²³Na-magnetic resonance imaging of the human lumbar vertebral discs: in聽vivo measurements at 3.0 T in healthy volunteers and patients with low back pain

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• 作者：Stefan Haneder ; MD^a ; ^{Stefan.Haneder@umm.de" class="auth_mail} ; Melissa M.L. Ong ; MD^a ; Johannes M. Budjan ; MD^a ; René ; Schmidt ; MD^b ; Simon Konstandin ; PhD^c ; John N. Morelli ; MD^d ; Lothar R. Schad ; PhD^c ; Stefan O. Schoenberg ; MD^a ; Ulrich H. Kerl ; MD^e
• 关键词：23Na-MRI ; Vertebral discs ; 3.0 T ; Healthy volunteers ; LBP ; Pfirrmann score
• 刊名：The Spine Journal
• 出版年：1 July 2014
• 年：2014
• 卷：14
• 期：7
• 页码：1343-1350
• 全文大小：831 K

文摘

¹H magnetic resonance imaging (MRI) of the spine can rule out common causes of low back pain (LBP), such as disc protrusions or nerve root compression; however, no significant causal relation exists between morphology and the extent of symptoms. Functional MRI techniques, such as ²³Na, may provide additional information, allowing indirect assessment of vertebral glycosaminoglycan concentrations, decreases in which are associated with early degenerative changes.

Purpose

To evaluate ²³Na-MRI of asymptomatic healthy volunteers and symptomatic patients with LPB and correlate the results to the Pfirrmann classification of MRI disc morphology.

Study design

Retrospective cohort study at an academic medical center.

Patient sample

Two groups were studied: (1) 55 healthy volunteers (31 men, 24 women; mean age 28.8 years) and (2) 12 patients (6 men, 6 women; mean age: 35.3 years) with a recent history of LBP.

Methods

Lumbar spines of the aforementioned groups were examined on a 3.0 T MRI scanner with morphological ¹H and ²³Na imaging. Intervertebral disc (IVD) ²³Na at each level was normalized (²³Na_norm). Distribution and differences between mean ²³Na_norm corresponding to each Pfirrmann classification were evaluated in the two study groups (analysis of variance). Linear correlations between ²³Na_norm, body mass index (BMI), and age were assessed (Pearson correlation coefficient). Gender-dependent differences were evaluated (paired t test).

Outcome measures

Physiological measure: IVD ²³Na_norm as determined by ²³Na-MRI.

Results

A normal distribution of ²³Na_norm was confirmed for both groups (p=.072 and p=.073, respectively). The mean Pfirrmann score statistically significantly differed between them (p<.0001). ²³Na_norm was statistically significantly reduced in degenerated IVDs (Pfirrmann scores 4+5) (p<.0001). No statistically significant differences were seen for the mean ²³Na_norm of IVDs with the same Pfirrmann score in healthy volunteers and patients (.469<p<.967). Age (0.007<R²<0.202) and BMI (0.074<R²<0.288) showed either weak or no correlation to ²³Na_norm. Mean ²³Na_norm was significantly (p=.0002) greater in women relative to men.

Conclusions

The results underline the feasibility and robustness of ²³Na-MRI of human IVDs and affirm, in a large cohort, decreases in ²³Na IVD content seen with disc degeneration.