Magnetic Resonance Imaging in the Diagnosis of Disc Degeneration

Schneiderman, Gary; Flannigan, B D; Kingston, Scott; Thomas, James S.; Dillin, William; Watkins, Robert G.

doi:10.1097/00007632-198704000-00016

Cited by 312 publications

(153 citation statements)

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“…The presence and extent of disc degeneration as well as other radiographic parameters of interest, as noted below, were assessed in every subject. Disc degeneration at each lumbar level was assessed based on the radiography criteria proposed by Schneiderman et al (35). Based on such criteria, a score of 0 was associated with no signal changes for the disc, a score of 1 was assigned when a slight decrease in signal intensity of the nucleus pulposus was present, a score of 2 was associated with the presence of hypointensity of the nucleus pulposus and normal disc height, and a score of 3 was reserved for a hypointense nucleus pulposus with disc space narrowing.…”

Section: Methodsmentioning

confidence: 99%

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Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Cheung¹,

Samartzis²,

Karppinen³

et al. 2010

Arthritis & Rheumatism

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Objective. Typically, age and abnormal physical loading ("wear and tear") have been associated with the development of intervertebral disc degeneration. In the past decade, various additional etiologic factors for disc degeneration have been sporadically reported in the literature; however, many investigators continue to place tremendous emphasis on the effects of age and biomechanics associated with disc degeneration. The aim of this study was to provide additional insight into the notion that age and biomechanics are key factors in the development of disc degeneration. To this end, we addressed the prevalence of and risk factors associated with a unique pattern of disc degeneration of the lumbar spine, "skipped" level (nonconsecutive) disc degeneration (SLDD).Methods. As part of a large genetics-based study in southern Chinese individuals (n ‫؍‬ 1,989), a crosssectional analysis was performed in subjects exhibiting disc degeneration in >2 levels (n ‫؍‬ 838) who were then categorized as having SLDD (n ‫؍‬ 174) or non-SLDD (contiguous, multilevel; n ‫؍‬ 664). Various radiographic parameters were assessed based on T2-weighted magnetic resonance imaging (MRI). Subject demographics were assessed, and univariate and multivariate logistic regression analyses were performed.Results. Overall, 8.7% of the whole population (n ‫؍‬ 1,989) had SLDD, while it was present in 20.8% of subjects with multilevel disc degeneration (n ‫؍‬ 838). SLDD was more prevalent in male subjects (adjusted odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.04-2.10, P ‫؍‬ 0.028). SLDD was significantly associated with the presence of Schmorl's nodes (adjusted OR 2.72, 95% CI 1.78-4.15, P < 0.001), which also presented in levels with no disc degeneration. A history of disc bulge/extrusion (P ‫؍‬ 0.004) and/or a history of back injury (P ‫؍‬ 0.010) was significantly associated with non-SLDD, and a greater degree of overall severity of disc degeneration was also associated with non-SLDD. Other demographic and MRI findings did not significantly differ between groups.Conclusion. To our knowledge, this report is the first to describe the prevalence and risk factors associated with SLDD. Our study challenges the paradigm that age and biomechanics are the key factors associated with the development of disc degeneration. Although age and biomechanical factors may play a role in the manifestation of disc degeneration, our novel findings of SLDD patterns provide further awareness of and support for the notion that additional etiologic factors may play a role in the development of disc degeneration. Such factors warrant further investigation to shed light on the cause of disc degeneration.

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Section: Methodsmentioning

confidence: 99%

“…Furthermore, our imaging interpretation was limited to T2-weighted sagittal MRI due to study costs. Regardless, analysis of disc degeneration via T2-weighted images has been shown to be a reliable and accurate modality in assessing degeneration in the lumbar spine (35,(56)(57)(58)(59)(60).…”

mentioning

confidence: 99%

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Cheung¹,

Samartzis²,

Karppinen³

et al. 2010

Arthritis & Rheumatism

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“…We plan on adding the capability to process both axial and sagittal scans in the near future to see if we can improve upon the performance on reliability scores. We also anticipate that we could also use our method and validate it against other disc degeneration classification systems [20][21][22]. Others have reported results of automated image analysis of lumbar MRI scans, but not on the scale that we have reported here [8].…”

