PDF herunterladen
Rofo 2018; 190(02): 152-160
DOI: 10.1055/s-0043-118130
Musculoskeletal System
© Georg Thieme Verlag KG Stuttgart · New York

Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences

Modic-Typ-1-Endplattenveränderungen: Detektionsrate mittels fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen
Tim Finkenstaedt
1   Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Filippo Del Grande
2   Institute of Diagnostic and Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
,
Nicolae Bolog
3   Phoenix Diagnostic Clinic, Bucharest, Romania
,
Nils Ulrich
4   Department of Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
,
Sina Tok
4   Department of Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland
,
Orpheus Kolokythas
5   Institute for Radiology and Nuclear Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
,
Johann Steurer
6   Horten Center for patient oriented research and knowledge transfer, University Hospital Zurich, Zurich, Switzerland
,
Gustav Andreisek
1   Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
Sebastian Winklhofer
1   Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
7   Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
,
on behalf of the LSOS Study Group › Institutsangaben
Weitere Informationen

Publikationsverlauf

06. April 2017

25. Juli 2017

Publikationsdatum:
27. November 2017 (online)

Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Purpose To assess the performance of fat-suppressed fluid-sensitive MRI sequences compared to T1-weighted (T1w) / T2w sequences for the detection of Modic 1 end-plate changes on lumbar spine MRI.

Materials and Methods Sagittal T1w, T2w, and fat-suppressed fluid-sensitive MRI images of 100 consecutive patients (consequently 500 vertebral segments; 52 female, mean age 74 ± 7.4 years; 48 male, mean age 71 ± 6.3 years) were retrospectively evaluated. We recorded the presence (yes/no) and extension (i. e., Likert-scale of height, volume, and end-plate extension) of Modic I changes in T1w/T2w sequences and compared the results to fat-suppressed fluid-sensitive sequences (McNemar/Wilcoxon-signed-rank test).

Results Fat-suppressed fluid-sensitive sequences revealed significantly more Modic I changes compared to T1w/T2w sequences (156 vs. 93 segments, respectively; p < 0.001). The extension of Modic I changes in fat-suppressed fluid-sensitive sequences was significantly larger compared to T1w/T2w sequences (height: 2.53 ± 0.82 vs. 2.27 ± 0.79, volume: 2.35 ± 0.76 vs. 2.1 ± 0.65, end-plate: 2.46 ± 0.76 vs. 2.19 ± 0.81), (p < 0.05). Modic I changes that were only visible in fat-suppressed fluid-sensitive sequences but not in T1w/T2w sequences were significantly smaller compared to Modic I changes that were also visible in T1w/T2w sequences (p < 0.05).

Conclusion In conclusion, fat-suppressed fluid-sensitive MRI sequences revealed significantly more Modic I end-plate changes and demonstrated a greater extent compared to standard T1w/T2w imaging.

Key Points 

  • When the Modic classification was defined in 1988, T2w sequences were heavily T2-weighted and thus virtually fat-suppressed.

  • Nowadays, the bright fat signal in T2w images masks edema-like changes.

  • The conventional definition of Modic I changes is not fully applicable anymore.

  • Fat-suppressed fluid-sensitive MRI sequences revealed more/greater extent of Modic I changes.

Citation Format

  • Finkenstaedt T, Del Grande F, Bolog N et al. Modic Type 1 Changes: Detection Performance of Fat-Suppressed Fluid-Sensitive MRI Sequences. Fortschr Röntgenstr 2018; 190: 152 – 160

Zusammenfassung

Ziel Ziel der Studie ist es, die Detektionsrate von Modic-Typ-1-Endplattenveränderungen mittels fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen gegenüber Standard T1- und T2-gewichteten Sequenzen an der Lendenwirbelsäule zu vergleichen.

Material und Methoden Sagittale T1, T2 und fettgesättigte, flüssigkeitssensitive MRT-Sequenzen von 100 Patienten (gesamt 500 Wirbelsegmente; 52 weiblich, Durchschnittsalter 74 ± 7,4 Jahre; 48 männlich, Durchschnittsalter 71 ± 6,3 Jahre) wurden retrospektiv untersucht. Das Vorhandensein (ja/nein) und die Ausdehnung (Likert-skalierte Höhen-, Volumen- und anteroposteriore Endplattenausdehnung) von Modic-1-Veränderungen auf T1/T2 gegenüber fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen wurden analysiert (McNemar/Wilcoxon-signed-rank test).

