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Prediction of Lumbar Disk Herniation and Clinical Outcome Using Quantitative Magnetic Resonance Imaging

A 5-Year Follow-Up Study

Raudner, Marcus, MD*,†; Schreiner, Markus M., MD; Juras, Vladimir, PhD*,§; Weber, Michael, MD*; Stelzeneder, David, MD; Kronnerwetter, Claudia; Windhager, Reinhard, MD; Trattnig, Siegfried, MD†,∥

doi: 10.1097/RLI.0000000000000527
Original Articles

Objectives The aim of this study was to assess the predictive value of T2 mapping at baseline with regard to the development of disk herniation and clinical outcome at a 5-year follow-up in patients with low back pain.

Materials and Methods Twenty-five symptomatic patients (13 male; mean age, 44.0 years; range, 24–64 years at baseline) were examined at 3 T magnetic resonance imaging, with a 5-year follow-up. Region of interest analysis was performed on 125 lumbar intervertebral disks on 2 central sagittal T2 maps. Absolute T2 relaxation times and a T2 value ratio of the posterior annulus fibrosus as a percentage of the nucleus pulposus (NPAF) were evaluated for each disk. All disks were graded morphologically using the Pfirrmann score. Roland-Morris Disability Questionnaires (RMDQ) and a visual analogue scale (VAS) were assessed for each patient at follow-up as a clinical end point and compared with diagnosed lumbar disk herniation. Statistical analysis was conducted by a biomedical statistician.

Results Using the baseline NPAF ratio, follow-up development of herniation was predicted with an area under the curve (AUC) of 0.893 in a receiver operating characteristic curve. The same was done using the baseline nucleus pulposus T2, resulting in an AUC of 0.901. Baseline and follow-up NPAF, as well as baseline and follow-up nucleus pulposus T2, differed significantly (P < 0.001) between disks with no herniation, disks with herniation at baseline, and disks with new herniation at follow-up. Difference was still significant (all P < 0.001), when only testing for difference in degenerated discs with Pfirrmann score III to V. Calculating sensitivity and specificity for herniation prediction only in discs with Pfirmann III to V using a receiver operating characteristic, AUC was 0.844 with baseline herniations excluded.

The lowest baseline nucleus pulposus T2 per patient correlated significantly with follow-up RMDQ (r = −0.517; P = 0.008) and VAS (r = −0.494; P = 0.012). The highest baseline NPAF correlated significantly with RMDQ (r = 0.462; P = 0.020), but not VAS (r = 0.279; P = 0.177).

Conclusions Quantitative T2 mapping may serve as a clinically feasible, noninvasive imaging biomarker that can indicate disks at risk for herniation and correlates with clinical outcome and subjective patient burden in a representative cohort of patients with low back pain.

From the *Department of Biomedical Imaging and Image-Guided Therapy,

High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, and

Department of Orthopaedics, Medical University of Vienna, Vienna, Austria;

§Department of Imaging Methods, Institute of Measurement Science, Bratislava, Slovakia; and

Christian Doppler Laboratory for Clinical Molecular MR Imaging (MOLIMA), Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.

Received for publication July 3, 2018; and accepted for publication, after revision, September 16, 2018.

Conflicts of interest and sources of funding: None of the authors has a conflict of interest to report. This study was funded by the Austrian Science Fund (FWF Grant TRP-L194-B05 alongside KLI541-B30).

Correspondence to: Siegfried Trattnig, MD, Department of Biomedical Imaging and Image-Guided Therapy, Christian Doppler Laboratory for Clinical Molecular MR Imaging (MOLIMA), Medical University of Vienna, Währinger Gürtel 18-201090 Vienna, Austria. E-mail:

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