Aaron J Fields1, Michele C Battié2, Richard J Herzog3, Jeffrey G Jarvik4, Roland Krug5, Thomas M Link5, Jeffrey C Lotz6, Conor W O'Neill6, Aseem Sharma7. 1. Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, Box 0514, San Francisco, CA, 94143-0514, USA. aaron.fields@ucsf.edu. 2. Faculty of Health Sciences and Western's Bone and Joint Institute, University of Western Ontario, London, ON, Canada. 3. Department of Radiology, Hospital for Special Surgery, New York, NY, USA. 4. Departments of Radiology, Neurosurgery and Health Services, and the Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, WA, USA. 5. Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA. 6. Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, Box 0514, San Francisco, CA, 94143-0514, USA. 7. Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
Abstract
PURPOSE: The positive association between low back pain and MRI evidence of vertebral endplate bone marrow lesions, often called Modic changes (MC), offers the exciting prospect of diagnosing a specific phenotype of chronic low back pain (LBP). However, imprecision in the reporting of MC has introduced substantial challenges, as variations in both imaging equipment and scanning parameters can impact conspicuity of MC. This review discusses key methodological factors that impact MC classification and recommends guidelines for more consistent MC reporting that will allow for better integration of research into this LBP phenotype. METHODS: Non-systematic literature review. RESULTS: The high diagnostic specificity of MC classification for a painful level contributes to the significant association observed between MC and LBP, whereas low and variable sensitivity underlies the between- and within-study variability in observed associations. Poor sensitivity may be owing to the presence of other pain generators, to the limited MRI resolution, and to the imperfect reliability of MC classification, which lowers diagnostic sensitivity and thus influences the association between MC and LBP. Importantly, magnetic field strength and pulse sequence parameters also impact detection of MC. Advances in pulse sequences may improve reliability and prove valuable for quantifying lesion severity. CONCLUSIONS: Comparison of MC data between studies can be problematic. Various methodological factors impact detection and classification of MC, and the lack of reporting guidelines hinders interpretation and comparison of findings. Thus, it is critical to adopt imaging and reporting standards that codify acceptable methodological criteria. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: The positive association between low back pain and MRI evidence of vertebral endplate bone marrow lesions, often called Modic changes (MC), offers the exciting prospect of diagnosing a specific phenotype of chronic low back pain (LBP). However, imprecision in the reporting of MC has introduced substantial challenges, as variations in both imaging equipment and scanning parameters can impact conspicuity of MC. This review discusses key methodological factors that impact MC classification and recommends guidelines for more consistent MC reporting that will allow for better integration of research into this LBP phenotype. METHODS: Non-systematic literature review. RESULTS: The high diagnostic specificity of MC classification for a painful level contributes to the significant association observed between MC and LBP, whereas low and variable sensitivity underlies the between- and within-study variability in observed associations. Poor sensitivity may be owing to the presence of other pain generators, to the limited MRI resolution, and to the imperfect reliability of MC classification, which lowers diagnostic sensitivity and thus influences the association between MC and LBP. Importantly, magnetic field strength and pulse sequence parameters also impact detection of MC. Advances in pulse sequences may improve reliability and prove valuable for quantifying lesion severity. CONCLUSIONS: Comparison of MC data between studies can be problematic. Various methodological factors impact detection and classification of MC, and the lack of reporting guidelines hinders interpretation and comparison of findings. Thus, it is critical to adopt imaging and reporting standards that codify acceptable methodological criteria. These slides can be retrieved under Electronic Supplementary Material.
Entities:
Keywords:
Bone marrow lesion; Endplate damage; Low back pain; Magnetic resonance imaging; Modic changes
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