Background: An association between cartilaginous endplate (CEP) defects and
intervertebral disc (IVD) degeneration has been previously suggested in animal and
cadaveric studies. CEP defects may also be involved in Schmorl’s nodes (SN). There
have been no previous reports in the literature that describe the use of ultrashort
time-to-echo (UTE) MRI to assess the CEP in humans in vivo. In chapter 5 of this
thesis, a retrospective study of paediatric spines and the neurocentral synchondrosis
(NCS) was singled out to report the incidence of NCS and to raise the hypothesis of
NCS as a precursor of SN.
Purpose: To assess the feasibility of detecting CEP defects in live humans using UTE
MRI, and to assess their relationship with IVD degeneration and SN.
Subjects and Methods: A total number of 22 subjects underwent T2-weighted (T2W)
and UTE MRI to assess for the presence and severity of IVD degeneration, the
presence of SN and for the presence of CEP defects. SN and IVD degeneration were
confirmed by assessing T2W images and IVD degeneration was graded according to
the Schneiderman classification. CEP defects were defined as discontinuity of high
signal over 4 consecutive images and were independently assessed by two raters.
Results: Analyses of CEP defects between IVD degeneration and SN were performed
separately. For the study of CEP defects and IVD degeneration, subjects with SN
were excluded. 37 out of 108 (34.3%) CEPs had defects, which mainly occurred at
T12/L1, L1/L2 and L4/L5 (p=0.008). Inter-rater reliability was substantial (Kappa
statistic= 0.67, p<0.001). Multivariate logistic regression revealed that lower BMI
(p=0.009) and younger (p=0.034) individuals had a decreased likelihood of having
CEP defects. A statistically significant association was found to exist between the
presence of cartilaginous endplate defects and intervertebral disc degeneration
(p=0.036). Degenerated discs with CEP defects were found in L4/5 and L5/S1, while
degenerated discs with no CEP defects were found throughout the whole lumbar
region. Mean degeneration scores of L4/5 and L5/S1 levels with CEP defects were
higher than that of L4/5 and L5/S1 levels without. For the study of CEP defects and
SN, with all 22 subjects assessed, 125 out of 264 (47.3%) CEPs had defects. 40 SN
were found, and among those, 35 SN had CEP defects (87.5%). 125 CEPs had the
presence of CEP defects; among them, a large number of CEP defects did not have
SN underneath (92 out of 125, 73.2%).
Conclusion: The studies demonstrate the feasibility of using UTE MRI in live humans
to assess the integrity of the CEP. Longitudinal studies may reveal the diagnosis of
CEP defects to be clinically beneficial for assessment of IVD degeneration and SN. / published_or_final_version / Diagnostic Radiology / Master / Master of Philosophy
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/161558 |
| Date | January 2011 |
| Creators | Law, Tsz-kwun., 羅子冠. |
| Contributors | Anthony, M, Khong, PL, Kim, M |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Source | http://hub.hku.hk/bib/B47869987 |
| Rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works., Creative Commons: Attribution 3.0 Hong Kong License |
| Relation | HKU Theses Online (HKUTO) |
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