Ergebnisse Mittels fettgesättigter, flüssigkeitssensitiver MRT-Sequenzen konnten signifikant mehr Modic-1-Veränderungen detektiert werden als mittels T1-/T2-Sequenzen (156 vs. 93 Segmente; p < 0,001). Die Ausdehnung von Modic-1-Veränderungen auf fettgesättigten, flüssigkeitssensitiven MRT-Sequenzen war signifikant größer gegenüber T1-/T2-Sequenzen (Höhe: 2,53 ± 0,82 vs. 2,27 ± 0,79, Volumen: 2,35 ± 0,76 vs. 2,1 ± 0,65, Endplattenausdehnung: 2,46 ± 0,76 vs. 2,19 ± 0,81), (p < 0,05). Modic-1-Veränderungen, die nur auf fettgesättigten, flüssigkeitssensitiven Sequenzen, aber nicht auf T1-/T2-Sequenzen detektiert werden konnten, waren signifikant kleiner im Vergleich zu Modic-1-Veränderungen, die auch auf T1-/T2-Sequenzen sichtbar waren (p < 0,05).

Schlussfolgerung Fettgesättigte, flüssigkeitssensitive Sequenzen haben nicht nur signifikant häufiger Modic-1-Veränderungen, sondern auch eine größere Ausdehnung ebendieser gegenüber Standard T1-/T2-Sequenzen nachweisen können.

Kernaussagen:

  • Als die Modic-Klassifikation 1988 definiert wurde, waren T2-Sequenzen technisch bedingt nahezu fettgesättigt

  • Fettsignal aktueller T2-Sequenzen ist deutlich heller, wodurch zusätzliches Knochenmarksödem maskiert werden kann

  • Die ursprüngliche Definition von Modic-1-Veränderungen ist daher heutzutage nicht mehr zutreffend

  • Fettgesättigte, flüssigkeitssensitive Sequenzen haben häufiger/größere Ausdehnung von Modic-1-Veränderungen gegenüber T1-/T2-Sequenzen nachweisen können

Key words

modic - magnetic resonance imaging - spinal canal - bone diseases - sensitivity and specificity
 

