A Comparative Study On MRI And Pathology Of The Neovascularization Of The Degenerated Intervertebral Disks In Patients With Lower Back Pain

Objective: We applied DCE-MRI and IVIM-DWI in patients of low back pain,to explore the relationship between the MRI parameters and MVD,disc degeneration Pm grade and VAS scores.Methods: Fifty-one patients with lumbar disc herniation treated by lumbar posterior approach were selected as the experimental group.Eight patients with lumbar fractures were selected as the control group.All subjects underwent IVIM and DCE-MRI examinations before operation.D*,D and f were calculated by double exponential model.DCE-MRI parameters Ktrans,Kep and Ve were analyzed by two chamber model.After operation,Immunohistochemistry of intervertebral disc were analyzed.The microvessel density(MVD)was calculated by CD34 labeled vascular endothelial cells.The correlation between IVIM-DWI and DCE-MRI parameters was analyzed by Pearson or Spearman correlation.To evaluate the correlation between the parameters of two imaging modalities and microvessel density and intervertebral disc degeneration classification.One-way analysis of variance was used to compare differences in IVIM-DWI and DCE-MRI parameters among patients with different degenerative degrees and different degrees of lumbago.Results: CD34 expression was not related to sex and age.The positive rate of CD34 in the extrusion type and sequestration type or severe intervertebral disc degeneration was higher than prtuded type.The Ktransvalue in experimental group was higher than the normal control group,while the D value was significantly lower than the control group,the difference was statistically significant(P <0.05).F values and Ktrans values were positively correlated(r =0.520,P = 0.001).The overall distribution of Ktrans and D values in different degeneration grades was different(P<0.05),Ktrans values increased with degenerative grading(P<0.05),and D values decreased with increasing grades of degeneration(P<0.05).Ktrans increased with increasing degree of low back pain(P<0.05),and D values decreased with increasing low back pain.The Ktrans,Kep,f and D * values of the two imaging modalities were positively correlated with the values of MVD(r = 0.794,0.496,0.477,0.589;P=0.000,0.000,0.000,0.000,respecticvly).The D value was negatively correlated with the grade of intervertebral disc degeneration(r =-0.897,P<0.05).The Ktrans value and f value were positively correlated intervertebral disc degeneration grade(r=0.617,0.306;P<0.05).Conclusions: There is a correlation between Ktrans and f.Ktrans value and f value and MVD have a good correlation with the degeneration of the intervertebral disc,suggesting that Ktrans and f values can be used for the evaluation of angiogenisis and degeneration of lumbar intervertebral disc.The Ktrans and D values are associated with disc degeneration and low back pain symptoms.