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Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type

BACKGROUND: Modic Changes (MCs) in the vertebral bone marrow were related to back pain in some studies but have uncertain clinical relevance. Diffusion weighted MRI with apparent diffusion coefficient (ADC)-measurements can add information on bone marrow lesions. However, few have studied ADC measur...

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Autores principales: Dagestad, Magnhild H., Vetti, Nils, Kristoffersen, Per M., Zwart, John-Anker, Storheim, Kjersti, Bakland, Gunnstein, Brox, Jens I., Grøvle, Lars, Marchand, Gunn H., Andersen, Erling, Assmus, Jörg, Espeland, Ansgar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9306145/
https://www.ncbi.nlm.nih.gov/pubmed/35869480
http://dx.doi.org/10.1186/s12891-022-05610-4
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author Dagestad, Magnhild H.
Vetti, Nils
Kristoffersen, Per M.
Zwart, John-Anker
Storheim, Kjersti
Bakland, Gunnstein
Brox, Jens I.
Grøvle, Lars
Marchand, Gunn H.
Andersen, Erling
Assmus, Jörg
Espeland, Ansgar
author_facet Dagestad, Magnhild H.
Vetti, Nils
Kristoffersen, Per M.
Zwart, John-Anker
Storheim, Kjersti
Bakland, Gunnstein
Brox, Jens I.
Grøvle, Lars
Marchand, Gunn H.
Andersen, Erling
Assmus, Jörg
Espeland, Ansgar
author_sort Dagestad, Magnhild H.
collection PubMed
description BACKGROUND: Modic Changes (MCs) in the vertebral bone marrow were related to back pain in some studies but have uncertain clinical relevance. Diffusion weighted MRI with apparent diffusion coefficient (ADC)-measurements can add information on bone marrow lesions. However, few have studied ADC measurements in MCs. Further studies require reproducible and valid measurements. We expect valid ADC values to be higher in MC type 1 (oedema type) vs type 3 (sclerotic type) vs type 2 (fatty type). Accordingly, the purpose of this study was to evaluate ADC values in MCs for interobserver reproducibility and relation to MC type. METHODS: We used ADC maps (b 50, 400, 800 s/mm(2)) from 1.5 T lumbar spine MRI of 90 chronic low back pain patients with MCs in the AIM (Antibiotics In Modic changes)-study. Two radiologists independently measured ADC in fixed-sized regions of interests. Variables were MC-ADC (ADC in MC), MC-ADC% (0% = vertebral body, 100% = cerebrospinal fluid) and MC-ADC-ratio (MC-ADC divided by vertebral body ADC). We calculated mean difference between observers ± limits of agreement (LoA) at separate endplates. The relation between ADC variables and MC type was assessed using linear mixed-effects models and by calculating the area under the receiver operating characteristic curve (AUC). RESULTS: The 90 patients (mean age 44 years; 54 women) had 224 MCs Th12-S1 comprising type 1 (n = 111), type 2 (n = 91) and type 3 MC groups (n = 22). All ADC variables had higher predicted mean for type 1 vs 3 vs 2 (p < 0.001 to 0.02): MC-ADC (10(− 6) mm(2)/s) 1201/796/576, MC-ADC% 36/21/14, and MC-ADC-ratio 5.9/4.2/3.1. MC-ADC and MC-ADC% had moderate to high ability to discriminate between the MC type groups (AUC 0.73–0.91). MC-ADC-ratio had low to moderate ability (AUC 0.67–0.85). At L4-S1, widest/narrowest LoA were for MC-ADC 20 ± 407/12 ± 254, MC-ADC% 1.6 ± 18.8/1.4 ± 10.4, and MC-ADC-ratio 0.3 ± 4.3/0.2 ± 3.9. Difference between observers > 50% of their mean value was less frequent for MC-ADC (9% of MCs) vs MC-ADC% and MC-ADC-ratio (17–20%). CONCLUSIONS: The MC-ADC variable (highest mean ADC in the MC) had best interobserver reproducibility, discriminated between MC type groups, and may be used in further research. ADC values differed between MC types as expected from previously reported MC histology. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05610-4.
