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Journal ArticleDOI

Espetroscopia (1H) por ressonância magnética do disco intervertebral lombar no adulto e sua aplicação na rotina imagiológica

01 Nov 2014-Saúde & Tecnologia (Escola Superior de Tecnologia da Saúde de Lisboa)-Iss: 12, pp 24-32

TL;DR: The (1H) spectroscopy of intervertebral discs may contribute with a supplementary semiology to the conventional MRI and suggest that disc degeneration vs involution in higher degrees defines a decrease in the lactate’s peak.

AbstractAims – To assess the potential of magnetic resonance spectroscopy (1H‑MRS) in the diagnostic of degenerative disease of the lumbar disc and to advocate the adding of this technique in the classification of the invertebral disc involution vs degeneration (L4‑L5 and L5‑S1) in the clinical routine of lumbar pain status, not related with mechanic causes. Material and method – We studied 102 out of 123 lumbar intervertebral discs. The distribution among spaces was 61 discs at L4‑L5, 41 at L5‑S1 level and 34 at D12‑L1 level. The magnetic resonance studies were performed using a 1.5 T scan-ner. A single‑voxel Point Resolved Spectra Selection (PRESS) technique was used. The ratios [Lac/Nacetyl], [Nacetyl/(Lac+Lip)] and additionally the resonance of lipids were applied to evaluate the biochemistry of the discs, its involution, disc disruption and eventual susceptibility to initiate degeneration process. The ratios and the lipidic value of L4‑L5‑S1 discs were ascertained with the different behavior of D12‑L1. Furthermore, the comparison between L4‑L5, L5‑S1 and D12‑L1 discs was performed according with rating in T2 weighted (adjusted scale 1‑4 from Pfirrmann1 criteria). Results – Related to D12‑L1, the ratios and the lipids of L4‑L5‑S1 discs are statistically different. When used as a complementary of conventional T2 weighted, they have a good discrimination in the all degrees of disc involution vs degeneration. The ratio [Lac/Nacetyl] at L4‑L5‑S1 level was increased when compared to D12‑L1 (p=0.033 for disks with [1+2] score of involution and p=0.004 for disks with score [3+4]). These results suggest that disc degeneration vs involution in higher degrees defines a decrease in the lactate’s peak. The ratio [Nacetyl/(Lac+Lip)] provides a good discrimination of involution between scores [1+2] and [3+4] at L4‑L5 level, presenting the values of the ratios (mean 0.65 and 0.5 with p=0.04). The mean ratio of [Nacetyl/(Lac+Lip)] in the L4‑L5 disc was 1.8 times higher than that of L1‑D12. The lipid spectrum at L4‑L5‑S1 in the higher scores showed no constant prevalence in the resonance frequencies. Conclusion – The (1H) spectroscopy of intervertebral discs may contribute with a supplementary semiology to the conventional MRI. The resonances of L4‑L5 and L5‑S1 discs, involuted or degenerated, must be related with D12‑L1, which are more stable and have lower likelihood of disc degeneration.

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References
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Journal ArticleDOI
Abstract: We performed magnetic resonance imaging on sixty-seven individuals who had never had low-back pain, sciatica, or neurogenic claudication. The scans were interpreted independently by three neuro-radiologists who had no knowledge about the presence or absence of clinical symptoms in the subjects. About one-third of the subjects were found to have a substantial abnormality. Of those who were less than sixty years old, 20 per cent had a herniated nucleus pulposus and one had spinal stenosis. In the group that was sixty years old or older, the findings were abnormal on about 57 per cent of the scans: 36 per cent of the subjects had a herniated nucleus pulposus and 21 per cent had spinal stenosis. There was degeneration or bulging of a disc at at least one lumbar level in 35 per cent of the subjects between twenty and thirty-nine years old and in all but one of the sixty to eighty-year-old subjects. In view of these findings in asymptomatic subjects, we concluded that abnormalities on magnetic resonance images must be strictly correlated with age and any clinical signs and symptoms before operative treatment is contemplated.

