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Spine Feature

MRI of the lumbar spine of a subject with chronic low back pain and disability. (Left) T2-weighted MRI noting multilevel disc degeneration and Modic changes. (Right) Ultra-short time-to-echo (UTE) MRI noting multilevel UTE disc sign (UDS), noted by white arrows.; Source: Hong Kong University

New Marker for Degenerative Disc Disease Disclosed

Elizabeth Hofheinz, M.P.H., M.Ed. • Thu, August 31st, 2017

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Fortunately for those suffering from low back pain (LBP), a team of researchers has just published work that discloses a novel imaging biomarker which is found inside the spinal disc, called the UTE (Ultra-Short Time-to-Echo) Disc Sign (UDS) on MRI (magnetic resonance imaging). The marker was found to be highly correlated to degenerative spine changes, LBP and disability.

This study, led by the Department of Orthopaedics and Traumatology at The University of Hong Kong (HKU), was published in the August 2017 online edition of Spine. For this work, entitled, “The UTE Disc Sign on MRI: A Novel Imaging Biomarker Associated With Degenerative Spine Changes, Low Back Pain and Disability,” the researchers recruited 108 patients.

Dino Samartzis, D.Sc., associate professor in the Department of Orthopaedics and Traumatology at HKU, was the lead investigator. He stated in the August 16, 2017 news release, “For the past 30 years, it has been argued time and time again that findings on conventional MRI or other imaging that are commonly used worldwide are not strongly related to LBP or disability. Many clinicians and scientists have often questioned the practical use of having patients undergo such costly conventional imaging to determine the source of pain and that degenerative disc findings are commonplace among individuals who are also not in pain.”

“Our study provides the ‘missing link’ between imaging findings of the spine and the development of LBP and disability. The UDS provides insight into ‘hidden’ degenerative disc changes that may be clinically relevant.”

Asked why no one else has published on the UDS, Dr. Samartzis told OTW, “These are expensive and challenging studies to perform. We were fortunate to have identified this UTE Disc Sign and been able to correlate it with other MRI phenotypes and pain. I believe that our extensive interest in spinal phenotyping, novel imaging, and the ability to carry out this study placed us in a unique position to address this topic.”

First author Dr. Henry Pang, Master of Research in Medicine student at Li Ka Shing Faculty of Medicine, HKU, told OTW, “The UDS on MRI is highly correlated with several spinal degenerative findings. The UDS may not be observed on conventional T2-weighted MRI. Compared to other MRI sequences and phenotyping patterns, the UDS was the one most significantly associated with low back pain and disability.”

Dr. Samartzis commented to OTW, “Our findings have broadened our understanding of degenerative disc disease and what may exist within the disc, which was previously unknown or not well understood with conventional imaging. The use of UTE MRI along with conventional T2-weighted sequences may provide us with a better understanding towards perhaps pinpointing the origin of pain, if indeed it may be coming from the disc. The UDS may serve as a new imaging phenotype that may have potential implications in diagnostic, therapeutic and prognostic platforms in patients presenting with LBP or possibly be able to predict the development of pain.”

“Taking this into account, more personalized and/or novel methods can be addressed in future to treat disc degeneration and optimize patient outcomes. Furthermore, the UDS may shed light in terms of which discs are more prone to degenerate further or be responsive to biological treatments. This imaging modality can be further used as a screening tool for proper patient selection for such therapeutic approaches in future and/or monitor their efficacy.”

The authors noted that future study plans are underway to identify what these UDS findings truly represent and how they contribute to the mechanism of LBP, as well as predicting future episodes of pain. Further initiatives are also being planned to address large-scale, prospective and multicenter international studies to further validate their findings.

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