Quantitative analysis of diurnal variation in volume and water content of lumbar intervertebral discs

Roberts, Neil; Hogg, D. A.; Whitehouse, G. H.; Dangerfield, Peter

doi:10.1002/(sici)1098-2353(1998)11:1<1::aid-ca1>3.0.co;2-z

Cited by 97 publications

(16 citation statements)

References 18 publications

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“…9 MRI studies have since confirmed that the diurnal variation in stature primarily results from increases in water content in the soft central portion of the intervertebral discs (nucleus pulposus) while at rest and water loss while standing or during other weight-bearing activities. 10 For children, one can expect a mean height difference of ϳ1.5 cm (SD: 0.46 cm) between rising and late afternoon, 11 with most of the change probably occurring during the first 2 to 3 hours of the day. 12 In practice, it is helpful to understand the expected diurnal variation in child height but probably impractical to try to time height measurements to accommodate it, unless one is engaged in a rigorous research protocol that requires serial measurements on a small number of individual children.…”

Section: Measurement Errors Due To Child Variationsupporting

confidence: 83%

Challenges of Accurately Measuring and Using BMI and Other Indicators of Obesity in Children

2009

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BMI is an important indicator of overweight and obesity in childhood and adolescence. When measurements are taken carefully and compared with appropriate growth charts and recommended cutoffs, BMI provides an excellent indicator of overweight and obesity that is sufficient for most clinical, screening, and surveillance purposes. Accurate measurements of height and weight require that adequate attention be given to data collection and management. Choosing appropriate equipment and measurement protocols and providing regular training and standardization of data collectors are critical aspects that apply to all settings in which BMI will be measured and used. Proxy measures for directly measured BMI, such as self-reports or parental reports of height and weight, are much less preferred and should only be used with caution and cognizance of the limitations, biases, and uncertainties attending these measures. There is little evidence that other measures of body fat such as skinfolds, waist circumference, or bioelectrical impedance are sufficiently practicable or provide appreciable added information to be used in the identification of children and adolescents who are overweight or obese. Consequently, for most clinical, school, or community settings these measures are not recommended for routine practice. These alternative measures of fatness remain important for research and perhaps in some specialized screening situations that include a specific focus on risk factors for cardiovascular or diabetic disease. ]) has probably become the most common indicator used to assess overweight and obesity in a wide variety of settings, including clinical, public health, and community-based programs. Although it is certainly not a perfect surrogate for total body fatness and not without its technical limitations, 1 BMI has been recommended as the most appropriate single indicator of overweight and obesity in children and adolescents outside of research settings. [2][3][4] One of the attractive features of BMI is that it is derived from measurements of height and weight. These 2 anthropometric dimensions are the ones most commonly collected on children worldwide. These 2 measurements are noninvasive, relatively inexpensive to obtain, and relatively easily understood by health practitioners, the individuals being measured, and their families.Mentioning child measurements of height and weight, individuals may be reminded of their own marks on the door sills and the bathroom scales of their childhood homes. So, although wide familiarity with height and weight enhances the use and understanding of a measure such as BMI, it also may desensitize health professionals to the need to give adequate attention to issues concerning how height and weight data are collected. Accordingly, one may hear the comment, "Anyone can measure height and weight." Although one must actually agree with the language, if not the intent, of this easy declaration, many health professionals are unaware that there are consequences for the usefulness and ac...

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Section: Measurement Errors Due To Child Variationsupporting

confidence: 83%

Challenges of Accurately Measuring and Using BMI and Other Indicators of Obesity in Children

2009

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“…Only Karakida et al (2) reported on a decrease of T2 during the day in a rectangular 15 mm ϫ 15 mm ROI in the nucleus pulposus. Similar results in combination with a decrease in vertebral disc volume were published by Roberts et al (17). Boos et al (9) reported on variations of water content between morning and evening measured by T2 time and proton density.…”

Section: Discussionmentioning

confidence: 99%

T2‐ and diffusion‐maps reveal diurnal changes of intervertebral disc composition: An in vivo MRI study at 1.5 Tesla

