Quantitative Assessment of Bone Marrow Edema in Adolescent Athletes with Lumbar Spondylolysis Using Contrast Ratio on Magnetic Resonance Imaging

Abstract

Study Design: Prospective cohort study.Purpose: To quantitatively evaluate bone marrow edema (BME) in the pedicle on magnetic resonance imaging (MRI) for adolescent athlete patients with spondylolysis.Overview of Literature: Spondylolysis, a stress fracture of the pars interarticularis, is a common occurrence in adolescent athletes with low back pain. T2-weighed fat-saturated MRI is reportedly useful for the detection of BME in the pedicle in the early stage of spondylolysis; however, to our knowledge, the quantitative assessment of BME in spondylolysis has not been reported.Methods: Adolescent athletes with spondylolysis, including those with symptoms of low back pain, were enrolled. The sporting activity of the patients was restricted, and a hard brace was attached to the spine. The BME range of interest was taken on T2-weighed fat-saturated MRI, and the signal intensity (SI) of the BME (SIedema) was measured. The contrast ratio (CR) between the SI of the BME and SI of the spinal cord (SIcord) was calculated per the following formulae: CRedema=(SIedema–SIcord)/(SIedema+SIcord). The CR of the normal pedicle was measured as a control per the following formulae: CRcontrol=(SIcontrol–SIcord)/(SIcontrol+SIcord).Results: The study enrolled 32 men and one woman; the mean patient age was 15.2 years (range, 12–18 years). The average CR of the edema and normal pedicle at the first visit was 0.506 (range, 0.097–0.804) and 0.137 (range, -0.741 to 0.572), respectively. The CR of the edema was significantly higher as compared to that of the normal pedicle (p<0.01). MRI that was performed 1 month after the first visit showed that the CR of the edema had decreased to 0.204 (range, -0.152 to 0.517). The CR of the edema 1 month thereafter was significantly lower than that at the first visit (p<0.01).Conclusions: Quantitative assessment of BME using CR on MRI is useful in the evaluation of the healing process of spondylolysis.

Differences between spinal cord injury and cervical compressive myelopathy in intramedullary high-intensity lesions on T2-weighted magnetic resonance imaging: A retrospective study

“…[33,34] In a previous study, MR images of acute and subacute SCI showed T2 high-intensity lesions with unclear boundaries spread in the sagittal direction. [27] In the present study, similar features to those of T2 high-intensity lesions in SCI were observed. In contrast, intramedullary T2 high-intensity lesions with sharp boundaries are often confined to the interbody region in CCM.…”

“…[23,24] Contrast ratio (CR) was used as the formula to calculate the above ratio. [25][26][27] The SI values of the intramedullary high-intensity lesion (H) and the spinal cord at the level of the first thoracic vertebra (C) were used to calculate the CR using the following formula:…”

Quantifying Bone Marrow Edema Adjacent to the Lumbar Vertebral Endplate on Magnetic Resonance Imaging: A Cross-Sectional Study of Patients with Degenerative Lumbar Disease

“…Although some studies have reported on the use of CRs on MRI in the pulmonary and liver fields [ 7 ], few trials have reported on CR use in spine research [ 19 , 20 ]. In the present cross-sectional study, the CR value of BME adjacent to the vertebral endplate was significantly higher than that in the normal bone marrow.…”

Sacral Stress Fracture in Athletes With Overuse

“…Low back pain in athletes may also arise from lumbar spondylolysis or a stress fracture of the pars interarticularis in the lumbar spine 3,4 . Lumbar stress fracture is caused by repetitive extension and rotation force of the lumbar spine, and magnetic resonance imaging (MRI) is a useful diagnostic tool for detecting stress fractures in their early stage 5–7 …”

“…3,4 Lumbar stress fracture is caused by repetitive extension and rotation force of the lumbar spine, and magnetic resonance imaging (MRI) is a useful diagnostic tool for detecting stress fractures in their early stage. [5][6][7] Among stress fractures in the lumbosacral region, sacral stress fractures are considered an unusual cause of low back pain in athletes. 8,9 As adolescents have developing bones with high elasticity, sacral stress fractures are likely to occur in athletes because they are caused by excessive repetitive movements of the trunk.…”