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- Eriksson, Stefanie, et al.
(author)
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Texture Analysis of Magnetic Resonance Images Enables Phenotyping of Potentially Painful Annular Fissures.
- 2022
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In: Spine. - 1528-1159. ; 47:5, s. 430-437
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Journal article (peer-reviewed)abstract
- Retrospective analysis of prospectively collected data.To investigate whether intervertebral disc (IVD) image features, extracted from magnetic resonance (MR) images, can depict the extension and width of annular fissures and associate them to pain.Annular fissures are suggested to be associated with low back pain (LBP). Magnetic resonance imaging (MRI) is a sensitive method, yet fissures are sometimes unobservable in T2-weighted MR-images, even though fissure information is present in the image. Image features can mathematically be calculated from MR-images and might reveal fissure characteristics.44 LBP patients who underwent MRI, low-pressure discography (<50psi) and computed tomography (CT) sequentially in one day, were reviewed. After semi-automated segmentation of 126 discs, image features were extracted from the T2-weighted images. The number of image features were reduced with principle component analysis (PCA). CT-discograms were graded and dichotomized regarding extension and width of fissures. IVDs were divided into fissures extending to outer annulus vs. short/no fissures. Fissure width was dichotomized into narrow (<10%) vs. broad fissures (>10%), and into moderately broad (10%-50%) vs. very broad fissures (>50%). Logistic regression was performed to investigate if image features could depict fissure extension to outer annulus and fissure width. As a sub-analysis, the association between image features used to depict fissure characteristics and discography-provoked pain-response were investigated.Fissure extension could be depicted with sensitivity/specificity=0.97/0.77 and area under curve (AUC)=0.97. Corresponding results for width depiction were sensitivity/specificity=0.94/0.39 and 0.85/0.62, and AUC=0.86 and 0.81 for narrow vs. broad and moderately broad vs. very broad fissures respectively. Pain prediction with image features used for depicting fissure characteristics showed sensitivity/specificity=0.90/0.36, 0.88/0.4, 0.93/0.33; AUC=0.69, 0.75 and 0.73 respectively.Standard MR-images contains fissure information associated to pain that can be depicted with image features, enabling non-invasive phenotyping of potentially painful annular fissures.Level of Evidence: 2.
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| 3. |
- Hebelka, Hanna, 1977, et al.
(author)
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Pressure Increase in Adjacent Discs During Clinical Discography, Questions the Methods Validity.
- 2014
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In: Spine. - 1528-1159. ; 39:11, s. 893-899
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Journal article (peer-reviewed)abstract
- Study Design. Observational in vivo clinical studyObjective. To investigate whether intradiscal pressure is transferred to adjacent discs during clinical discography in subjects with discogenic painSummary of Background Data. Despite the introduction of pressure registration in discography, the validity of the method remains controversial. Discography in vivo in anesthetized pigs has shown that the pressure increase during disc injection is transmitted to adjacent discs. If pressure transmission is confirmed in human spines, it could be a potential source of false positive discography responses.Methods. 25 discograms were performed in nine consecutive patients. A pressure sensor was introduced through a 22 G needle into the nucleus pulposus in two adjacent discs. Contrast was injected with a manometer (approx. 0.03 ml/s) into one of the discs, while intradiscal pressure was measured simultaneously in both discs. The injection continued until one of the endpoints was reached - concordant pain with an intensity of ≥ 5/10, intradiscal pressure of 80 psi (absolute pressure) and/or 3.5 ml contrast volume.Results. Intradiscal pressure was successfully measured in 22 adjacent discs of which seven were not filled with contrast and 15 were pre-filled from the previous discogram. A mean pressure increase of 13 psi (range 3-42) was recorded in 54% (12) of the adjacent discs, corresponding to an increase of 62% above baseline. Of discograms inducing pressure transmission, all had Pfirrmann degeneration grade of ≥ 3 and, of adjacent discs with increased pressure, 75% had degeneration of ≥ 3. Maximum pressure in injected discs averaged 35 psi above opening pressure (range 10-69).Conclusion. Clinical discography induces a pressure increase in adjacent discs. The induced pressure increase was of a clinically relevant magnitude and was evident despite low absolute pressures in the injected disc. Pressure transmission during discography constitutes a potential major source of false positive responses, questioning the ability of discography to provoke pain at just a single disc level.
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| 4. |
- Hutchins, John, et al.
