Diurnal T2 Value Changes in the Lumbar Intervertebral Discs

doi:10.1016/S0009-9260(02)00583-4

Clinical Radiology

Volume 58, Issue 5, May 2003, Pages 389-392

https://doi.org/10.1016/S0009-9260(02)00583-4 Get rights and content

Abstract

AIM: To investigate if there is any in vivo diurnal T2 value changes in the nucleus pulposus in normal and degenerated lumbar intervertebral discs.

MATERIALS AND METHODS: Eighteen volunteers (16 men, two women) with no symptoms related to lumbar disease were imaged in the morning before beginning daily work and in the evening after finishing work. Sagittal fast spin-echo T2-weighted images were obtained, following spin-echo transverse imaging for T2 analysis.

RESULTS: The normal disc group (n=71) showed statistically significant diurnal T2 value changes (p<0.001), whilst the degenerating disc group (n=19) showed no significant diurnal changes. The normal disc group up to age 34 years showed statistically significant diurnal T2 value changes. However no significant changes were demonstrated after the age 35 years.

CONCLUSION: Statistically significant diurnal T2 value changes in the normal lumbar intervertebral discs were demonstrated. Disappearance of the diurnal T2 value changes in the normal discs after the age 35 years was revealed for the first time and thought to be an aspect of aging, not caused by degeneration.

Introduction

It has been known since the 19th century that the spine becomes shorter during the day and recovers during the night. De Puky [1] showed from a sample of 1216 people that, on an average, a person is about 1% shorter by the evening compared with the morning height. He also mentioned a corresponding figure of 2% for children and 0.5% for 70–80 year-old people; the reduction in height during the day changes with increase of age. This phenomenon has been thought to result from a decrease in disc hydration with age, which results in the disc not being able to recover fully from daily compression. This hypothesis has been supported by several investigators studying morphological aspects of the intervertebral discs 2, 3.

A few studies have revealed diurnal water content changes in intervertebral discs, in vivo, using magnetic resonance (MR) imaging 4, 5, 6, 7. MR imaging is the method of choice for the evaluation of normal and abnormal states of intervertebral discs, providing both gross anatomical and biochemical informations. This study was undertaken to investigate diurnal T2 value changes, and loss of diurnal T2 value changes with increase of age in normal and degenerated lumbar intervertebral discs.

Section snippets

Study Population

The study group consisted of 18 healthy volunteers (16 men, two women; age range, 23–56 years; mean, 37 years). Recruitment for the study was from hospital staff (10 radiological technologists and eight radiologists). Individuals were only enrolled if they had never experienced relevant low back pain, which was defined as never having seen a physician, physiotherapist, chiropractor, or other such healthcare professionals because of low back pain, and never having been absent from work because

Results

In the patient population, there were no adolescent discs (grade 1). There were 71 normal discs (grade 2) and 19 degenerated discs (grades 3–5). These 19 degenerated discs were seen in 12 participants (67%); six participants showed disc degeneration only in one disc level, five participants showed degeneration in two levels and one participant showed degeneration in three levels. The number of the degenerated discs according to the disc levels were as follows where number in parenthesis is the

Discussion

Disc degeneration, defined as diminished signal intensity on T2-weighted MR images, combined with loss of disc space height, is commonly seen in asymptomatic population. Jensen et al. [9] in their prospective study reported that 64% of the asymptomatic patients had an intervertebral disc abnormality; 38% had a disc abnormality at more than one level. In another report by Stadnik et al. [10] the prevalence of mild and severe disc degeneration were 72 and 56%, respectively. Our results (67%)

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Cited by (37)

