MODIFIED MRI SHORT TIME INVERSION RECOVERY SEQUENCE GRADING SYSTEM FOR LUMBAR INTERVERTEBRAL DISC DEGENERATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PAN Wenqi , WANG Jian , LIU Jie , LU Yan , HUANG Bo.

Department of Orthopaedics, Affiliated Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, P.R.China. Corresponding author: WANG Jian, E-mail: tonywjxq@yahoo.com.cn;

Corresponding author：

Keywords：

Lumbar intervertebral disc degeneration; MRI; Short time inversion recovery sequence; Degeneration grading

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Objective To develop a modified short time inversion recovery (STIR) sequence grading system for lumbar intervertebral disc degeneration based on MRI STIR sequences, and to test the validity and reproducibility of this grading system. Methods A modified 8-level grading system for lumbar intervertebral disc degeneration based on routine sagittal STIR sequences and modified Pfirrmann grading system was developed. Between April 2011 and February 2012, 60 patients with different degrees of lumbar intervertebral disc degeneration were selected as objects of study, including 32 males and 28 females with an average of 50 years (range, 17-85 years). T2 weighted and STIR sequence images were obtained from the lumbar discs of L1, 2-L5, S1 of each object (total, 300 discs). All examinations were analyzed independently by 3 observers and a consensus readout was performed after all data collected. The validity and reproducibility were analyzed by calculating consistent rate and Kappa value. Results According to the grading system, there were 0 grade 1, 83 (27.7%) grade 2, 87 (29.0%) grade 3, 66 (22.0%) grade 4, 31 (10.3%) grade 5, 15 (5.0%) grade 6, 12 (4.0%) grade 7, and 6 (2.0%) grade 8. Intra-observer consistency was b (Kappa value range, 0.822-0.952), and inter-observer consistency was high to b (Kappa value range, 0.749-0.843). According to the consensus analysis, the total consistent rate was 82.7%-92.7% (mean, 85.6%). A difference of one grade occurred in 13.9% and a difference of two or more grades in 0.5% of all the cases. Conclusion Disc degeneration can be graded by using modified STIR sequence grading system, which can improve the accuracy of grading different degrees of lumbar intervertebral disc degeneration.

Citation： PAN Wenqi,WANG Jian,LIU Jie,LU Yan,HUANG Bo.. MODIFIED MRI SHORT TIME INVERSION RECOVERY SEQUENCE GRADING SYSTEM FOR LUMBAR INTERVERTEBRAL DISC DEGENERATION. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(12): 1430-1434. doi: Copy

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2.	Pfirrmann CW, Metzdorf A, Zanetti A, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine, 2001, 26(17): 1873-1878.
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6.	Landis RJ, Koch GG. The measurement of observer agreement for categorical data. Biometrics, 1977, 33(1): 159-174.
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8.	Kapoor SG, Huff J, Cohen SP. Systematic review of the incidence of discitis after cervical discography. Spine J, 2010, 10(8): 739-745.
9.	Antoniou J, Steffen T, Nelson F, et al. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest, 1996, 98(4): 996-1003.
10.	Liebscher T, Haefeli M, Wuertz K, et al. Age-related variation in cell density of human lumbar intervertebral disc. Spine, 2011, 36(2): 153-159.
11.	Watanabe A, Benneker LM, Boesch C, et al. Classification of intervertebral disk degeneration with axial T2 mapping. AJR Am J Roentgenol, 2007, 189(4): 936-942.
12.	Andersson GB. Epidemiology of low back pain. Acta Orthop Scand Suppl, 1998, 281: 28-31.
13.	Peterson CK, Bolton JE, Wood AR. A cross-sectional study correlating lumbar spine degeneration with disability and pain. Spine, 2000, 25(2): 218-223.
14.	Chiebler ML, Camerino VJ, Fallon MD, et al. In vivo and ex vivo magnetic resonance imaging evaluation of early disc degeneration with histopathologic correlation. Spine (Phila Pa 1976), 1991, 16(6): 635-640.

1. Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J, 2006, 15(6): 705-718.
2. Pfirrmann CW, Metzdorf A, Zanetti A, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine, 2001, 26(17): 1873-1878.
3. Griffith JF, Wang YX, Antonio GE, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2007, 32(24): E708-712.
4. Thompson JP, Pearce RH, Schechter MT, et al. Preliminary evaluation of ascheme for grading the gross morphology of the human intervertebral disc. Spine (Phila Pa 1976), 1990, 15(5): 411-415.
5. Adams MA, Dolan P, Hutton WC. The stages of disc degeneration as revealed by discograms. J Bone Joint Surg (Br), 1986, 68(1): 36-41.
6. Landis RJ, Koch GG. The measurement of observer agreement for categorical data. Biometrics, 1977, 33(1): 159-174.
7. Saifuddin A, Renton P, Taylor BA. Effects on the vertebral end-plate of uncomplicated lumbar discography: an MRI study. Eur Spine J, 1998, 7(1): 36-39.
8. Kapoor SG, Huff J, Cohen SP. Systematic review of the incidence of discitis after cervical discography. Spine J, 2010, 10(8): 739-745.
9. Antoniou J, Steffen T, Nelson F, et al. The human lumbar intervertebral disc: evidence for changes in the biosynthesis and denaturation of the extracellular matrix with growth, maturation, ageing, and degeneration. J Clin Invest, 1996, 98(4): 996-1003.
10. Liebscher T, Haefeli M, Wuertz K, et al. Age-related variation in cell density of human lumbar intervertebral disc. Spine, 2011, 36(2): 153-159.
11. Watanabe A, Benneker LM, Boesch C, et al. Classification of intervertebral disk degeneration with axial T2 mapping. AJR Am J Roentgenol, 2007, 189(4): 936-942.
12. Andersson GB. Epidemiology of low back pain. Acta Orthop Scand Suppl, 1998, 281: 28-31.
13. Peterson CK, Bolton JE, Wood AR. A cross-sectional study correlating lumbar spine degeneration with disability and pain. Spine, 2000, 25(2): 218-223.
14. Chiebler ML, Camerino VJ, Fallon MD, et al. In vivo and ex vivo magnetic resonance imaging evaluation of early disc degeneration with histopathologic correlation. Spine (Phila Pa 1976), 1991, 16(6): 635-640.

Chinese Journal of Reparative and Reconstructive Surgery

MODIFIED MRI SHORT TIME INVERSION RECOVERY SEQUENCE GRADING SYSTEM FOR LUMBAR INTERVERTEBRAL DISC DEGENERATION

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