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Axial loading during MRI reveals deviant characteristics within posterior IVD regions between low back pain patients and controls

Journal article
Authors Hanna Hebelka
Leif Torén
Kerstin M Lagerstrand
Helena Brisby
Published in European Spine Journal
Volume 27
Issue 11
Pages 2840-2846
ISSN 0940-6719
Publication year 2018
Published at Institute of Clinical Sciences
Pages 2840-2846
Language en
Keywords Intervertebral disk, T2-mapping, Low back pain, MRI, Axial loading during MRI, lumbar intervertebral disc, magnetic-resonance, annulus fibrosus, nucleus pulposus, water-content, 3.0 tesla, degeneration, spine, feasibility, repair, Neurosciences & Neurology, Orthopedics
Subject categories Clinical chemistry


Purpose To investigate differences in functional intervertebral disk (IVD) characteristics between low back pain (LBP) patients and controls using T2-mapping with axial loading during MRI (alMRI). Methods In total, 120 IVDs in 24 LBP patients (mean age 39years, range 25-69) were examined with T2-mapping without loading of the spine (uMRI) and with alMRI (DynaWell((R)) loading device) and compared with 60 IVDs in 12 controls (mean age 38 years, range 25-63). The IVD T2-value was acquired after 20-min loading in five regions of interests (ROI), ROI1-5 from anterior to posterior. T2-values were compared between loading states and cohorts with adjustment for Pfirrmann grade. Results In LBP patients, mean T2-value of the entire IVD was 64 ms for uMRI and 66 ms for alMRI (p = 0.03) and, in controls, 65 ms and 65 ms (p = 0.5). Load-induced T2-differences (alMRI-uMRI) were seen in all ROIs in both patients (0.001>p<0.005) and controls (0.0001>p<0.03). In patients, alMRI induced an increase in T2-value for ROI1-3 (23%, 18% and 5%) and a decrease for ROI4 (3%) and ROI5 (24%). More pronounced load-induced decrease was detected in ROI4 in controls (9%/p=0.03), while a higher absolute T2-value was found for ROI5 during alMRI in patients (38 ms) compared to controls (33 ms) (p = 0.04). Conclusion The alMRI-induced differences in T2-value in ROI4 and ROI5 between patients and controls most probably indicate biomechanical impairment in the posterior IVD regions. Hence, alMRI combined with T2-mapping offers an objective and clinical feasible tool for biomechanical IVD characterization that may deepen the knowledge regarding how LBP is related to altered IVD matrix composition.

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