Determinants of diurnal variation in lumbar intervertebral discs and paraspinal muscles: A prospective quantitative magnetic resonance imaging study
2023, European Journal of Radiology
To prospectively investigate the determinants of diurnal variations in lumbar intervertebral discs and paraspinal muscles.
71 females aged 19 ∼ 31 years were examined by morning-evening T2 mapping/diffusion kurtosis imaging (DKI), with weight and lifestyle information (time in night bed-rest [TIB], bed-napping, activity time, and sitting time) assessed by standardized questionnaires. Diurnal shifts in T2, mean diffusivity and mean kurtosis (T2-DS, MD-DS and MK-DS; morning-value minus evening-value) were evaluated for L4-S1 discs (normal, Pfirrmann grade Ⅰ/Ⅱ; degenerative, III/IV). T2 and T2-DS were assessed for L4/5 multifidus and erector spinalis.
For normal discs, bed-napping correlated with MD-DS and MK-DS in disc entirety (p = 0.001 and 0.004); increased activity time suggested higher T2-DS in nucleus pulposus (p = 0.004); prolonged sitting time predicted greater T2-DS in disc entirety and posterior inner annulus fibrosus (PI-AF, p ≤ 0.011); decreased TIB and weight suggested lower T2-DS and higher MK-DS in PI-AF (p = 0.001 ∼ 0.035). For degenerative discs, bed-napping predicted lower T2-DS in nucleus pulposus and PI-AF (p = 0.019); increased TIB suggested higher T2-DS and lower MK-DS in PI-AF (p = 0.006 and 0.034); longer sitting time predicted higher MK-DS in PI-AF (p = 0.020). Paraspinal muscles exhibited diurnal T2 variation (p < 0.001) which did not correlate with lifestyle factors (p > 0.050).
Lifestyle and weight have causal effects on the diurnal variation of lumbar discs. Bed-rest may correlate with disc hydration and microstructural stability reserves for subsequent daytime activities. Sitting behavior could induce greater dehydration in normal discs and may alleviate diurnal microstructural rearrangement in degenerative discs. T2 mapping and DKI are promising tools to evaluate disc biomechanics in clinics.
Catching the circadian rhythm of intervertebral disc and association with clinical outcomes by twice-a-day magnetic resonance imaging
2022, European Journal of Radiology
Citation Excerpt :
Boos et al. used asymptomatic young volunteers (n = 10; average age: 24 years) as study subjects and reported in 1993 for the first time that the diurnal T2 value changed in the normal lumbar intervertebral discs. [24] In 2003 Karakida et al. reported the loss of the diurnal T2 value changes in the normal discs after the age 35 years (n = 18; average age: 37 years). [25] But they also confirmed that it was difficult to delineate the diurnal T2 value changes in the discs between normal aging and pathological degeneration.
We conducted a prospective magnetic resonance imaging(MRI) surveillance program of the whole spine twice a day to aim at investigating the diurnal prevalence of MRI parameters of intervertebral discs and their associations with relevant symptoms.
Sixty-four young volunteers underwent MRI of the whole spine twice on the same day (in the morning and evening). Sagittal T2-weighted MRIs of the whole spine were compared and analyzed. Two independent observers assessed the images for the disc height, anterior-posterior distance, and T2 values. Subject demographics and clinical findings were assessed by standardized questionnaires.
There was a statistically significant diurnal disc height change in all the disc level groups. Except four lumbar levels, there was no statistically significant diurnal disc AP distance change seen in other levels. There were statistically significant diurnal T2 value changes in all intervertebral discs except T3/4 levels. The multivariate linear regression analysis showed a positive linear trend association between BMI and the diurnal variations of T1/2 T2 value, T12/L1, L1/2, L2/3, L3/4,L4/5 and L5/S1 disc heights (p < 0.05) . Smoking and passive smoking affected cervical levels of T2 value changes. Interestingly, a reverse trend was observed in all disc changes in the case of more than ten years shift work history.
Smoking and passive smoking are associated with cervical disc T2 value diurnal changes and BMI is associated with lumbar disc height changes. Long time disruption of circadian clock may cause reverse changes of discs, however not in short or medium-time shift workers.
Modeling and validation of a detailed FE viscoelastic lumbar spine model for vehicle occupant dummies
2018, Computers in Biology and Medicine
The dummies currently used for predicting vehicle occupant response during frontal crashes or whole-body vibration provide insufficient information about spinal loads. Although they aptly approximate upper-body rotations in different loading scenarios, they overlook spinal loads, which are crucial to injury assessment. This paper aims to develop a modified dummy finite element (FE) model with a detailed viscoelastic lumbar spine. This model has been developed and validated against in-vitro and in-silico data under different loading conditions, and its predicted ranges of motion (RoM) and intradiscal pressure (IDP) maintain close correspondence with the in-vitro data. The dominant frequency of the model was f = 8.92 Hz, which was close to previous results. In the relaxation test, a force reduction of up to 21% was obtained, showing high agreement in force relaxation during the in-vitro test. The FE lumbar spine model was placed in the HYBRID III test dummy and aligned in a seated position based on available MRI data. Under two impulsive acceleration loadings in flexion and lateral directions with a peak acceleration of 60 m/s², flexion responses of the modified and original dummies were close (RoMs of 29.1° and 29.6°, respectively), though not in lateral bending (RoMs of 34.1° and 15.6°, respectively), where the modified dummy was more flexible than the original. By reconstructing a real frontal crash, it was found that the modified dummy provided a 10% reduction in the Head Injury Criterion (HIC). Other than the more realistic behavior of this modified dummy, its capability of approximating lumbar loads and risk of lumbar spine injuries in vehicle crashes or whole-body vibration is of great importance.
Real T1 relaxation time measurement and diurnal variation analysis of intervertebral discs in a healthy population of 50 volunteers
2017, European Journal of Radiology
