Imaging Evaluation of Intervertebral Disc Degeneration and Painful Discs-Advances and Challenges in Quantitative MRI

In recent years, various quantitative and functional magnetic resonance imaging (MRI) sequences have been developed and used in clinical practice for the diagnosis of patients with low back pain (LBP). Until now, T2-weighted imaging (T2WI), a visual qualitative evaluation method, has been used to diagnose intervertebral disc (IVD) degeneration. However, this method has limitations in terms of reproducibility and inter-observer agreement. Moreover, T2WI observations do not directly relate with LBP. Therefore, new sequences such as T2 mapping, T1ρ mapping, and MR spectroscopy have been developed as alternative quantitative evaluation methods. These new quantitative MRIs can evaluate the anatomical and physiological changes of IVD degeneration in more detail than conventional T2WI. However, the values obtained from these quantitative MRIs still do not directly correlate with LBP, and there is a need for more widespread use of techniques that are more specific to clinical symptoms such as pain. In this paper, we review the state-of-the-art methodologies and future challenges of quantitative MRI as an imaging diagnostic tool for IVD degeneration and painful discs.

QSIPrep: an integrative platform for preprocessing and reconstructing diffusion MRI data

Diffusion-weighted magnetic resonance imaging (dMRI) is the primary method for noninvasively studying the organization of white matter in the human brain. Here we introduce QSIPrep, an integrative software platform for the processing of diffusion images that is compatible with nearly all dMRI sampling schemes. Drawing on a diverse set of software suites to capitalize on their complementary strengths, QSIPrep facilitates the implementation of best practices for processing of diffusion images.

Detecting Mild Lower-limb Skeletal Muscle Fatigue with Stimulated-echo q-space Imaging

The feasibility of detecting mild exercise-related muscle fatigue via stimulated echo (STE) and q-space imaging (qsi) was evaluated. The right calves of seven healthy volunteers were subjected to mild exercise loading, and qsi was generated using spin echo (Δ: 45.6 ms) and three different STE (Δ: 114, 214, and 414 ms) acquisitions. We concluded that qsi with an increased STE diffusion time can detect mild fatigue in the gastrocnemius muscle.

Quantitative analysis of intervertebral disc degeneration using Q-space imaging in a rat model

The degree of intervertebral disc (IVD) degeneration is qualitatively evaluated on T2-weighted imaging (T2WI). However, it is difficult to assess subtle changes in IVD degeneration using T2WI. Q-space imaging (QSI) is a quantitative diffusion-weighted imaging modality used to detect subtle changes in microenvironments. This study aimed to evaluate whether QSI can detect the inhibitory effects of the antioxidant N-acetylcysteine (NAC) in IVD degeneration. We classified female Wistar rats into control, puncture, and NAC groups (n = 5 per group). In the puncture and NAC groups, IVDs were punctured using a needle. The antioxidant NAC, which suppresses the progression of IVD degeneration, was orally administered in the NAC group 1 week prior to puncture. The progression and inhibitory effect of NAC in IVD degeneration were assessed using magnetic resonance imaging (MRI): IVD height, T2 mapping, apparent diffusion coefficient (ADC), and QSI. MRI was performed using a 7-Tesla system with a conventional probe (20 IVDs in each group). QSI parameters that were assessed included Kurtosis, the probability at zero displacement (ZDP), and full width at half maximum (FWHM). IVD degeneration by puncture was confirmed by histology, IVD height, T2 mapping, ADC, and all QSI parameters (P < .001); however, the inhibitory effect of NAC was confirmed only by QSI parameters (Kurtosis and ZDP: both P < .001; FWHM: P < .01). Kurtosis had the largest effect size (Kurtosis: 1.13, ZDP: 1.06, and FWHM: 1.02) when puncture and NAC groups were compared. QSI has a higher sensitivity than conventional quantitative methods for detecting the progressive change and inhibitory effect of NAC in IVD degeneration.

Detecting white matter alterations in multiple sclerosis using advanced diffusion magnetic resonance imaging

Multiple sclerosis is a neurodegenerative and inflammatory disease, a hallmark of which is demyelinating lesions in the white matter. We hypothesized that alterations in white matter microstructures can be non-invasively characterized by advanced diffusion magnetic resonance imaging. Seven diffusion metrics were extracted from hybrid diffusion imaging acquisitions via classic diffusion tensor imaging, neurite orientation dispersion and density imaging, and q-space imaging. We investigated the sensitivity of the diffusion metrics in 36 sets of regions of interest in the brain white matter of six female patients (age 52.8 ± 4.3 years) with multiple sclerosis. Each region of interest set included a conventional T2-defined lesion, a matched perilesion area, and normal-appearing white matter. Six patients with multiple sclerosis (n = 5) or clinically isolated syndrome (n = 1) at a mild to moderate disability level were recruited. The patients exhibited microstructural alterations from normal-appearing white matter transitioning to perilesion areas and lesions, consistent with decreased tissue restriction, decreased axonal density, and increased classic diffusion tensor imaging diffusivity. The findings suggest that diffusion compartment modeling and q-space analysis appeared to be sensitive for detecting subtle microstructural alterations between perilesion areas and normal-appearing white matter.

