meta-Analysis

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