Ultrashort echo time (UTE) MRI of the spine in thalassaemia

Back pain is common in adult patients with homozygous thalassaemia, and degenerative disc disease is increasingly recognised as a cause. Ultrashort echo time (UTE) pulse sequences, which are sensitive to the presence of short T(2) relaxation components in tissue produced by iron deposition and other processes, were used to examine the lower thoracic and lumbar spine in symptomatic patients with beta-thalassaemia major or intermedia. Three patients were studied with fat suppressed as well as both fat suppressed and long T(2) suppressed UTE (TE=0.08 ms) pulse sequences. Conventional 2D Fourier transformation T(1) and T(2) weighted scans were also performed for comparison. Normal controls showed narrow high signal areas in the region of the end-plate and annulus fibrosus. Patients showed hyperintense bands adjacent to the vertebral end plate in lower thoracic and lumbar spine discs using a UTE sequence with both long T(2) component and fat suppression. The extent of the changes was most marked in the patient with the most severe degenerative change. In the patient with minimal disease, findings of this type were present in discs which did not show evidence of degeneration with conventional MR imaging. High signal changes of a type previously not described were observed in each patient. The effect may be due to organic iron entering the disc and decreasing its T(1) and T(2), but susceptibility effects from iron in the vertebral bodies, fibrosis and other causes also need to be considered.