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spelling pubmed-93061452022-07-23 Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type Dagestad, Magnhild H. Vetti, Nils Kristoffersen, Per M. Zwart, John-Anker Storheim, Kjersti Bakland, Gunnstein Brox, Jens I. Grøvle, Lars Marchand, Gunn H. Andersen, Erling Assmus, Jörg Espeland, Ansgar BMC Musculoskelet Disord Research BACKGROUND: Modic Changes (MCs) in the vertebral bone marrow were related to back pain in some studies but have uncertain clinical relevance. Diffusion weighted MRI with apparent diffusion coefficient (ADC)-measurements can add information on bone marrow lesions. However, few have studied ADC measurements in MCs. Further studies require reproducible and valid measurements. We expect valid ADC values to be higher in MC type 1 (oedema type) vs type 3 (sclerotic type) vs type 2 (fatty type). Accordingly, the purpose of this study was to evaluate ADC values in MCs for interobserver reproducibility and relation to MC type. METHODS: We used ADC maps (b 50, 400, 800 s/mm(2)) from 1.5 T lumbar spine MRI of 90 chronic low back pain patients with MCs in the AIM (Antibiotics In Modic changes)-study. Two radiologists independently measured ADC in fixed-sized regions of interests. Variables were MC-ADC (ADC in MC), MC-ADC% (0% = vertebral body, 100% = cerebrospinal fluid) and MC-ADC-ratio (MC-ADC divided by vertebral body ADC). We calculated mean difference between observers ± limits of agreement (LoA) at separate endplates. The relation between ADC variables and MC type was assessed using linear mixed-effects models and by calculating the area under the receiver operating characteristic curve (AUC). RESULTS: The 90 patients (mean age 44 years; 54 women) had 224 MCs Th12-S1 comprising type 1 (n = 111), type 2 (n = 91) and type 3 MC groups (n = 22). All ADC variables had higher predicted mean for type 1 vs 3 vs 2 (p < 0.001 to 0.02): MC-ADC (10(− 6) mm(2)/s) 1201/796/576, MC-ADC% 36/21/14, and MC-ADC-ratio 5.9/4.2/3.1. MC-ADC and MC-ADC% had moderate to high ability to discriminate between the MC type groups (AUC 0.73–0.91). MC-ADC-ratio had low to moderate ability (AUC 0.67–0.85). At L4-S1, widest/narrowest LoA were for MC-ADC 20 ± 407/12 ± 254, MC-ADC% 1.6 ± 18.8/1.4 ± 10.4, and MC-ADC-ratio 0.3 ± 4.3/0.2 ± 3.9. Difference between observers > 50% of their mean value was less frequent for MC-ADC (9% of MCs) vs MC-ADC% and MC-ADC-ratio (17–20%). CONCLUSIONS: The MC-ADC variable (highest mean ADC in the MC) had best interobserver reproducibility, discriminated between MC type groups, and may be used in further research. ADC values differed between MC types as expected from previously reported MC histology. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05610-4. BioMed Central 2022-07-22 /pmc/articles/PMC9306145/ /pubmed/35869480 http://dx.doi.org/10.1186/s12891-022-05610-4 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Dagestad, Magnhild H.
Vetti, Nils
Kristoffersen, Per M.
Zwart, John-Anker
Storheim, Kjersti
Bakland, Gunnstein
Brox, Jens I.
Grøvle, Lars
Marchand, Gunn H.
Andersen, Erling
Assmus, Jörg
Espeland, Ansgar
Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type
title Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type
title_full Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type
title_fullStr Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type
title_full_unstemmed Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type
title_short Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type
title_sort apparent diffusion coefficient values in modic changes – interobserver reproducibility and relation to modic type
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9306145/
https://www.ncbi.nlm.nih.gov/pubmed/35869480
http://dx.doi.org/10.1186/s12891-022-05610-4
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