(author)
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Evaluation of Cervical Vertebral Motion and Foraminal Changes During the Spurling Test Using Zero Echo Time Magnetic Resonance Imaging and Computed Tomography-Based Micromotion Analysis
- 2024
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In: SPINE. - 0362-2436 .- 1528-1159. ; 49:14
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Journal article (peer-reviewed)abstract
- Study Design.Clinical experimental diagnostic study.Objective.The objective of the study was to investigate cervical spine dynamics including changes in the cervical foramina in patients experiencing intermittent arm radiculopathy.Background.Cervical foraminal stenosis is a frequent cause of radicular arm pain. The Spurling test, while specific, lacks the precision to identify symptomatic nerve roots. The relationship among vertebral motion, foraminal changes, and radiculopathy during a Spurling test remains underexplored.Patients and Methods.Ten patients with positive Spurling tests and magnetic resonance imaging (MRI) confirmed 1 or 2-level cervical foraminal stenosis were scanned using the Dynamic MRI Compression System enabling a simulated Spurling test inside the MRI gantry of a 3T MRI scanner with a dedicated neck coil. First, a relaxed image acquisition was undertaken, followed by slowly applying the Spurling test until the patient reported aggravation of radiculopathy or discomfort, where the next image series was taken. Zero echo time MRI was employed to obtain computed tomography (CT)-like images. The images were thereafter analyzed using the Sectra (R) CT-based Micromotion Analysis software for motion analysis.Results.The C4/C5 level exhibited the most significant movements both in translation and rotation, with less movements observed in C5 to C6 and C6 to C7 levels. No uniform pattern emerged that differentiated suspected stenotic levels from nonsuspected levels. Despite relatively small vertebral movements, 9/10 of patients reported arm pain during provocation, indicating extremely narrow margins of tolerance.Conclusion.This study demonstrates the utility of zero echo time MRI and CT-based Micromotion Analysis in detecting subtle yet clinically relevant vertebral motions influencing the foramina in the cervical spine during the Spurling maneuver. These findings could lead to a better understanding and potentially improved diagnostic strategies for cervical foraminal stenosis, although further research with a larger cohort is necessary to confirm these results.
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| 5. |
- Torén, Leif, et al.
(author)
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Different Load-Induced Alterations in Intervertebral Discs Between Low Back Pain Patients and Controls
- 2024
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In: SPINE. - 0362-2436 .- 1528-1159. ; 49:15
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Journal article (peer-reviewed)abstract
- Study Design. Prospective cohort study. Objective. Investigate load-induced effects in lumbar intervertebral discs (IVDs) and differences between low back pain (LBP) patients and controls. Summary of Background Data.T2-map values, obtained from quantitative MRI sequences, reflect IVD tissue composition and integrity. Feasibility studies with T2-mapping indicate different load-induced effects in entire IVDs and posterior IVD parts between LBP patients and controls. Larger studies are required to confirm these findings and increase the understanding of specific characteristics distinguishing IVD changes in LBP patients compared with controls. Materials and Methods. Lumbar IVDs of 178 patients (mean age: 43.8 yr; range: 20-60 yr) with >3 months of LBP and 74 controls (mean age: 40.3 yr; range: 20-60 yr) were imaged with T2-map sequence in a 3T scanner in supine position without axial load, immediately followed by a repeated examination, using the same sequence, with axial load. On both examinations, mean T2-map values were obtained from entire IVDs and from central/posterior IVD parts on the three midsagittal slices in 855 patient IVDs and 366 control IVDs. Load-induced effect was compared with Fold-change ratio and adjusted for IVD-degeneration grade. Results. Loading induced an increase in T2-map values in both patients and controls. Excluding most extreme values, the ranges varied between -15% and +35% in patients and -11% and +36% in controls (first to 99th percentile). Compared with controls, the T2-map value increase in patients was 2% smaller in entire IVDs (Fold-change: 0.98, P=0.031), and for central and posterior IVD parts 3% (Fold-change: 0.98, P=0.005), respectively, 2% (Fold-change: 0.9, P=0.015) smaller. Conclusions. This quantitative study confirmed diverse load-induced behaviors between LBP patients and controls, suggesting deviant biomechanical characteristics between IVDs in patients and controls not only attributed to the global grade of degeneration. These findings are an important step in the continuous work of identifying specific IVD phenotypes for LBP patients. Level of Evidence.Level II.
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| 6. |
- Torén, Leif, et al.
(author)
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MRI During Spinal Loading Reveals Intervertebral Disc Behavior Corresponding to Discogram Findings of Annular Fissures and Pain Provocation. : Torén L, Lagerstrand K, Waldenberg C, Brisby H, Hebelka H.
- 2020
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In: Spine. - 0362-2436 .- 1528-1159. ; 45:22
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Journal article (peer-reviewed)abstract
- Study design: Retrospective analysis of prospectively collected data. Objective: The aim of this study was to investigate whether spinal loading, depicted with magnetic resonance imaging (MRI), induces regional intervertebral disc (IVD) differences associated with presence and width of annular fissure and induced pain at discography. Summary of background data: Annular fissures play a role in low back pain (LBP) but cannot be accurately characterized with conventional MRI. Recently, annular fissures were suggested to influence different load-induced IVD behavior during MRI when comparing LBP-patients and controls. Thus, the loading effect could characterize behavior related to annular fissures noninvasively with MRI. Methods: Lumbar spines of 30 LBP-patients were investigated with MRI with and without loading, discography and CT. Five IVD regions were outlined on sagittal MRI images. Difference in normalized signal intensity (SI) with and without loading was calculated for each region. Eighty-three CT-discograms were graded regarding presence and width of fissures. Discograms were classified as pain-positive if a concordant pain response was obtained at a pressure <50 psi. Results: Comparing IVDs with outer fissures with IVDs without fissures, loading induced different behavior in the two ventral regions and in the posterior region. Higher SI increase in the central region was induced in IVDs with narrower fissures compared to IVDs with wider fissures. In the group of pain-negative discograms, a SI decrease was induced in the dorsal region whereas lack of such in the pain-positive group. Conclusion: The spinal loading-effect, depicted with MRI, reveals different regional behaviors between IVDs with outer fissures compared to those without, and between IVDs with narrow and broad fissures, as well as within posterior annulus between pain-positive and pain-negative discograms. Findings are of importance for future attempts to uncover phenotypes of painful IVDs.
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