A Preliminary Study On The Correlation Between The Integrity Of The Vertebral Cartilage Endplate And The IVIM Parameters Of The Bone Marrow In The Subendplate Area And The Pain Score In Patients With CNLBP

Purpose:The MRI IDEAL-FSPGR-3D and IVIM sequences were used analyze the correlation between the integrity of the lumbar cartilage endplate of CNLBP patients and lumbar intervertebral disc segments,the degenerative changes of lumbar intervertebral disc Pfirrmann grading,the values of IVIM parameters in the subendplate area of the lumbar spine,and the patient’s pain score.Materials and methods:Using the GE Discovery MR 750 3.0T magnetic resonance scanner combined with the back coil of the 32-channel abdominal coil,35 patients with low back pain were scanned for the lumbar spine.The scanning sequence included conventional sagittal T1WI,sagittal T2WI,axial T2WI,and sagittal IDEAL-SPGR and sagittal IVIM-DWI.According to the Pfirrmann grading standard of the lumbar intervertebral disc,each segment of the lumbar intervertebral disc was graded.The integrity of each lumbar cartilage endplate was evaluated on the IDEAL-SPGR sagittal image;When analyzing the relationship between cartilage endplate integrity and lumbar intervertebral disc segment,degenerative changes of lumbar intervertebral disc Pfirrmann classification,the cartilage endplate integrity is divided into no defect,only one side defect,and both side defect according to the severity of the defect;When analyzing the relationship between the cartilage endplate integrity and the IVIM parameter values of the subendplate area of the lumbar spine,as well as the patient’s pain score,the cartilage endplate integrity is divided into two categories:without defect and with defect according to the severity of the defect.The D,D*and f values of the subendplate area were measured on the sagittal IDEAL-FSPGR-3D and IVIM-DWI fusion image.The comparison and correlation analysis of cartilage endplate integrity distribution among different intervertebral disc segments and Pfirrmann grading of intervertebral disc degeneration were respectively performed using R×C contingency table chi-square test and Spearman rank correlation;The independent sample t test was used to compare the differences in the IVIM related parameters(D*,D,f)of the sub-endplate area of the head and caudal endplates of the cartilage endplate integrity groups(without defect,with defect);Two independent sample non-parametric tests(Mann-Whitney U test)were used to analyze the differences in VAS,JOA score and ODI between the L3/4～L5/S1 cartilage endplate group without defect and the group with defect in CNLBP patients.Results:32 subjects,including 160 intervertebral discs,320 cartilage endplates,and 320 subendplate areas were included in the analysis.①The level of intervertebral disc segment was moderately positively correlated with the degree of cartilage endplate defect(r=0.476,P<0.001),the lower the intervertebral disc segment,the higher the degree of cartilage endplate defect;②the Pfirrmann grading of intervertebral disc degeneration is positively correlated with cartilage endplate integrity(r=0.247,P<0.05),the higher the Pfirrmann grading of the intervertebral disc,the higher the degree of cartilage endplate defect Higher.③The differences of D*,D,f in the subendplate area of the cranial endplate in different cartilage endplate integrity groups were statistically significant(P<0.05),there was no significant difference in D*,D,f in the caudal subendplate area of different cartilage endplate integrity groups(P>0.05).④There are statistically significant differences in visual analog VAS and ODI between the L3/4～L5/S1 cartilage endplate non-defective group and the defective group in patients with chronic non-specific low back pain(P<0.05),and the median VAS and ODI of the defect group were higher than those of the non-defect group.Conclusion:The cartilage endplate integrity on the MRI IDEAL-FSPGR-3D image is positively related to the intervertebral disc segment and the degree of disc degeneration.There is a notable difference in VAS and ODI in patients with chronic non-specific low back pain without defect in cartilage endplates and those with defect,and the median VAS and ODI of the defect group were higher than those of the non-defect group,it suggested that there was a correlation between cartilage endplate defect and chronic nonspecific low back pain pain symptoms,and the assessment of cartilage endplate integrity is expected to provide a new idea to search for the probable cause of chronic non-specific low back pain.