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Kuisma, M., Karppinen, J., Niinimaki, J., Ojala, R., Haapea, M., Heliovaara, M., Korpelainen, R., Taimela, S., Natri, A. and Tervonen, O. (2007) Modic changes in end-plates of lumbar vertebral bodies: Prevalence and association with low back and sciatic pain among middle-aged male workers. Spine (Phila Pa 1976), 32, 1116- 1122.

has been cited by the following article:

• TITLE: Normalized intervertebral disc MRI signal as a biomarker of pain

  AUTHORS: Mohamed Aissiou, Delphine Périé, Jean-Marc Mac-Thiong

  KEYWORDS: MRI; Intervertebral Disc; Normalized Signal Intensity; Low Back Pain; Vertebral Fractures

  JOURNAL NAME: Journal of Biomedical Science and Engineering, Vol.6 No.3A, March 29, 2013

  ABSTRACT: The drop in the MRI signal intensity, analysed without any normalisation, was found related to the intervertebral disc degeneration, but its association with low back pain remains controversial. The authors developed the analysis of MR signal intensity distribution (AMRSID) method that analyzes the 3D distribution of the normalized T2-weighted MR signal intensity within the intervertebral disc using descriptive statistics of histograms and weighted centers. In this study, we hypothesized that the distribution of the normalized MRI signal intensity within T2- weighted images of the intervertebral disc is a bio-marker of low back pain (LBP) independently of age and disc degenerescence. The aims were to: 1) characterize intervertebral disc degeneration in vertebral fracture from MR T1-weighted and T2-weighted images; 2) evaluate the sensitivity of the normalized MRI signal distribution to the presence of LBP, discs height loss and aging. We prospectively studied 22 patients who underwent an MRI acquisition within 48h after an accidental lumbar vertebral fracture. The presence of prefracture low back pain, spinal stenosis, annular disruption, intervertebral disc height loss was noted from each patient’s medical record. The presence of Modic changes, High-Intensity Zones (HIZs) and vertebral endplate perforations was recorded from MRI. The descriptive statistics of the normalized T2-weighted signal were compared using one-way ANOVAs and a principal component analysis was proposed. MRI, associated to normalisation of the signal intensity and principal component analysis, offers a remarkable potential for in-vivo imaging and analysis of vertebral fractures and adjacent tissues for the patient’s follow-up. The mean normalized MRI signal intensity of the adjacent intervertebral disc to the vertebral fracture was found to be a bio-marker of pain, independently of age and disc degeneration. However, the parameters describing the distribution of the normalized signal intensity were found to be not sensitive to the presence of low back pain, discs height loss and aging. Further studies need to be performed to detect small abnormalities that may explain the presence of LBP.