2,542 citations


Journal ArticleDOI
01 Sep 2001-Spine
TL;DR: Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation.
Abstract: Study design A reliability study was conducted Objectives To develop a classification system for lumbar disc degeneration based on routine magnetic resonance imaging, to investigate the applicability of a simple algorithm, and to assess the reliability of this classification system Summary of background data A standardized nomenclature in the assessment of disc abnormalities is a prerequisite for a comparison of data from different investigations The reliability of the assessment has a crucial influence on the validity of the data Grading systems of disc degeneration based on state of the art magnetic resonance imaging and corresponding reproducibility studies currently are sparse Methods A grading system for lumbar disc degeneration was developed on the basis of the literature An algorithm to assess the grading was developed and optimized by reviewing lumbar magnetic resonance examinations The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients (33 men and 27 women) with a mean age of 40 years (range, 10-83 years) All scans were analyzed independently by three observers Intra- and interobserver reliabilities were assessed by calculating kappa statistics Results There were 14 Grade I, 82 Grade II, 72 Grade III, 68 Grade IV, and 64 Grade V discs The kappa coefficients for intra- and interobserver agreement were substantial to excellent: intraobserver (kappa range, 084-090) and interobserver (kappa range, 069-081) Complete agreement was obtained, on the average, in 838% of all the discs A difference of one grade occurred in 159% and a difference of two or more grades in 13% of all the cases Conclusion Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation

2,506 citations


Book
01 Dec 1987
TL;DR: This book discusses Radiography and Related Diagnostic Techniques in the Evaluation of Bone, Joint and Soft Tissue Diseases and their applications in Musculoskeletal Diseases.
Abstract: Volume I: Radiography and Related Diagnostic Techniques in the Evaluation of Bone, Joint and Soft Tissue Diseases. Imaging of the Postoperative Patient . Volume II: Basic Sciences of Musculoskeletal Diseases. Rheumatoid Arthritis and Related Diseases. Connective Tissue Diseases . Volume III: Degenerative Diseases. Crystal-Induced and Related Diseases. Temporomandibular Manifestations of Articular Diseases. Target Area Approach to Articular Diseases. Volume IV: Metabolic Disease. Endocrine Diseases. Diseases of the Hematopoietic System. Infectious Diseases. Volume V: Traumatic, Iatrogenic and Neurogenic Diseases. Osteonecrosis and Osteochondrosis. Volume VI: Tumours and Tumor-Like Diseases. Congenital Diseases. Miscellaneous Diseases

2,257 citations


Journal ArticleDOI
TL;DR: It is suggested that structural changes within the annulus and endplate lead to a transfer of load from the nucleus to the posterior annulus, and high 'stress' concentrations within the Annulus may cause pain, and lead to further disruption.
Abstract: We investigated the distribution of compressive 'stress' within cadaver intervertebral discs, using a pressure transducer mounted in a 13 mm diameter needle The needle was pulled along the midsagittal diameter of a lumbar disc with the face of the transducer either vertical or horizontal while the disc was subjected to a constant compressive force The resulting 'stress profiles' were analysed in order to characterise the distribution of vertical and horizontal compressive stress within each disc A total of 87 discs from subjects aged between 16 and 87 years was examined Our results showed that age-related degenerative changes reduced the diameter of the central hydrostatic region of each disc (the 'functional nucleus') by approximately 50%, and the pressure within this region fell by 30% The width of the functional annulus increased by 80% and the height of compressive 'stress peaks' within it by 160% The effects of age and degeneration were greater at L4/L5 than at L2/L3, and the posterior annulus was affected more than the anterior Age and degeneration were themselves closely related, but the stage of degeneration had the greater effect on stress distributions We suggest that structural changes within the annulus and endplate lead to a transfer of load from the nucleus to the posterior annulus High 'stress' concentrations within the annulus may cause pain, and lead to further disruption

652 citations


Journal ArticleDOI
01 Feb 1988-Spine
TL;DR: Using data from 16 published reports, the authors correlated macroscopic disc degeneration grades with age, sex, and spine level in 600 lumbar Intervertebral discs from 273 cadavers and suggest that higher mechanical stress, perhaps combined with longer nutritional pathways, may be responsible for the earlier degeneration of male discs.
Abstract: Using data from 16 published reports, the authors correlated macroscopic disc degeneration grades with age, sex, and spine level in 600 lumbar intervertebral discs from 273 cadavers (ages: 0-96 years). Male discs were more degenerated than female discs at most ages; significantly so in the second, fifth, sixth, and seventh decades. On average, L4-L5 and L3-L4 level discs showed more degeneration than discs at other lumbar levels. These macroscopic findings corroborate radiographic data from epidemiologic studies. The calculations suggest that higher mechanical stress, perhaps combined with longer nutritional pathways, may be responsible for the earlier degeneration of male discs.

586 citations