Citation Excerpt :
Quantitative T2 approach also seems to be sensitive to early degeneration [16,18–20]. It has also been shown that diurnal changes occur in normal intervertebral discs using lumbar length measurement (height loss) and T2 mapping (decreasing T2 values) [21,22]. T1 mapping has been evaluated in different part of the body, like brain [23] and cartilage [24–26] and was demonstrated to be correlated to water content [27,28].
To measure the real T1 relaxation time of the lumbar intervertebral discs in a young and healthy population, using different inversion recovery times, and assess diurnal variation.
Intervertebral discs from D12 to S1 of 50 healthy volunteers from 18 to 25 years old were evaluated twice the same day, in the morning and in the late afternoon. Dedicated MRI sequences with different inversion recovery times (from 100 to 2500 ms) were used to calculate the real T1 relaxation time. Three regions of interest (ROIs) were defined in each disc, the middle representing the nucleus pulposus (NP) and the outer parts the annulus fibrosus (AF) anterior and posterior. Diurnal variation and differences between each disc level were analyzed.
T1 mean values in the NP were 1142 ± 12 ms in the morning and 1085 ± 13 ms in the afternoon, showing a highly significant decrease of 57 ms (p < 0.001). A highly significant difference between the levels of the spine was found. The mean T1 of the anterior part of the AF was 577 ± 9 ms in the morning and 554 ± 8 ms in the afternoon. For the posterior part, the mean values were 633 ± 8 ms in the morning and 581 ± 7 ms in the evening. It shows a highly significant decrease of 23 ms for the anterior part and 51 ms for the posterior part (all p < 0.001).
T1 mapping is a promising method of intervertebral disc evaluation. Significant diurnal variation and difference between levels of the lumbar spine were demonstrated. A potential use for longitudinal study in post-operative follow up or sport medicine needs to be evaluated.
Review of the fluid flow within intervertebral discs - How could in vitro measurements replicate in vivo?
2016, Journal of Biomechanics
Citation Excerpt :
Diurnal variations in T2 values are significantly lower in degenerate and aged than in normal intervertebral discs. Karakida et al. (2003) investigated diurnal T2 value changes in subjects with varying age (23–56 years) with non-degenerate (grade 1–2 (Weishaupt et al., 1998): n=71) and degenerate (grade 3–5: n=19) lumbar intervertebral discs (L1/2-L5/S1). They found a significant diurnal T2 value change in non-degenerate discs (morning: 75.56±18.8 ms, evening: 68.85±14.1 ms).
By maintaining a balance between external mechanical loads and internal osmotic pressure, fluid content of intervertebral discs constantly alters causing fluctuations in disc hydration, height, diameter and pressure that govern disc temporal response. This paper reviews and discusses the relevant findings of earlier studies on the disc fluid flow with the aim to understand and remedy discrepancies between in vivo and in vitro observations. New results of finite element model studies are also exploited in order to help identify the likely causes for such differences and underlying mechanisms observed in vitro.
In vivo measurements of changes in spinal height and disc fluid content/pressure via stadiometry, magnetic resonance imaging and intradiscal pressure measurements have been carried out. They have demonstrated that the disc volume, fluid content, height and nucleus pressure alter depending to a large extent on prior-current external load conditions. Although the diurnal loading lasts on average nearly twice longer than the subsequent resting (16 vs. 8 h), the disc completely recovers its height and volume during the latter period through fluid inflow. In view of much longer periods required to recover disc height and pressure in vitro in ovine, porcine, caprine, bovine and rat discs, concerns have been raised on the fluid inflow through the endplates that might be hampered by clogged blood vessels post mortem.
Analyses of discrepancies in the flow-dependent recoveries in vivo and in vitro highlight an excessive fluid content in the latter as a likely cause. To replicate in vivo conditions as closely as possible in vitro, preparation and preconditioning of specimens and/or pressure and osmolarity of the culture media in which specimens are immersed should hence be designed in a manner as to diminish disc hydration level and/or fluid transport.
Analysis of chronic low back pain with magnetic resonance imaging T2 mapping of lumbar intervertebral disc
2015, Journal of Orthopaedic Science
Magnetic resonance imaging (MRI) T2 mapping utilizes the T2 values for quantification of moisturecontent and collagen sequence breakdown. Recently, attempts at quantification of lumbar disc degeneration through MRI T2 mapping have been reported. We conducted an analysis of the relationship between T2 values of degenerated intervertebral discs (IVD) and chronic low back pain (CLBP).
The subjects who had CLBP comprised 28 patients (15 male, 13 female; mean age 48.9 ± 9.6 years; range 22–60 years). All subjects underwent MRI and filled out the low back pain visual analog scale (VAS) and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The disc was divided into the anterior annulus fibrosus (AF), the nucleus pulposus (NP), and the posterior AF, and each T2 value was measured. This study involved 25 asymptomatic control participants matched with the CLBP group subjects for gender and age (13 male, 12 female; mean age 43.8 ± 14.5 years; range 23–60 years). These subjects had no low back pain, and constituted the control group.
T2 values for IVD tended to be lower in the CLBP group than in the control group, and these values were significantly different within the posterior AF. The correlation coefficients between the VAS scores and T2 values of anterior AF, NP and posterior AF were r = 0.30,−0.15 and −0.50. The correlation coefficient between the JOABPEQ scores (low back pain) and T2 values of anterior AF, NP and posterior AF were r = −0.0041, 0.11 and 0.42.Similarly, the JOABPEQ scores (lumbar function) were r = −0.22, −0.12 and 0.57.
The results indicated a correlation between posterior AF degeneration and CLBP. This study suggeststhat MRI T2 mapping could be used as a quantitative method for diagnosing discogenic pain.

