Juergen Lutz MD, Presenter: Nothing to Disclose

Gustav Schelling MD,PhD, Abstract Co-Author: Nothing to Disclose

Robert Stahl, Abstract Co-Author: Nothing to Disclose

Olaf Dietrich, Abstract Co-Author: Nothing to Disclose

Maximilian Ferdinand Reiser MD, Abstract Co-Author: Nothing to Disclose

Lorenz Jaeger MD, Abstract Co-Author: Nothing to Disclose

For some patients with chronic lower back pain (CLBP) there is no identifiable morphological cause. When back pain is chronified, it is highly debilitating. The neurobiology of chronic pain, and especially chronic back pain is not fully understood. Therefore, we investigated anisotropy changes in patients with chronic low back pain (CLBP) using Diffusion Tensor imaging (DTI).

20 Patients with confirmed diagnosis of chronic low back pain (> six months) and 20 aged-matched normal healthy controls were examined using an1,5 T MR System with a IPAT DTI Epi-sequence (TE 71ms, TR 6000ms, 36 Slices, 1.8x1.8x3.6 mm spatial resolution) along six different diffusion directions with a b-value of 1000s/mm2. After normalization and coregistration of the DTI data sets, standardized regions of interests (ROI) were placed bilaterally in the prefrontal cortex, anterior cingulate cortex, thalamus, amygdala, hippocampus and somatosensory cortex. The fractional anisotropy (FA) and the relative anisotropy (RA) were calculated. After testing for normal distribution, Student's T-test was used for statistical analysis.

We found a significant increase (p<0.05) of mean RA and FA values in the cingulate gyrus, the postcentral gyrus, and the superior frontal gyrus of patients with CLBP compared to normal controls. In contrast, the mean RA and FA values of the thalamocortical tract showed a significant decrease (p<0.05) in patients with CLBP compared to the normal healthy controls. No significant differences in the RA and FA values in the hippocampus, the amygdala and the thalamus. Additionally, we found no significant differences in the RA and FA values of the superior temporal lobes, a brain region not associated with stress processing.

The results support the hypothesis that chronification of lower back pain is associated with cortical and subcortical microstructural anisotropy changes in patients with CLBP compared to normal subjects. Moreover, these results argue for plastic changes of the cingulate gyrus, postcentral gyrus and the prefrontal cortex in chronic pain processing.

DTI has high potential to provide a better understanding of the cerebral changes in patients with CLBP.

Lutz, J, Schelling, G, Stahl, R, Dietrich, O, Reiser, M, Jaeger, L, Diffusion Tensor Imaging (DTI) Danisotropic Changes in the Brain Associated with Chronic Low Back Pain.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4433436.html