Ludescher¹,

Effelsberg

Martirosian³

et al. 2008

Magnetic Resonance Imaging

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Purpose: To investigate the lumbar intervertebral discs (IVDs) by MRI in the morning and evening after a diurnal load cycle. Changes in MR characteristics (T2-weighted imaging, T2-and apparent diffusion coefficient [ADC] -mapping) during the course of the day were visualized and analyzed visually and quantitatively. The length of the lumbar spine was measured in between the lower anterior edge of Th12 and the upper anterior edge of S1. T2 changes and diffusion characteristics of the vertebral disc tissue were investigated with a higher spatial resolution than in former studies. Materials and Methods:In six males, lumbar IVDs were investigated in the morning and evening. T2-maps and ADC maps were generated. Data were analyzed by selecting regions of interest (ROI) in the annulus fibrosus (AF), nucleus pulposus (NP), and an intermediate area.Results: From morning to evening, T2 decreased in the center of the NP (Ϫ7.9%; P ϭ 0.001) and the intermediate voxels (Ϫ6.4%; P Ͻ 0.0005). T2 increased (8.5%; P Ͻ 0.048) in the AF. ADC decreased in the AF (Ϫ5.2%; P ϭ 0.007) and the intermediate ROIs (Ϫ2.2%; P ϭ 0.004). There was no significant change of ADC in the NP (Ϫ1.6%; P ϭ 0.242).Conclusion: T2 and diffusion (ADC) changes of IVDs in humans were investigated with a spatial differentiation between NP and AF. T2 and ADC turned out to be sensitive parameters in investigating changes in the MR characteristics of the IVD matrix during a day. Highly resolved MR imaging and parameter mapping is expected to be an interesting tool in characterizing structural changes in the vertebral disc architecture in an early stage of degeneration.

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“…This observation is consistent with previous studies that have reported substantial variations in the intensity of T 2 -signals in the nuclear region of lumbar IVDs, when the same subject is imaged in the early morning and again in the evening. 1,29,42 In an attempt to control for variation in diffusion due to these diurnal influences we performed all initial and follow-up scans at the same time of day. Despite this, it is likely that normal (hyperintense IVDs) had a true between-scan variation of 6.1% to 10.1%, while those IVDs with signs of degeneration (intermediate discs)…”

Section: Test-retest Variability Of Adcmentioning

confidence: 99%

Diffusion-Weighted Magnetic Resonance Imaging of Normal and Degenerative Lumbar Intervertebral Discs: A New Method to Potentially Quantify the Physiologic Effect of Physical Therapy Intervention

Beattie

Morgan²,

Peters³

2008

J Orthop Sports Phys Ther

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STUDY DESIGN: Observational, repeatedmeasures design. OBJECTIVES:To determine the reliability of the apparent diffusion coefficient (ADC) calculated from diffusion-weighted magnetic resonance images (MRI) of the nuclear region of lumbar intervertebral discs (IVDs), to investigate the differences in the ADC based upon T 2 -signal intensity, and to examine the test-retest variation in these measures obtained from subjects undergoing serial, diffusion-weighted MRI scans.BACKGROUND: Impaired diffusion of water within the lumbar IVD is a central characteristic of degenerative disc disease. Diffusion-weighted MRI scans can provide quantitative estimates of water diffusion and may be useful to evaluate the physiologic effects of healing or the change in hydration related to interventions such as traction, manual therapy, or exercise on normal and degenerative lumbar IVDs. METHODS:Thirty subjects underwent T 2 -weighted and diffusion-weighted lumbar MRI scans. Twenty-one of these subjects underwent a second diffusion-weighted MRI scan 4 to 7 weeks after the initial scan. The ADC was calculated from midsagittal diffusion-weighted images for the IVDs of L1-2 to L5-S1. To assess reliability, repeated measures of the ADC were performed on the first 16 scans. The T 2 -signal of the nuclear region of each disc was classified as hyperintense, intermediate, or hypointense, and its relationship to the mean ADC of the nuclear region was determined. Test-retest variation in the ADC was described using the coefficient of variation (CV), plus or minus the width of the 95% confidence interval of the standard error of measurement (SEM). RESULTS: Intraclass correlation coefficientsfor estimates of intrarater and interrater reliability ranged from 0.95 to 0.99 and the SEM ranged from 0.006 to 0.026 10 -3 mm 2 /s. The mean ADC was significantly greater for hyperintense IVDs compared to intermediate and hypointense IVDs. The CV plus or minus the 95% CI of the SEM between scans ranged from 9.0% to 13.6% for all discs, 6.1% to 10.1% for hyperintense discs, and 13.1% to 23.7% for intermediate discs. The prevalence of hypointense discs was too low to make meaningful judgments about their normal degree of variation over time. CONCLUSION:The ADC of the nuclear region of the lumbar IVDs may be reliably measured from diffusion-weighted images. Degenerative discs had lower mean ADC values than normal discs but demonstrated greater variation between scans. Diffusion-weighted imaging may be a useful procedure to assess change in diffusion of water in lumbar discs that occurs over time.

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Quantitative analysis of diurnal variation in volume and water content of lumbar intervertebral discs

Cited by 97 publications

References 18 publications

Challenges of Accurately Measuring and Using BMI and Other Indicators of Obesity in Children

Challenges of Accurately Measuring and Using BMI and Other Indicators of Obesity in Children

T2‐ and diffusion‐maps reveal diurnal changes of intervertebral disc composition: An in vivo MRI study at 1.5 Tesla

Diffusion-Weighted Magnetic Resonance Imaging of Normal and Degenerative Lumbar Intervertebral Discs: A New Method to Potentially Quantify the Physiologic Effect of Physical Therapy Intervention

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