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(23)Na - MR of the human lumbar vertebral discs: in-vivo measurements at 3.0T in healthy volunteers and patients with low back pain

S. Haneder, M. Ong, J. Budjan, R. Schmidt, S. Konstandin, J. Morelli, L. Schad, S. Schoenberg and H. Kerl

Spine J, 14 (7), pp.1343-1350

(1)H magnetic resonance imaging 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 extent of symptoms. Functional MR techniques, such as (23)Na, may provide additional information, allowing indirect assessment of vertebral glycosaminoglycan concentrations, decreases in which are associated with early degenerative changes.To evaluate (23)Na-MR of (1) asymptomatic healthy volunteers and (2) symptomatic patients with LPB and correlate the results to the Pfirrmann classification of MR disk morphology.Retrospective cohort study at an academic medical center.Two groups were studied: (1) 55 healthy volunteers (31 m, 24 w; mean age 28.8 years) and (2) 12 patients (6 m, 6 w; mean age: 35.3 years) with a recent history of LBP.This study was performed without grant support; the authors have no conflicts of interest to disclose. Lumbar spines of the above groups were examined on a 3.0 Tesla MR-scanner with morphologic (1)H and (23)Na imaging. Intervertebral disk (IVD) (23)Na at each level was normalized ((23)Nanorm). Distribution and differences between mean (23)Nanorm corresponding to each Pfirrmann classification were evaluated in the two study groups (ANOVA). Linear correlations between (23)Nanorm, BMI, and age were assessed (Pearson Correlation Coefficient). Gender-dependent differences were evaluated (paired t-test).Physiologic measure - IVD (23)Nanorm as determined by (23)Na MRI.A normal distribution of (23)Nanorm was confirmed for both groups (p = 0.072 and p = 0.073). The mean Pfirrmann score statistically significantly differed between them (p < 0.0001). (23)Nanorm was statistically significantly reduced in degenerated IVDs (Pfirrmann scores 4+5) (p < 0.0001). No statistically significant differences were seen for the mean (23)Nanorm of IVDs with the same Pfirrmann score in healthy volunteers and patients (0.469 < p < 0.967). Age (0.007< R(2) < 0.202) and BMI (0.074 < R(2) < 0.288) showed either weak or no correlation to (23)Nanorm. Mean (23)Nanorm was significantly (p = 0.0002) greater in women relative to men.The results underline the feasibility and robustness of (23)Na-MR imaging of human IVDs and affirm in a large cohort decreases in (23)Na IVD content seen with disc degeneration.

Contact: Dr. Frank Zöllner last modified: 18.03.2019
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