Espetroscopia (1H) por ressonância magnética do disco intervertebral lombar no adulto e sua aplicação na rotina imagiológica
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.
Abstract: Aims – 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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TL;DR: Axial T2* mapping is effective to detect early stages of degenerative disc disease in patients suffering from lumbar spine problems using 1.5-Tesla magnetic resonance imaging (MRI) in a clinical setting.
Abstract: Objectives
To demonstrate the potential benefits of biochemical axial T2* mapping of intervertebral discs (IVDs) regarding the detection and grading of early stages of degenerative disc disease using 1.5-Tesla magnetic resonance imaging (MRI) in a clinical setting.
61 citations
Book•
01 Jan 2014
TL;DR: Quantitative MRI of the Spinal Cord introduces the theory behind each quantitative technique, reviews each theory's applications in the human spinal cord and describes its pros and cons, and suggests a simple protocol for applying each quantitative techniques to the spinal cord.
Abstract: Quantitative MRI of the Spinal Cord is the first book focused on quantitative MRI techniques with specific application to the human spinal cord. This work includes coverage of diffusion-weighted imaging, magnetization transfer imaging, relaxometry, functional MRI, and spectroscopy. Although these methods have been successfully used in the brain for the past 20 years, their application in the spinal cord remains problematic due to important acquisition challenges (such as small cross-sectional size, motion, and susceptibility artifacts). To date, there is no consensus on how to apply these techniques; this book reviews and synthesizes state-of-the-art methods so users can successfully apply them to the spinal cord. Quantitative MRI of the Spinal Cord introduces the theory behind each quantitative technique, reviews each theory's applications in the human spinal cord and describes its pros and cons, and suggests a simple protocol for applying each quantitative technique to the spinal cord. * Chapters authored by international experts in the field of MRI of the spinal cord* Contains "cooking recipes -examples of imaging parameters for each quantitative technique-designed to aid researchers and clinicians in using them in practice* Ideal for clinical settings
55 citations
TL;DR: It is demonstrated for the first time that short‐echo PRESS on a clinical 3T MR scanner can be used to noninvasively and can reproducibly quantify metabolic changes associated with degeneration of intervertebral discs.
Abstract: This study examined the feasibility of using short-echo water-suppressed point-resolved spectroscopy (PRESS) on a clinical 3T magnetic resonance (MR) scanner for evaluating biochemical changes in degenerated bovine and cadaveric human intervertebral discs. In bovine discs (N = 17), degeneration was induced with papain injections. Degeneration of human cadaveric discs (N = 27) was assessed using the Pfirrmann grading on T(2)-weighted images. Chemicals in the carbohydrate region (Carb), the choline head group (Cho), the N-acetyl region (N-acetyl), and the lipid and lactate region (Lac+Lip) were quantified using (1)H PRESS, and were compared between specimens with different degrees of degeneration. The correlation between the spectroscopic findings and glycosaminoglycan (GAG) quantification using biochemical assays was determined. Significant differences were found between the ratios (N-acetyl/Cho, N-acetyl/Lac+Lip) acquired before and after papain injection in bovine discs. For human cadaveric discs, significant differences in the ratios (N-acetyl/Carb, N-acetyl/Lac+Lip) were found between discs having high and low Pfirrmann scores. Significant correlations were found between N-acetyl/Lac+Lip and GAG content in bovine discs (R = 0.77, P = 0.0007) and cadaveric discs (R = 0.83, P < 0.0001). Significant correlation between N-acetyl/Cho and GAG content was also found in cadaver discs (R = 0.64, P = 0.0039). This study demonstrates for the first time that short-echo PRESS on a clinical 3T MR scanner can be used to noninvasively and can reproducibly quantify metabolic changes associated with degeneration of intervertebral discs.
40 citations
TL;DR: New and evolving MRI disk-imaging techniques, including grading, relaxation-time measurements, diffusion, and contrast perfusion, and high-resolution magic-angle spinning methods to correlate in vitro disk degeneration (with pain, etc) and in vivo spectroscopic results are discussed.
26 citations
TL;DR: This review of cervical and lumbar disk arthroplasty highlights the clinical results and experience with standard fusion techniques, incidence of ALD in the population of patients with surgical fusion, and indications for arthro Plasty, as well as the biomechanical and clinical outcomes following arthro plasty.
Abstract: In contrast to cervical and lumbar fusion procedures, the principal aim of disk arthroplasty is to recapitulate the normal kinematics and biomechanics of the spinal segment affected. Following decompression of the neural elements, disk arthroplasty allows restoration of disk height and maintenance of spinal alignment. Based on clinical observations and biomechanical testing, the anticipated advantage of arthroplasty over standard arthrodesis techniques has been a proposed reduction in the development of symptomatic ALD. In this review of cervical and lumbar disk arthroplasty, we highlight the clinical results and experience with standard fusion techniques, incidence of ALD in the population of patients with surgical fusion, and indications for arthroplasty, as well as the biomechanical and clinical outcomes following arthroplasty. In addition, we introduce the devices currently available and provide a critical appraisal of the clinical evidence regarding arthroplasty procedures.
24 citations