  • References

  • 1 Gallucci M, Puglielli E, Splendiani A. et al. Degenerative disorders of the spine. Eur Radiol 2005; 15: 591-598
    CrossrefPubMedSuche in Google Scholar
  • 2 Brant-Zawadzki MN, Dennis SC, Gade GF. et al. Low back pain. Radiology 2000; 217: 321-330
    CrossrefPubMedSuche in Google Scholar
  • 3 Arnbak B, Jensen TS, Egund N. et al. Prevalence of degenerative and spondyloarthritis-related magnetic resonance imaging findings in the spine and sacroiliac joints in patients with persistent low back pain. Eur Radiol 2016; 26: 1191-1203
    CrossrefPubMedSuche in Google Scholar
  • 4 Airaksinen O, Brox JI, Cedraschi C. et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 (Suppl. 02) S192-S300
    CrossrefPubMedSuche in Google Scholar
  • 5 Modic MT, Steinberg PM, Ross JS. et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988; 166: 193-199
    CrossrefPubMedSuche in Google Scholar
  • 6 Jevtic V. Magnetic resonance imaging appearances of different discovertebral lesions. Eur Radiol 2001; 11: 1123-1135
    CrossrefPubMedSuche in Google Scholar
  • 7 Jensen TS, Karppinen J, Sorensen JS. et al. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 2008; 17: 1407-1422
    CrossrefPubMedSuche in Google Scholar
  • 8 Albert HB, Kjaer P, Jensen TS. et al. Modic changes, possible causes and relation to low back pain. Med Hypotheses 2008; 70: 361-368
    CrossrefPubMedSuche in Google Scholar
  • 9 Jarvinen J, Karppinen J, Niinimaki J. et al. Association between changes in lumbar Modic changes and low back symptoms over a two-year period. BMC Musculoskelet Disord 2015; 16: 98
    CrossrefPubMedSuche in Google Scholar
  • 10 Weishaupt D, Zanetti M, Hodler J. et al. Painful Lumbar Disk Derangement: Relevance of Endplate Abnormalities at MR Imaging. Radiology 2001; 218: 420-427
    CrossrefPubMedSuche in Google Scholar
  • 11 Mitra D, Cassar-Pullicino VN, McCall IW. Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 2004; 14: 1574-1581
    PubMedSuche in Google Scholar
  • 12 Kjaer P, Korsholm L, Bendix T. et al. Modic changes and their associations with clinical findings. Eur Spine J 2006; 15: 1312-1319
    CrossrefPubMedSuche in Google Scholar
  • 13 Liphofer JP, Theodoridis T, Becker GT. et al. (Modic) signal alterations of vertebral endplates and their correlation to a minimally invasive treatment of lumbar disc herniation using epidural injections. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2006; 178: 1105-1114
    Thieme ConnectPubMedSuche in Google Scholar
  • 14 Kuisma M, Karppinen J, Niinimaki J. et al. Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine (Phila Pa 1976) 2007; 32: 1116-1122
    CrossrefPubMedSuche in Google Scholar
  • 15 Toyone T, Takahashi K, Kitahara H. et al. Vertebral bone-marrow changes in degenerative lumbar disc disease: An MRI study of 74 patients with low back pain.. J Bone Joint Surg Br 1994; 76: 757-764
    PubMedSuche in Google Scholar
  • 16 Dudli S, Fields AJ, Samartzis D. et al. Pathobiology of Modic changes. Eur Spine J 2016; 25: 3723-3734
    CrossrefPubMedSuche in Google Scholar
  • 17 Albert HB, Manniche C. Modic changes following lumbar disc herniation. Eur Spine J 2007; 16: 977-982
    CrossrefPubMedSuche in Google Scholar
  • 18 Perilli E, Parkinson IH, Truong LH. et al. Modic (endplate) changes in the lumbar spine: bone micro-architecture and remodelling. Eur Spine J 2015; 24: 1926-1934
    CrossrefPubMedSuche in Google Scholar
  • 19 Farshad-Amacker NA, Hughes A, Herzog RJ. et al. The intervertebral disc, the endplates and the vertebral bone marrow as a unit in the process of degeneration. Eur Radiol 2017; 27: 2507-2520
    CrossrefPubMedSuche in Google Scholar
  • 20 Becker GT, Willburger RE, Liphofer J. et al. Distribution of MRI signal alterations of the cartilage endplate in pre-operated patients with special focus on recurrent lumbar disc herniation. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 2006; 178: 46-54
    Thieme ConnectPubMedSuche in Google Scholar
  • 21 Albert HB, Lambert P, Rollason J. et al. Does nuclear tissue infected with bacteria following disc herniations lead to Modic changes in the adjacent vertebrae?. Eur Spine J 2013; 22: 690-696
    CrossrefPubMedSuche in Google Scholar
  • 22 Albert HB, Sorensen JS, Christensen BS. et al. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J 2013; 22: 697-707
    CrossrefPubMedSuche in Google Scholar
  • 23 Patel ND, Broderick DF, Burns J. et al. ACR Appropriateness Criteria Low Back Pain. J Am Coll Radiol 2016; 13: 1069-1078
    CrossrefPubMedSuche in Google Scholar
  • 24 Steurer J, Nydegger A, Held U. et al. LumbSten: the lumbar spinal stenosis outcome study. BMC Musculoskelet Disord 2010; 11: 254
    CrossrefPubMedSuche in Google Scholar
  • 25 Arana E, Royuela A, Kovacs FM. et al. Lumbar spine: agreement in the interpretation of 1.5-T MR images by using the Nordic Modic Consensus Group classification form. Radiology 2010; 254: 809-817
    CrossrefPubMedSuche in Google Scholar
  • 26 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
    CrossrefPubMedSuche in Google Scholar
  • 27 Fayad F, Lefevre-Colau MM, Rannou F. et al. Relation of inflammatory modic changes to intradiscal steroid injection outcome in chronic low back pain. Eur Spine J 2007; 16: 925-931
    CrossrefPubMedSuche in Google Scholar
  • 28 Cao P, Jiang L, Zhuang C. et al. Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes. Spine J 2011; 11: 100-106
    CrossrefPubMedSuche in Google Scholar
  • 29 Mefford J, Sairyo K, Sakai T. et al. Modic type I changes of the lumbar spine in golfers. Skeletal radiology 2011; 40: 467-473
    CrossrefPubMedSuche in Google Scholar
  • 30 Delfaut EM, Beltran J, Johnson G. et al. Fat suppression in MR imaging: techniques and pitfalls. Radiographics 1999; 19: 373-382
    CrossrefPubMedSuche in Google Scholar
  • 31 Fredericson M, Bergman AG, Hoffman KL. et al. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23: 472-481
    CrossrefPubMedSuche in Google Scholar