Hybrid Diffusion Imaging in Mild Traumatic Brain Injury

Mild traumatic brain injury (mTBI) is an important public health problem. Although conventional medical imaging techniques can detect moderate-to-severe injuries, they are relatively insensitive to mTBI. In this study, we used hybrid diffusion imaging (HYDI) to detect white matter alterations in 19 patients with mTBI and 23 other trauma control patients. Within 15 days (standard deviation = 10) of brain injury, all subjects underwent magnetic resonance HYDI and were assessed with a battery of neuropsychological tests of sustained attention, memory, and executive function. Tract-based spatial statistics (TBSS) was used for voxel-wise statistical analyses within the white matter skeleton to study between-group differences in diffusion metrics, within-group correlations between diffusion metrics and clinical outcomes, and between-group interaction effects. The advanced diffusion imaging techniques, including neurite orientation dispersion and density imaging (NODDI) and q-space analyses, appeared to be more sensitive then classic diffusion tensor imaging. Only NODDI-derived intra-axonal volume fraction (V_ic) demonstrated significant group differences (i.e., 5–9% lower in the injured brain). Within the mTBI group, V_ic and a q-space measure, P₀, correlated with 6 of 10 neuropsychological tests, including measures of attention, memory, and executive function. In addition, the direction of correlations differed significantly between groups (R² > 0.71 and p_interation < 0.03). Specifically, in the control group, higher V_ic and P₀ were associated with better performances on clinical assessments, whereas in the mTBI group, higher V_ic and P₀ were associated with worse performances with correlation coefficients >0.83. In summary, the NODDI-derived axonal density index and q-space measure for tissue restriction demonstrated superior sensitivity to white matter changes shortly after mTBI. These techniques hold promise as a neuroimaging biomarker for mTBI.

Development of an outdoor MRI system for measuring flow in a living tree

An outdoor MRI system for noninvasive, long-term measurements of sap flow in a living tree in its natural environment has been developed. An open-access, 0.2 T permanent magnet with a 160 mm gap was combined with a radiofrequency probe, planar gradient coils, electromagnetic shielding, several electrical units, and a waterproofing box. Two-dimensional cross-sectional images were acquired for a ring-porous tree, and the anatomical structures, including xylem and phloem, were identified. The MRI flow measurements demonstrated the diurnal changes in flow velocity in the stem on a per-pixel basis. These results demonstrate that our outdoor MRI system is a powerful tool for studies of water transport in outdoor trees.

Non-Gaussian diffusion-weighted imaging for assessing diurnal changes in intervertebral disc microstructure

PURPOSE

To investigate the use of non-Gaussian diffusion-weighted imaging (q-space imaging [QSI]) to estimate diurnal changes in intervertebral disc (IVD) microstructure.

MATERIALS AND METHODS

IVDs of 15 male subjects (mean age, 27.3 years; mean body mass index, 22.50 kg/m(2) ) were investigated once in the morning, less than 30 min after rising, and a second time in the evening after at least 10 h of normal physical activity, using 3 Tesla (T) MR imaging. T2 mapping and QSI data values (apparent diffusion coefficient [ADC], root mean square displacement [RMSD], and apparent kurtosis coefficient [AKC]) were calculated and compared between the morning and evening imaging sessions.

RESULTS

The T2, ADC, and RMSD values showed a significant decrease in the evening (175.8 ± 49.5 ms, 1.56 ± 0.32 10(-3) mm(2) /s and 40.0 ± 3.0 μm, respectively; P < 0.05 for all values; paired t-test), when compared with the morning values (226.5 ± 83.8 ms, 1.69 ± 0.29 10(-3) mm(2) /s and 45.2 ± 2.9 μm, respectively). The AKC value showed a significant increase in the evening (0.67 ± 0.08), when compared with the morning value (0.58 ± 0.04; P < 0.05).

CONCLUSION

The RMSD and AKC values obtained from QSI analysis may be biomarkers for IVD diurnal microstructural changes.