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      An In Vitro Study of the Intervertebral Disc Structure Using 3 T Magnetic Resonance Imaging

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          Abstract

          Supplemental Digital Content is available in the text

          The potential of 3 Tesla magnetic resonance imaging (MRI) to obtain higher quality 2D/3D data-sets of the intervertebral disc (IVD) has been investigated using cadaveric IVDs and three clinical imaging protocols optimized based on image quality. Details of the IVD substructure including annulus and endplate features were seen better than what is normally seen in routine clinical MRI.

          Abstract

          Study Design.

          An in vitro magnetic resonance imaging (MRI) study.

          Objective.

          Investigate the potential of high-field MRI for producing higher quality images of the intervertebral disc (IVD) to better distinguish structural details.

          Summary of Background Data.

          Higher spatial and contrast resolution are important advantages when imaging the complex tissue structures in the spine such as the IVDs. However, at present it is challenging to capture the substructural details in the IVD such as the lamellae.

          Methods.

          Three MRI sequences; two-dimensional proton-density-weighted Turbo-Spin-Echo (PD-TSE), 2D T2-weighted Turbo-Spin-Echo (T2W-TSE) with fat-saturation (FS), and 3D Spoiled-Gradient-Echo (3D-GE), were modified based on the image quality and scan duration. IVDs of three intact cadaveric lumbar-spines (T12–S1, Age 83–94 yr) were imaged using these optimized sequences. Thereafter each IVD was transversely sectioned and the exposed surfaces were photographed. Landmark observations from corresponding MRI slices and photographs were compared to confirm the MRI captured morphology. The image quality was evaluated using signal-to-noise ratio (SNR), and relative-contrast values. Finally, the underlying tissue structures, including specific pathological features, were qualitatively compared between the MR images and photographs.

          Results.

          Observations from photographs and corresponding MRI slices matched well. The PD-TSE sequence had better overall SNR, but the relative contrast between the tissue types was relatively poor. The 3D-GE sequence had higher relative contrast between the IVD and bone, but not between annulus and nucleus regions. The T2W images provided the best relative contrast between the annulus and nucleus, however the standard deviations here were high. Structural details including fissures, vascular and granular tissue proliferation, and pathologies in the endplate region, were identifiable from the MR images obtained using the optimized sequences.

          Conclusion.

          The results demonstrate the potential of high-field MRI to capture the IVD structural details. Since the acquisition durations were within clinically acceptable levels, these methodological improvements have the potential to enhance clinical diagnostics.

          Level of Evidence: 4

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          Most cited references14

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          Modified Pfirrmann grading system for lumbar intervertebral disc degeneration.

          A reliability study was conducted. OBJECTIVE.: To modify a grading system for lumbar disc degeneration and to test the reliability of this modified grading system. The 5-level Pfirrmann grading system for disc degeneration did not prove discriminatory when used to assess disc degeneration in the elderly spine. Such discriminatory power is necessary to test the association between other variables and severity of disc degeneration. An 8-level modified grading system for lumbar disc degeneration was developed including a description of the changes expected for each grade and a 24-image reference panel. The reliability of the modified grading system was tested on 260 lumbar intervertebral discs in 52 subjects (26 men, 26 female) with a mean age of 73 years (range, 67-83 years). All examinations were analyzed independently by 3 readers. Intraobserver and interobserver reliabilities were assessed by calculating weighted kappa statistics. On average, for all 3 readers, 0.39% of the 260 discs were classified as Grade 2, 22% were classified as Grade 3, 21.5% were classified as Grade 4, 25.3% were classified as Grade 5, 19.1% were classified as Grade 6, 7.1% were classified as Grade 7, and 4.8% were classified as Grade 8. Intraobserver agreement was excellent (weighted kappa range, 0.79-0.91) with substantial interobserver agreement (weighted kappa range, 0.65-0.67). Complete intraobserver agreement was obtained, on average, in 85% of all discs with 84% of disagreement being as a result of a 1 grade difference. Complete interobserver agreement was obtained, on average, in 66% of all discs with 91% of disagreement being as a result of a 1 grade difference. The modified Pfirrmann grading system is useful at discriminating severity of disc degeneration in elderly subjects. The system can be applied with good intra- and interobserver agreement.
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            Inflammation in intervertebral disc degeneration and regeneration.