Section: Discussionmentioning

confidence: 84%

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2017: Automation of reading of radiological features from magnetic resonance images (MRIs) of the lumbar spine without human intervention is comparable with an expert radiologist

et al. 2017

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Study design Investigation of the automation of radiological features from magnetic resonance images (MRIs) of the lumbar spine. Objective To automate the process of grading lumbar intervertebral discs and vertebral bodies from MRIs. Summary of background data MR imaging is the most common imaging technique used in investigating low back pain (LBP). Various features of degradation, based on MRIs, are commonly recorded and graded, e.g., Modic change and Pfirrmann grading of intervertebral discs. Consistent scoring and grading is important for developing robust clinical systems and research. Automation facilitates this consistency and reduces the time of radiological analysis considerably and hence the expense.Methods 12,018 intervertebral discs, from 2009 patients, were graded by a radiologist and were then used to train: (1) a system to detect and label vertebrae and discs in a given scan, and (2) a convolutional neural network (CNN) model that predicts several radiological gradings. The performance of the model, in terms of class average accuracy, was compared with the intra-observer class average accuracy of the radiologist. Results The detection system achieved 95.6% accuracy in terms of disc detection and labeling. The model is able to produce predictions of multiple pathological gradings that consistently matched those of the radiologist. The model identifies 'Evidence Hotspots' that are the voxels that most contribute to the degradation scores. Conclusions Automation of radiological grading is now on par with human performance. The system can be beneficial in aiding clinical diagnoses in terms of objectivity of gradings and the speed of analysis. It can also draw the attention of a radiologist to regions of degradation. This objectivity and speed is an important stepping stone in the investigation of the relationship between MRIs and clinical diagnoses of back pain in large cohorts. Level of Evidence: Level 3.

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“…Films were assessed by an experienced physician blinded to the results of the genetic analysis and clinical history. The grade of disc degeneration was determined according to Schneiderman's classification [17]. Grade zero indicated a normal disc with a hyperintense signal within the nucleus; Grade 1, a slight decrease in signal intensity in the nucleus pulposus; Grade 2, a generalized hypointense nucleus; and Grade 3, a hypointense nucleus with disc space narrowing.…”

Section: Subjectsmentioning

confidence: 99%

Association between the -1306C/T polymorphism of matrix metalloproteinase-2 gene and lumbar disc disease in Chinese young adults

et al. 2007

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Matrix metalloproteinase-2 (MMP-2) has been shown to play a pivotal role in the pathophysiology of lumbar disc disease (LDD). Increased expression and activity of MMP-2 has been documented in degenerative discs. The polymorphism -1306C/T in the promoter region of MMP-2 gene was reported to influence gene transcription and expression. The objective of this study was therefore to investigate the possible association of MMP-2 -1306C/T polymorphism with the occurrence and the clinical characteristics of LDD. MMP-2 genotypes were determined by polymerase chain reaction (PCR) and direct DNA sequencing in a case-control study involving 162 younger patients with LDD and 318 age-and sex-matched healthy adults. The results showed that the frequency of MMP-2 -1306CC genotype was significantly higher in LDD patients when compared with controls. Subjects with the CC genotype had nearly threefold increased risk for LDD (odds ratio 3.08; 95% confidence interval 1.84-5.16) compared with subjects carrying at least one variant T allele. Furthermore, this genotype was found to correlate with more severe grades of disc degeneration observed on magnetic resonance imaging scan. These findings suggest that MMP-2 -1306C/T polymorphism may be a genetic risk factor related to LDD susceptibility in the young adult population.

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Magnetic Resonance Imaging in the Diagnosis of Disc Degeneration

Cited by 312 publications

References 0 publications

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2017: Automation of reading of radiological features from magnetic resonance images (MRIs) of the lumbar spine without human intervention is comparable with an expert radiologist

Association between the -1306C/T polymorphism of matrix metalloproteinase-2 gene and lumbar disc disease in Chinese young adults

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