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Clinical Radiology

Abstract

Introduction

Section snippets

Study Population

Results

Discussion

References (17)

Diurnal stature variation in ankylosing spondylitis

Clin Biomechanics

The physiological oscillation of the length of the body

Acta Orthop Scand

Shrinkage as a measure of the effect of load on the spine

Spine

Quantitative MR imaging of lumbar intervertebral disks and vertebral bodies: influence of diurnal water content variations

Radiology

Diurnal fluid changes of lumbar discs measured indirectly by magnetic resonance imaging

J Orthop Res

Quantitative analysis of diurnal variation in volume and water content of lumbar intervertebral discs

Clin Anat

An in vivo magnetic resonance imaging study of lumbar intervertebral discs during diurnal load cycle

Spine

MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers

Radiology

Cited by (37)

Determinants of diurnal variation in lumbar intervertebral discs and paraspinal muscles: A prospective quantitative magnetic resonance imaging study

Catching the circadian rhythm of intervertebral disc and association with clinical outcomes by twice-a-day magnetic resonance imaging

Modeling and validation of a detailed FE viscoelastic lumbar spine model for vehicle occupant dummies

Real T1 relaxation time measurement and diurnal variation analysis of intervertebral discs in a healthy population of 50 volunteers

Review of the fluid flow within intervertebral discs - How could in vitro measurements replicate in vivo?

Analysis of chronic low back pain with magnetic resonance imaging T2 mapping of lumbar intervertebral disc