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Modic changes on MR images as studied with provocative diskography: clinical relevance--a retrospective study of 2457

Kerry J Thompson1, Azar P Dagher, Timothy S Eckel

  • 1Annapolis Spine Institute, 2002 Medical Pkwy, Suite 235, Annapolis, MD 21401, USA.

Radiology
|February 27, 2009
PubMed
Abstract

Insights

Magnetic resonance imaging (MRI) Modic type 1 changes in vertebral endplates are highly predictive of painful intervertebral discs. This finding aids in identifying the source of back pain using non-invasive imaging.

Area of Science:

  • Radiology
  • Orthopedic Imaging
  • Spinal Diagnostics

Background:

  • Intervertebral disc degeneration is a common cause of low back pain.
  • Accurate identification of painful discs is crucial for effective treatment.
  • Magnetic resonance (MR) imaging is a key tool in spinal assessment.

Purpose of the Study:

  • To evaluate the diagnostic value of vertebral body endplate signal intensity (Modic) changes on MR images.
  • To determine the predictive accuracy of Modic changes for identifying painful discs, using provocative discography as the gold standard.

Main Methods:

  • Retrospective review of 736 patients' lumbar spine MR images and discograms (2457 discs).
  • Classification of discs into Modic subtypes (0, 1, 2, 3) based on endplate signal intensity.
  • Statistical analysis including calculation of positive predictive value (PPV) for each Modic subtype.

Main Results:

  • Modic type 1 changes demonstrated a high PPV (0.81) for a painful disc on provocative discography.
  • Modic type 2 changes had a lower PPV (0.64), and type 3 changes were not significant.
  • PPV for Modic type 1 endplate changes predicting annulus fibrosis tears was insignificant (0.14).

Conclusions:

  • Vertebral body endplate Modic type 1 signal intensity changes on MR imaging are a strong indicator of a pain-generating disc.
  • These findings support the utility of MR imaging in non-invasively identifying painful discogenic sources.

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