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. 2024 May 27:15:1394189.
doi: 10.3389/fphys.2024.1394189. eCollection 2024.

Evaluation of spine disorders using high contrast imaging of the cartilaginous endplate

Jiyo S Athertya  1 , Sheronda Statum  1 , Xiaojun Chen  1 , Kevin Du  1 , Soo Hyun Shin  1 , Saeed Jerban  1 , Christine B Chung  1   2 , Eric Y Chang  1   2 , Yajun Ma  1
Affiliations

Evaluation of spine disorders using high contrast imaging of the cartilaginous endplate

Jiyo S Athertya et al. Front Physiol. .

Abstract

Introduction: Many spine disorders are caused by disc degeneration or endplate defects. Because nutrients entering the avascular disc are channeled through the cartilaginous endplate (CEP), structural and compositional changes in the CEP may block this solute channel, thereby hindering disc cell function. Therefore, imaging the CEP region is important to improve the diagnostic accuracy of spine disorders. Methods: A clinically available T1-weighted and fat-suppressed spoiled gradient recalled-echo (FS-SPGR) sequence was optimized for high-contrast CEP imaging, which utilizes the short T1 property of the CEP. The FS-SPGR scans with and without breath-hold were performed for comparison on healthy subjects. Then, the FS-SPGR sequence which produced optimal image quality was employed for patient scans. In this study, seven asymptomatic volunteers and eight patients with lower back pain were recruited and scanned on a 3T whole-body MRI scanner. Clinical T2-weighted fast spin-echo (T2w-FSE) and T1-weighted FSE (T1w-FSE) sequences were also scanned for comparison. Results: For the asymptomatic volunteers, the FS-SPGR scans under free breathing conditions with NEX = 4 showed much higher contrast-to-noise ratio values between the CEP and bone marrow fat (BMF) (CNRCEP-BMF) (i.e., 7.8 ± 1.6) and between the CEP and nucleus pulposus (NP) (CNRCEP-NP) (i.e., 6.1 ± 1.2) compared to free breathing with NEX = 1 (CNRCEP-BMF: 4.0 ± 1.1 and CNRCEP-NP: 2.5 ± 0.9) and breath-hold condition with NEX = 1 (CNRCEP-BMF: 4.2 ± 1.3 and CNRCEP-NP: 2.8 ± 1.3). The CEP regions showed bright linear signals with high contrast in the T1-weighted FS-SPGR images in the controls, while irregularities of the CEP were found in the patients. Discussion: We have developed a T1-weighted 3D FS-SPGR sequence to image the CEP that is readily translatable to clinical settings. The proposed sequence can be used to highlight the CEP region and shows promise for the detection of intervertebral disc abnormalities.

Keywords: CEP; contrast enhancement; degenerations; spine disorders; spine imaging.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

FIGURE 1
FIGURE 1
Sequence diagram of the 3D fat-suppressed spoiled gradient echo (FS-SPGR) sequence. The product SPECtral Inversion At Lipid (SPECIAL) technique was used for fat suppression.
FIGURE 2
FIGURE 2
Clinical FS T2w-FSE (A,F) and T1w-FSE (B,G) images as well as 3D FS-SPGR images (C–E,H–J) from a 32-year-old and a 38-year-old healthy male subject, respectively. Panels (C,H) and (D,I) show the single NEX FS-SPGR images with and without breath-hold (BH) for the two different controls respectively. To improve the SNR, NEX was increased to 4 for the free breathing scan (E,J), with yellow arrows indicating the high contrast CEP region.
FIGURE 3
FIGURE 3
Clinical FS T2w-FSE (A,D) and T1w-FSE (B,E) images as well as 3D FS-SPGR (free breathing, NEX = 4) (C,F) images acquired from two patients with lower back pain (first row: 67-year-old female; second row: 61-year-old male). The abnormal CEP regions are indicated by red arrows in panels (C,F) while other pathologies like disc desiccation [panel (A)], Schmorl’s nodes [panel (F)], Modic II changes [panel (B)] are pointed by yellow arrows.
FIGURE 4
FIGURE 4
Clinical FS T2w-FSE (A,D) and T1w-FSE (B,E) images as well as 3D FS-SPGR (free breathing, NEX = 4) (C,F) images acquired from two patients with lower back pain (first row: 70-year-old female; second row: 46-year-old female). The CEP discontinuities are indicated by red arrows in panels (C,F) while the other pathologies, namely, Modic I changes [panel (A)], mild disc desiccation [panel (C)] and disc loss and vacuum [panel (C)] are marked by yellow arrows.
FIGURE 5
FIGURE 5
Clinical FS T2w-FSE (A,D) and T1w-FSE (B,E) images as well as 3D FS-SPGR (free breathing, NEX = 4) (C,F) images acquired from two patients with lower back pain (first row: 63-year-old male; second row: 67-year-old male). The CEP disruptions are pointed by red arrow and Schmorl’s nodes are indicated by yellow arrows in panels (C,F), respectively.
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