            Intervertebral disc (IVD) degeneration is one of the major causes of low back pain, a problem with a heavy economic burden, which has been increasing in prevalence as populations age. Deeper knowledge of the complex spatial and temporal orchestration of cellular interactions and extracellular matrix remodelling is critical to improve current IVD therapies, which have so far proved unsatisfactory. Inflammation has been correlated with degenerative disc disease but its role in discogenic pain and hernia regression remains controversial. The inflammatory response may be involved in the onset of disease, but it is also crucial in maintaining tissue homeostasis. Furthermore, if properly balanced it may contribute to tissue repair/regeneration as has already been demonstrated in other tissues. In this review, we focus on how inflammation has been associated with IVD degeneration by describing observational and in vitro studies as well as in vivo animal models. Finally, we provide an overview of IVD regenerative therapies that target key inflammatory players.
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              Increased nerve and blood vessel ingrowth associated with proteoglycan depletion in an ovine anular lesion model of experimental disc degeneration.

              Nerves and blood vessel distribution in discs were localized immunohistochemically and correlated with the proteoglycan contents of normal and degenerate disc tissues. The aim of the present study was to systematically evaluate whether nerve and blood vessel ingrowth was associated with depletion of disc proteoglycans and degenerative changes in an established experimental model of disc degeneration. Animal models of disc degeneration, allowing longitudinal study of pathogenic mechanisms, are limited. The ovine model enables systematic monitoring of blood vessel and nerve ingrowth during the development of disc degeneration after injury to the anulus fibrosus. Merino sheep received a controlled left anterolateral surgical defect in the outer anulus fibrosus of the L1-L2 and L3-L4 discs (lesion group); sham-operated controls received the retroperitoneal anterolateral approach only. Animals were killed 3, 6, 12, and 26 months postoperation, and the discs were collected for histology and compositional and morphologic analyses. Sagittal tissue sections were stained with toluidine blue and hematoxylin and eosin; Type IV collagen immunolocalization visualized blood vessel ingrowth, and nerves were immunolocalized using monoclonal antibodies to growth-associated protein (GAP-43), protein gene product 9.5, and glial fibrillary acidic protein. Compositional and histologic results demonstrated early focal depletion 3-12 months postoperation of glycosaminoglycan associated with lesion development, increased blood vessel and nerve ingrowth, and infiltration of cells from the outer anulus fibrosus along the plane of the original defect. Blood vessel numbers in the outer to mid third of the anulus fibrosus were elevated in the lesion discs 3-6 months postoperation reaching a maximum at 12 months postoperation; nerves immunoreactive with protein gene product 9.5 (also maximal at 12 months postoperation) were often found associated (but not exclusively) with blood vessels, and some nerves were also reactive with GAP-43 and glial fibrillary acidic protein, but only at 12 months postoperation. Nerve and blood vessel ingrowth into the anulus fibrosis were strongly associated with proteoglycan depletion. The ovine anular lesion model of disc degeneration is a useful experimental model for the systematic evaluation of nerve and blood vessel development after anular injury.
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                Author and article information

                Journal
                Spine (Phila Pa 1976)
                Spine
                BRS
                Spine
                Lippincott Williams & Wilkins
                0362-2436
                1528-1159
                1 June 2019
                15 January 2019
                : 44
                : 11
                : 793-800
                Affiliations
                []Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
                []National Institute for Health Research Leeds Biomedical Research Centre, Chapel Allerton Hospital, Chapeltown Road, Leeds, West Yorkshire, UK
                []Department of Medical Physics & Engineering, Leeds Teaching Hospitals Trust, Bexley Wing, St. James University Hospital, Leeds, UK.
                Author notes
                Address correspondence and reprint requests to Vithanage N. Wijayathunga, PhD, Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK; E-mail: V.N.Wijayathunga@ 123456leeds.ac.uk
                Article
                SPINE 157395 00014
                10.1097/BRS.0000000000002958
                6530962
                31095529
                b0fe9777-f2e0-4f99-b615-f377b7c2e0ae
                Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 20 June 2018
                : 19 October 2018
                : 19 November 2018
                Categories
                Diagnostics
                Custom metadata
                TRUE
                T

                annular fissures,annulus fibrosus,annulus lamellae,gradient echo,granular tissue,high-field magnetic resonance imaging,image quality,intervertebral disc,nucleus pulposus,relative contrast,signal to noise,spin echo

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