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Lumbar Disk Herniation: Correlation of Histologic Findings with Marrow Signal Intensity Changes in Vertebral Endplates at MR Imaging¹

¹ From the Departments of Radiology and Nuclear Medicine (G.S., A.W., M.J., O.K.) and Orthopaedic Surgery (R.W.), St Josef Hospital, and the Institute of Pathology, Ruhr-Universität Bochum, Gudrunstrasse 56, 44791 Bochum, Germany (C.K.). From the 1999 RSNA scientific assembly. Received October 31, 2002; revision requested March 6, 2003; final revision received October 1; accepted October 21. Address correspondence to G.S. (e-mail: gebhard.schmid@ruhr-uni-bochum.de).

View larger version (24K): [in a new window]   Figure 1. Histogram shows proportion of extrusions with (black bars) or without (white bars) cartilaginous material in different age groups. Percentage of disk herniations containing cartilaginous endplate increased with age, but hyaline cartilage was found most often in disk herniations in the middle age group.

View larger version (29K): [in a new window]   Figure 2. Histogram shows proportion of extrusions with (black bars) or without (white bars) cartilaginous material, dependant on weight of herniated material (in grams). Percentage of disk herniations containing cartilaginous endplate increased with weight of extruded disk material. Larger disk herniations more often contained hyaline cartilage from endplates.

View larger version (25K): [in a new window]   Figure 3. Histogram shows relationship between number of extrusions with (black bars) or without (white bars) cartilaginous material and Modic type of signal intensity change. When type 1 or 2 changes were present, many more extrusions contained cartilage from the endplates than when there were no changes (type 0). Because types 1 and 2 changes behave in the same way, they were statistically analyzed together.

View larger version (31K): [in a new window]   Figure 4. Histogram shows relationship between number of extrusions with (black bars) or without (white bars) cartilage and extension of signal intensity changes along vertebral endplate. When signal intensity changes occur in more than one-third of sagittal diameter of vertebral endplate, a significantly greater number of extrusions contain cartilaginous material.

View larger version (180K): [in a new window]   Figure 5a. (a) In a 66-year-old male patient, sagittal T2-weighted MR image (4,000/120, section thickness of 4 mm) obtained in the lumbar spine shows vertebral corner defect (arrow) at upper dorsal aspect of vertebral body L5 adjacent to disk herniation in segment from L4 through L5. In comparison, vertebral corners at level above and that below are normal. (b) In same patient as in a, transverse T1-weighted MR image (500/15, section thickness of 4 mm) shows vertebral corner defect (arrows) at dorsal aspect of vertebral body L5 adjacent to disk herniation in segment from L4 through L5. (c) In 64-year-old female patient, sagittal T2-weighted MR image (4,000/120, section thickness of 4 mm) shows large disk herniation (weight, 5.3 g). Signal intensity changes along vertebral endplates, with rounded corner at lower dorsal aspect of vertebral body L4 (arrow). Extruded material consisted of 60% anulus fibrosus, 10% nucleus pulposus, and 30% hyaline cartilage from endplate.

View larger version (157K): [in a new window]   Figure 5b. (a) In a 66-year-old male patient, sagittal T2-weighted MR image (4,000/120, section thickness of 4 mm) obtained in the lumbar spine shows vertebral corner defect (arrow) at upper dorsal aspect of vertebral body L5 adjacent to disk herniation in segment from L4 through L5. In comparison, vertebral corners at level above and that below are normal. (b) In same patient as in a, transverse T1-weighted MR image (500/15, section thickness of 4 mm) shows vertebral corner defect (arrows) at dorsal aspect of vertebral body L5 adjacent to disk herniation in segment from L4 through L5. (c) In 64-year-old female patient, sagittal T2-weighted MR image (4,000/120, section thickness of 4 mm) shows large disk herniation (weight, 5.3 g). Signal intensity changes along vertebral endplates, with rounded corner at lower dorsal aspect of vertebral body L4 (arrow). Extruded material consisted of 60% anulus fibrosus, 10% nucleus pulposus, and 30% hyaline cartilage from endplate.

View larger version (195K): [in a new window]   Figure 5c. (a) In a 66-year-old male patient, sagittal T2-weighted MR image (4,000/120, section thickness of 4 mm) obtained in the lumbar spine shows vertebral corner defect (arrow) at upper dorsal aspect of vertebral body L5 adjacent to disk herniation in segment from L4 through L5. In comparison, vertebral corners at level above and that below are normal. (b) In same patient as in a, transverse T1-weighted MR image (500/15, section thickness of 4 mm) shows vertebral corner defect (arrows) at dorsal aspect of vertebral body L5 adjacent to disk herniation in segment from L4 through L5. (c) In 64-year-old female patient, sagittal T2-weighted MR image (4,000/120, section thickness of 4 mm) shows large disk herniation (weight, 5.3 g). Signal intensity changes along vertebral endplates, with rounded corner at lower dorsal aspect of vertebral body L4 (arrow). Extruded material consisted of 60% anulus fibrosus, 10% nucleus pulposus, and 30% hyaline cartilage from endplate.

View larger version (26K): [in a new window]   Figure 6. Histogram shows proportion of extrusions with (black bars) or without (white bars) cartilage in group A (no vertebral corner defect or no definite vertebral corner) and group B (definite vertebral corner defect). Extrusions containing hyaline cartilage were seen more than twice as often in group B than they were in group A.