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Ultrashort Echo Time Magnetization Transfer MR Imaging of Lumbar Nerve Roots in Patients With Disc Herniation
Jin Liu1,2, Jiaxin Feng2, Wei Li2
1Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
Lumbar disc herniation (LDH) causes compositional alterations within compressed nerve roots, resulting in low back pain (LBP). The ultrashort echo time magnetization transfer technique (UTE-MT) facilitates assessment of macromolecular changes in collagen- or myelin-rich tissues in nerve roots.
Purpose:
To assess lumbar nerve root composition in LDH using UTE-MT.
Study Type:
Prospective.
Population:
One hundred and seventy-six participants (age range, 20-89; 72 females) with LDH.
Field Strength/Sequence:
3T/UTE-MT, Carr-Purcell-Meiboom-Gill (CPMG).
Assessment:
UTE-MT ratio (UTE-MTR) and T2 value in compressed nerve roots (determined on axial T2) were evaluated by UTE-MT and CPMG in LDH patients (L4/5-L5/S1). Additionally, pain and functionality were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI).
Statistical Tests:
Linear regression and Bland-Altman assessed UTE-MT reproducibility. One-way ANOVA assessed the statistical significance of UTE-MTR and T2 measures between compressed and intact nerve roots. ROC and DCA evaluated diagnostic performance and clinical value of UTE-MTR and T2 in discriminating between compressed and intact nerve roots. Linear regression correlated UTE-MTR and T2 with pain and functionality scores. The p value < 0.05 was considered significant.
Results:
Significant increases in UTE-MTR and decreases in T2 values in compressed nerve roots compared to intact ones. High AUC values for UTE-MTR (0.912 at L4/5 and 0.900 at L5/S1) highlighted its superior ability to distinguish between compressed and intact nerve roots, outperforming T2 (AUCs of 0.840 and 0.790, respectively) in cohort discrimination. Strong significant positive correlations were found between UTE-MTR and VAS (R 2 = 0.63) and ODI (R 2 = 0.62), while T2 values showed moderate significant negative correlations with VAS (R 2 = 0.32) and ODI (R 2 = 0.32) for the measurement of the most severely compressed nerve roots (determined on axial T2).
Data Conclusion:
UTE-MT technique can detect macromolecular alterations in the compressed nerve roots of patients diagnosed with LDH.
Technical Efficacy:
Stage 2.
