Quantitative T2 magnetic resonance imaging compared to morphological grading of the early cervical intervertebral disc degeneration: an evaluation approach in asymptomatic young adults

Chun Chen, Minghua Huang, Zhihua Han, Lixin Shao, Yan Xie, Jianhong Wu, Yan Zhang, Hongkui Xin, Aijun Ren, Yong Guo, Deli Wang, Qing He, Dike Ruan, Chun Chen, Minghua Huang, Zhihua Han, Lixin Shao, Yan Xie, Jianhong Wu, Yan Zhang, Hongkui Xin, Aijun Ren, Yong Guo, Deli Wang, Qing He, Dike Ruan

Abstract

Objective: The objective of this study was to evaluate the efficacy of quantitative T2 magnetic resonance imaging (MRI) for quantifying early cervical intervertebral disc (IVD) degeneration in asymptomatic young adults by correlating the T2 value with Pfirrmann grade, sex, and anatomic level.

Methods: Seventy asymptomatic young subjects (34 men and 36 women; mean age, 22.80±2.11 yr; range, 18-25 years) underwent 3.0-T MRI to obtain morphological data (one T1-fast spin echo (FSE) and three-plane T2-FSE, used to assign a Pfirrmann grade (I-V)) and for T2 mapping (multi-echo spin echo). T2 values in the nucleus pulposus (NP, n = 350) and anulus fibrosus (AF, n = 700) were obtained. Differences in T2 values between sexes and anatomic level were evaluated, and linear correlation analysis of T2 values versus degenerative grade was conducted.

Findings: Cervical IVDs of healthy young adults were commonly determined to be at Pfirrmann grades I and II. T2 values of NPs were significantly higher than those of AF at all anatomic levels (P<0.000). The NP, anterior AF and posterior AF values did not differ significantly between genders at the same anatomic level (P>0.05). T2 values decreased linearly with degenerative grade. Linear correlation analysis revealed a strong negative association between the Pfirrmann grade and the T2 values of the NP (P = 0.000) but not the T2 values of the AF (P = 0.854). However, non-degenerated discs (Pfirrmann grades I and II) showed a wide range of T2 relaxation time. T2 values according to disc degeneration level classification were as follows: grade I (>62.03 ms), grade II (54.60-62.03 ms), grade III (<54.60 ms).

Conclusions: T2 quantitation provides a more sensitive and robust approach for detecting and characterizing the early stage of cervical IVD degeneration and to create a reliable quantitative in healthy young adults.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. For the representative intervertebral disc,…
Figure 1. For the representative intervertebral disc, regions of interest (ROIs) evaluation on the sagittal T2WI, an ellipse ROI was selected for the nucleus pulposus (NP).
Suitable ROIs for both the anterior and posterior annulus fibrosus (AF) were selected. Then these ROIs in T2WI were copied to the T2 map and T2 colored-map. T2 values were measured.
Figure 2. Box plots of T2 value…
Figure 2. Box plots of T2 value of both nucleus pulposus (NP) and annulus fibrosus (AF) according to the anatomic level of each disc.
The boxes represent the median and the interquartile range, with the vertical lines showing the range. *P

Figure 3. Box plots of T2 value…

Figure 3. Box plots of T2 value of nucleus pulposus (NP) by sex according to…

Figure 3. Box plots of T2 value of nucleus pulposus (NP) by sex according to the anatomic level of each disc.
White: Male; Black: Female. The boxes represent the median and the interquartile range, with the vertical lines showing the range.

Figure 4. Box plots of T2 value…

Figure 4. Box plots of T2 value of nucleus pulposus (NP) according to the grade…

Figure 4. Box plots of T2 value of nucleus pulposus (NP) according to the grade of Pfirrmann.
The boxes represent the median and the interquartile range, with the vertical lines showing the range. Three case with Pfirrmann grade IV (T2 value = 36.72) was excluded. *P

Figure 5. Receiver-operating characteristic (ROC) curve between…

Figure 5. Receiver-operating characteristic (ROC) curve between each grade in the NP and cut-off value.

Figure 5. Receiver-operating characteristic (ROC) curve between each grade in the NP and cut-off value.
The most accurate point was obtained from the ROC curve as the cut-off value. A. The T2 cut-off value between grades I and II was found to be 62.03 ms, sensitivity 83.80%, specificity 64.40%, and Area Under curve (AUC) 0.785, separately. B. The values between grades II and III were 54.60 ms, 66.80%, 71.18%, and 0.722, separately.
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Figure 3. Box plots of T2 value…
Figure 3. Box plots of T2 value of nucleus pulposus (NP) by sex according to the anatomic level of each disc.
White: Male; Black: Female. The boxes represent the median and the interquartile range, with the vertical lines showing the range.
Figure 4. Box plots of T2 value…
Figure 4. Box plots of T2 value of nucleus pulposus (NP) according to the grade of Pfirrmann.
The boxes represent the median and the interquartile range, with the vertical lines showing the range. Three case with Pfirrmann grade IV (T2 value = 36.72) was excluded. *P

Figure 5. Receiver-operating characteristic (ROC) curve between…

Figure 5. Receiver-operating characteristic (ROC) curve between each grade in the NP and cut-off value.

Figure 5. Receiver-operating characteristic (ROC) curve between each grade in the NP and cut-off value.
The most accurate point was obtained from the ROC curve as the cut-off value. A. The T2 cut-off value between grades I and II was found to be 62.03 ms, sensitivity 83.80%, specificity 64.40%, and Area Under curve (AUC) 0.785, separately. B. The values between grades II and III were 54.60 ms, 66.80%, 71.18%, and 0.722, separately.
Figure 5. Receiver-operating characteristic (ROC) curve between…
Figure 5. Receiver-operating characteristic (ROC) curve between each grade in the NP and cut-off value.
The most accurate point was obtained from the ROC curve as the cut-off value. A. The T2 cut-off value between grades I and II was found to be 62.03 ms, sensitivity 83.80%, specificity 64.40%, and Area Under curve (AUC) 0.785, separately. B. The values between grades II and III were 54.60 ms, 66.80%, 71.18%, and 0.722, separately.

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