Classification of High Intensity Zones of the Lumbar Spine and Their Association with Other Spinal MRI Phenotypes: The Wakayama Spine Study.
Classification of High Intensity Zones of the Lumbar Spine and Their Association with Other Spinal MRI Phenotypes: The Wakayama Spine Study.
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DOI：
10.1371/journal.pone.0160111
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Yoshida M
中科院分区：
文献类型：
--
作者：
Teraguchi M;Samartzis D;Hashizume H;Yamada H;Muraki S;Oka H;Cheung JP;Kagotani R;Iwahashi H;Tanaka S;Kawaguchi H;Nakamura K;Akune T;Cheung KM;Yoshimura N;Yoshida M
腰椎的高强度区（HIZ）是MRI上椎间盘的一种表型，其临床相关性一直存在争议。传统上，t2加权（T2W）磁共振成像（MRI）被用来识别腰椎间盘的HIZ。然而，关于HIZ的形态、地形以及与其他MRI脊柱表型的关联存在争议。此外，过去没有彻底定义HIZ的分类，并且没有解决使用额外的成像参数（例如T1W MRI）来帮助定义这种表型的问题。对来自日本同质人群的平均年龄63.6岁的814名受试者（69.8%为女性）进行了横断面研究。对所有受试者进行T2W和T1W矢状1.5T MRI检查，以评估L1-S1的HIZ。我们根据椎间盘水平、形状类型（圆形、裂隙、垂直、边缘和扩大）、椎间盘内位置（后方、前方）和T1W MRI上的信号类型（低、高和等强度）与T2W MRI上典型的高强度进行了形态学和地形学上的HIZ分类。38.0%的受试者出现HIZ。其中，整个腰椎后路、前路和后路/前路HIZ的患病率分别为47.3%、42.4%和10.4%。后路HIZ最常见，发生在L4/5（32.5%）和L5/S1(47.0%)，而前路HIZ最常见于L3/4（41.8%）。以T1W等强度型HIZ最常见（71.8%），其次为T1W高强度型（21.4%）和T1W低强度型（6.8%）。在所有椎间盘中，圆形最常见（前型：3.6%，后型：3.7%），其次是垂直型（后型：1.6%）。在所有病变水平，HIZ与椎间盘退变、椎间盘突出和Modic II型有显著相关性（p<0.01）。后路型HIZ和T1W型高强度型HIZ与椎间盘突出、退变有显著相关性（p<0.01）。此外，后部HIZ与Modic II型和III型显著相关。T1W低强度型HIZ与Modic II型显著相关。这是首次报道腰椎HIZ的新分类方案的大规模研究。这项研究是第一个利用T2W和T1W mri来区分HIZ亚表型的研究。发现特定的HIZ亚表型与特定的MRI退行性改变更相关。有了更详细的HIZ表型描述，该方案可以为未来的临床和研究计划标准化。
High intensity zones (HIZ) of the lumbar spine are a phenotype of the intervertebral disc noted on MRI whose clinical relevance has been debated. Traditionally, T2-weighted (T2W) magnetic resonance imaging (MRI) has been utilized to identify HIZ of lumbar discs. However, controversy exists with regards to HIZ morphology, topography, and association with other MRI spinal phenotypes. Moreover, classification of HIZ has not been thoroughly defined in the past and the use of additional imaging parameters (e.g. T1W MRI) to assist in defining this phenotype has not been addressed. A cross-sectional study of 814 (69.8% females) subjects with mean age of 63.6 years from a homogenous Japanese population was performed. T2W and T1W sagittal 1.5T MRI was obtained on all subjects to assess HIZ from L1-S1. We created a morphological and topographical HIZ classification based on disc level, shape type (round, fissure, vertical, rim, and enlarged), location within the disc (posterior, anterior), and signal type on T1W MRI (low, high and iso intensity) in comparison to the typical high intensity on T2W MRI. HIZ was noted in 38.0% of subjects. Of these, the prevalence of posterior, anterior, and both posterior/anterior HIZ in the overall lumbar spine were 47.3%, 42.4%, and 10.4%, respectively. Posterior HIZ was most common, occurring at L4/5 (32.5%) and L5/S1 (47.0%), whereas anterior HIZ was most common at L3/4 (41.8%). T1W iso-intensity type of HIZ was most prevalent (71.8%), followed by T1W high-intensity (21.4%) and T1W low-intensity (6.8%). Of all discs, round types were most prevalent (anterior: 3.6%, posterior: 3.7%) followed by vertical type (posterior: 1.6%). At all affected levels, there was a significant association between HIZ and disc degeneration, disc bulge/protrusion and Modic type II (p<0.01). Posterior HIZ and T1W high-intensity type of HIZ were significantly associated with disc bulge/protrusion and disc degeneration (p<0.01). In addition, posterior HIZ was significantly associated with Modic type II and III. T1W low-intensity type of HIZ was significantly associated with Modic type II. This is the first large-scale study reporting a novel classification scheme of HIZ of the lumbar spine. This study is the first that has utilized T2W and T1W MRIs in differentiating HIZ sub-phenotypes. Specific HIZ sub-phenotypes were found to be more associated with specific MRI degenerative changes. With a more detailed description of the HIZ phenotype, this scheme can be standardized for future clinical and research initiatives.
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