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. 2011 Dec 1;36(25):2190-6.
doi: 10.1097/BRS.0b013e31820287bf.

T1ρ magnetic resonance imaging and discography pressure as novel biomarkers for disc degeneration and low back pain

Arijitt Borthakur  1 , Philip M Maurer, Matthew Fenty, Chenyang Wang, Rachelle Berger, Jonathon Yoder, Richard A Balderston, Dawn M Elliott
Affiliations

T1ρ magnetic resonance imaging and discography pressure as novel biomarkers for disc degeneration and low back pain

Arijitt Borthakur et al. Spine (Phila Pa 1976). .

Abstract

Study design: Prospective magnetic resonance imaging (MRI) study of patients low back pain (LBP) requiring discography as part of their routine clinical diagnoses and asymptomatic age-matched volunteers.

Objective: To determine whether T1ρ MRI and discography opening pressure (OP) are quantitative biomarkers of disc degeneration in LBP patients and in asymptomatic volunteers.

Summary of background data: Disc degenerative disease, a common cause of LBP, is related to the patient's prognosis and serves as a target for therapeutic interventions. However, there are few quantitative measures in the clinical setting. Discography OP and T1ρ MRI are potential biomarkers of disc degenerative disease related to biochemical composition of the intervertebral disc.

Methods: The institutional review board approved all experiments, and informed consent was provided by each subject. Patients being treated for LBP (n = 17; 68 levels; mean age, 44 ± 6 years; and range, 30-53) and control subjects (n = 11; 44 levels; mean age, 43 ± 17 years; and range, 22-76) underwent T1ρ and T2 MRI on a Siemens 3T Tim Trio clinical scanner (Siemens Medical Solutions, Malvern, PA). The LBP patients also received multilevel provocative discography before their MRI. OP was recorded as the pressure when fluid first enters the nucleus of the intervertebral disc.

Results: T1ρ was significantly lower in the painful discs (55.3 ± 3.0 ms, mean ± SE) from control (92.0 ± 4.9 ms, P < 0.001) and nonpainful discs (83.6 ± 3.2 ms, P < 0.001). Mean OP for the painful discs (11.8 ± 1.0 psi, mean ± SE) was significantly lower than that for nonpainful discs (19.1 ± 0.7 psi, P < 0.001). Both T1ρ and OP correlated moderately with Pfirrmann degenerative grade. Receiver-operating-characteristic area under the curve was 0.91 for T1ρ MRI and 0.84 for OP for predicting painful discs.

Conclusion: T1ρ and OP are quantitative measures of degeneration that are consistent across both control subjects and LBP patients. A significant and strong correlation exists between T1ρ values and in vivo OP measurements obtained by discography in LBP patients.

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Figures

Figure 1
Figure 1
Representative proton T2 MRI (grayscale) and corresponding T1ρ maps (in color overlaid on grayscale T1ρ-weighted image) of the lumbar discs from a 52-year old female (A) and a 35-year old male (B) patients diagnosed with LBP and from an asymptomatic 38-year old male (C). Average T1ρ (in ms) was measured in the NP and is displayed below the discs, followed by the OP (in psi) and whether discs were painful (P) or non-painful (N), both determined by discography are indicated in the LBP patients. The asymptomatic subject only displays T1ρ values since discography was not performed on the control cohort. Color bar on the right indicates a T1ρ scale from 0–250ms.
Figure 2
Figure 2
Plot of mean T1ρ (in ms) for the control (c), LBP non-painful (n) and painful (p) disc cohorts along with 95% confidence intervals (A). T1ρ was 92.0±4.9 ms (mean ± std. error) for the control group and in the LBP cohorts’ discs without pain was 83.6±3.2 ms and with pain was 55.3ms±3.0 ms. Mean OP in the painful discs along with the respective 95% confidence intervals (B) was 19.1±0.7 psi (mean ± std. error) and 11.8±1.0 psi, in the non-painful and painful cohorts respectively. The percent decrease between cohorts and the significance of this difference (p-value) are shown.
Figure 3
Figure 3
T1ρ in the NP correlates significantly with Pfirrmann degenerative grade (A) with r= 0.59 (p< 0.001) from painful discs ( formula image, n=25) discs with no pain ( formula image, n=43) in the LBP cohort and in control discs (△, n=44). Disc OP and Pfirrmann grade (B) are correlated significantly with r=-0.52 (p<0.001) in LBP patients with painful discs ( formula image) discs with no pain ( formula image).
Figure 4
Figure 4
T1ρ was correlated with disc OP (r=0.54, p<0.001) with painful discs ( formula image) exhibiting both lower pressure and T1ρ values compared to discs with no pain ( formula image). The horizontal lines indicate significantly (p<0.001) different mean T1ρ of the painful (55.3 ms, solid line) and non-painful (83.6 ms, dashed line). Also shown are the 95% confidence limits for both means as corresponding curved lines.
Figure 5
Figure 5
ROC curve of T1ρ and OP as predictors of painful discs. The results are summarized in Table 1.
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