Chad Eric Sarver MD, Presenter: Nothing to Disclose

Houchun Harry Hu, Abstract Co-Author: Nothing to Disclose

Alex Lerner MD, Abstract Co-Author: Nothing to Disclose

Samuel Valencerina RT, Abstract Co-Author: Nothing to Disclose

Krishna S. Nayak PhD, Abstract Co-Author: Nothing to Disclose

Eu-Meng Law MBBS, Abstract Co-Author: Nothing to Disclose

The increasing treatment of patients with lower back pain with spinal fusion is dependent on finding evidence of spinal instability at the degenerate disc spaces. Some of the conventional early signs of disc space instability include loss of T2 signal in the disc, lost of disc height and end plate degenerative signal changes seen on T1 and T2-weighted imaging. IDEAL is a new MRI method that can quantify fat and water content. The purpose is to determine if we can quantify early changes in fat and water with IDEAL at the endplates and discs prior to signal changes seen on conventional T1 and T2-weighted MRI.

10 patients (5 normals, 5 moderate DDD) were imaged with a conventional MRI spine protocol consisting of sagittal and axial T1 and T2-weighted imaging as well as a sagittal IDEAL sequence. IDEAL is a provides robust decomposition of fat and water components and yields a fat fraction map across the imaging volume in addition to fat, water, in-phase, out-of-phase, and T2* data sets. The endplate fat % and water content and disc water content were quantified in normal and abnormal appearing disc spaces at L1/2 through L5/S1 using region-of-interest measurements.

The L4/5 and L5/S1 levels were most commonly affected with degenerative findings of signal loss, lost of disc height as well as end plate degenerative changes. IDEAL was able to demonstrate these changes in water signal (upper spine: normal 192., abnormal 237, lower spine: normal 215, abnormal 280) and fat content in % (upper spine: normal 25.7, abnormal 21.5, lower spine: normal 3.4, abnormal 9.8) at the end plates as well as loss of water signal within the disc spaces at these abnormal levels compared with the normal disc spaces and end plates at L1/2, L2/3 and L3/4 (upper spine: normal 266, abnormal 259, lower spine: normal 277, abnormal 345).

IDEAL is able to demonstrate changes in the fat/water content at the endplates in normal and abnormal patients with degenerative disc disease as well as quantify disc desiccation in the degenerate disc spaces.

Quantizing endplate fat & water content & disc water content with IDEAL may allow earlier detection of instability and degeneration before changes on standard MR imaging allowing earlier intervention.

Sarver, C, Hu, H, Lerner, A, Valencerina, S, Nayak, K, Law, E, Characterization of Early Endplate and Disc Degenerative Changes Prior to Signal Change Using IDEAL as an Early Indicator of Disc Space Instability and Degeneration.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9013842.html