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Classification of Intervertebral Disk Degeneration with Axial T2 Mapping

¹ Department of Clinical Research, Unit for MR Spectroscopy and Methodology, University of Bern, CH-3010 Bern, Switzerland.
² Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern, Switzerland.
³ Present address: Department of Radiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan.
⁴ Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
⁵ Tissue Engineering and Osteoarticular Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland.
⁶ Department of Biophysics, Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan.

OBJECTIVE. The aim of this study was to establish an MRI classification system for intervertebral disks using axial T2 mapping, with a special focus on evaluating early degenerative intervertebral disks.

MATERIALS AND METHODS. Twenty-nine healthy volunteers (19 men, 10 women; age range, 20–44 years; mean age, 31.8 years) were studied, and axial T2 mapping was performed for the L3–L4, L4–L5, and L5–S1 intervertebral disks. Grading was performed using three classification systems for degenerative disks: our system using axial T2 mapping and two other conventional classification systems that focused on the signal intensity of the nucleus pulposus or the structural morphology in sagittal T2-weighted MR images. We analyzed the relationship between T2, which is known to correlate with change in composition of intervertebral disks, and degenerative grade determined using the three classification systems.

RESULTS. With axial T2 mapping, differences in T2 between grades I and II were smaller and those between grades II and III, and between grades III and IV, were larger than those with the other grading systems. The ratio of intervertebral disks classified as grade I was higher with the conventional classification systems than that with axial T2 mapping. In contrast, the ratio of intervertebral disks classified as grade II or III was higher with axial T2 mapping than that with the conventional classification systems.

CONCLUSION. Axial T2 mapping provides a more T2-based classification. The new system may be able to detect early degenerative changes before the conventional classification systems can.

Keywords: classification • degeneration • intervertebral disks • MRI • T2 mapping

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