MRI of the Intervertebral Disc: Focus on Signal Intensity Changes

Congress:

ECR 2020

Poster Number:

C-04740

Type:

Educational Exhibit

Keywords:

Not applicable, Calcifications / Calculi, Education, MR, Musculoskeletal spine, Anatomy, Musculoskeletal

Authors:

M. Maturi, F. de cecco, G. Mansueto, F. B. Pizzini; Verona/IT

DOI:

10.26044/ecr2020/C-04740

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-04740

Fig. 1: A normal intervertebral disc is composed by nucleus pulposus (proteoglycans and...

Fig. 3: Signal intensity changes on T2wI, T1wI, STIR, contrast enhancement (CE) T1wI...

Fig. 4: Progressive degenerative changes on T2wI of the intervertebral lumbar disc, as...

Fig. 5: Incidental finding on MRI of a 45 y.o. male Patient: intradiscal calcification...

Fig. 6: Incidental finding on MRI of a 69 y.o. Patient with lower back pain:...

Fig. 7: Incidental finding on MRI of an 83 y.o. male Patient with lower back pain:...

Learning objectives

Magnetic resonance (MRI) represents the imaging of choice for investigating intervertebral disc disorders. Understanding of the anatomy and physio-pathological changes in the intervertebral disc is fundamental for an accurate interpretation of the MRI examination. The objective of this Poster is to illustrate signal intensity changes related to normal and pathological intervertebral disc aspects on MRI.

Background

Accurate interpretation of intervertebral disc signal intensity (SI) changes on MRI requires understanding of the anatomy and physiology of the disc in normal and pathological conditions. In response to stress, degenerative changes occur in various degrees, and it is fundamental to recognize and characterize correctly the different aspects of degenerated intervertebral discs. Physiology A normal intervertebral disc is composed by nucleus pulposus, which is a gelatinous structure with high viscosity and high elasticity made of proteoglycans and collagen, and an outer fibrous ring called anulus...

Findings and procedure details

Normal disc Normal signal intensity of nucleus pulposus on MRI reflects its high content in water, which is up to 80% in normal discs: imaging appearance is homogeneously hyperintense on T2 weighted images (wI) and homogeneously hypointense compared to normal vertebral marrow on T1wI. Regarding annulus fibrosus, the inner portion gradually blends with the nucleus pulposus, with similar signal intensity: homogeneously hyperintense on T2wI and homogeneously hypointense on T1wI. The outer portion of annulus fibrosus is composed by collagen type II fibers and appears hypointense...

Conclusion

Knowledge of signal intensity changes in the intervertebral disc is fundamental to identify physiologic and pathologic modification of the spine; MRI constitutes an excellent imaging technique for evaluating intervertebral discs and for providing an accurate diagnosis. MRI is also extremely valuable in order to guide treatment and to perform follow up evaluations.

Personal information and conflict of interest

M. Maturi; Verona/IT - nothing to disclose F. de Cecco; Verona/IT - nothing to disclose G. Mansueto; Verona/IT - nothing to disclose F. B. Pizzini; Verona/IT - nothing to disclose

References

-Morgan S, Saifuddin A. MRI of the Lumbar Intervertebral Disc. Clinical Radiology (1999) 54, 703-723. -Pﬁrrmann CWA, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic Resonance Classiﬁcation of Lumbar Intervertebral Disc Degeneration. Spine (2001) 26(17):1873–1878. -Kushchayev SV, Glushko T, Jarraya M,Schuleri KH, Preul MC,Brooks ML, Teytelboym OM. ABCs of the degenerative spine. Insights Imaging (2018) 9:253–274. -Diehn FE, Maus TP, Morris JM, Carr CM, Kotsenas AL, Luetmer PH, Lehman VT, Thielen KR, Nassr A, Wald JT. Uncommon Manifestations of Intervertebral Disk Pathologic Conditions. RadioGraphics...