Purpose
To develop a robust sequence that combines T1ρ and T2 quantifications and to examine the in-vivo repeatability and diurnal variation of T1ρ and T2 quantifications in knee cartilage.

/pdf/simultaneous-acquisition-of-t1r-and-t2-quantification-in-5aw8wynawt.pdf

Simultaneous acquisition of T1ρ and T2 quantification in knee cartilage: repeatability and diurnal variation.

Objective
To assess the relationship of morphologically defined lumbar disc abnormalities with quantitative T2 mapping.

Lumbar intervertebral disc abnormalities: comparison of quantitative T2 mapping with conventional MR at 3.0 T.

Objective
Magnetic resonance T2 mapping allows for the quantification of water and proteoglycan content within tissues and can be used to detect early cartilage abnormalities as well as to track the response to therapy. The goal of the present study was to use T2 mapping to quantify intervertebral disk water content according to the Pfirrmann classification.

Correlation between T2 relaxation time and intervertebral disk degeneration

Study design Nonrandomized controlled study. Objective To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated controls or asymptomatic controls. Summary of background data Some but not all patients with LBP report improvement in function after SMT. When compared with nonresponders, studies suggest that SMT responders demonstrate significant changes in spinal stiffness, muscle contraction, and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls. Methods Participants with LBP and asymptomatic controls attended 3 sessions for 7 days. On sessions 1 and 2, participants with LBP received SMT (+LBP/+SMT, n = 32) whereas asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from an LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/nonresponders on the basis of self-reported disability on day 7. A repeated measures analysis of covariance was used to compare apparent diffusion coefficients among responders, nonresponders, and +LBP/-SMT subjects, as well as spinal stiffness or multifidus thickness ratio among responders, nonresponders, and -LBP/-SMT subjects. Results After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups. Similarly, only SMT responders displayed significant post-SMT improvement in apparent diffusion coefficients. Conclusion Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT responders not present in all patients with LBP. This work provides a foundation to investigate the heterogeneous nature of LBP, mechanisms underlying differential therapeutic response, and the biomechanical and imaging characteristics defining responders at baseline. Level of evidence 3.

Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls?

Introduction 
Low-back pain (LBP) has been correlated to the presence of intervertebral disc (IVD) degeneration on T2-weighted (T2w) MRI. It remains challenging, however, to accurately stage degenerative disc disease (DDD) based on T2w MRI and measurements of IVD height, particularly for early DDD. Several quantitative MRI techniques have been introduced to detect changes in matrix composition signifying early DDD. In this study, we correlated quantitative T2, T1rho and Apparent Diffusion Coefficient (ADC) values to disc mechanical behavior and gold standard early DDD markers in a graded degenerated lumbar IVD caprine model, to assess their potential for early DDD detection.


Methods 
Lumbar caprine IVDs were injected with either 0.25 U/ml or 0.5 U/ml Chondroitinase ABC (Cabc) to trigger early DDD-like degeneration. Injection with phosphate-buffered saline (PBS) served as control. IVDs were cultured in a bioreactor for 20 days under axial physiological loading. High-resolution 9.4 T MR images were obtained prior to intervention and after culture. Quantitative MR results were correlated to recovery behavior, histological degeneration grading, and the content of glycosaminoglycans (GAGs) and water.


Results 
Cabc-injected IVDs showed aberrancies in biomechanics and loss of GAGs without changes in water-content. All MR sequences detected changes in matrix composition, with T1rho showing largest changes pre-to-post in the nucleus, and significantly more than T2 and ADC. Histologically, degeneration due to Cabc injection was mild. T1rho nucleus values correlated strongest with altered biomechanics, histological degeneration score, and loss of GAGs.


Conclusions 
T2- and T1rho quantitative MR-mapping detected early DDD changes. T1rho nucleus values correlated better than T2 and ADC with biomechanical, histological, and GAG changes. Clinical implementation of quantitative MRI, T1rho particularly, could aid in distinguishing DDD more reliably at an earlier stage in the degenerative process.

/pdf/quantitative-mri-in-early-intervertebral-disc-degeneration-td7llvl46r.pdf

Quantitative MRI in early intervertebral disc degeneration: T1rho correlates better than T2 and ADC with biomechanics, histology and matrix content

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 (−7.9%; P = 0.001) and the intermediate voxels (−6.4%; P < 0.0005). T2 increased (8.5%; P < 0.048) in the AF. ADC decreased in the AF (−5.2%; P = 0.007) and the intermediate ROIs (−2.2%; P = 0.004). There was no significant change of ADC in the NP (−1.6%; P = 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. J. Magn. Reson. Imaging 2008;28:252–257. © 2008 Wiley-Liss, Inc.

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

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