Diagnostic value and clinical significance of magnetic resonance imaging with the FS-PD-TSE sequence in diagnosing lumbar cartilaginous endplate failure.

Purpose: The aims were to use magnetic resonance imaging (MRI) to compare the efficacy of fat-suppressed proton-density turbo-spin-echo (FS-PD-TSE) images and T1-weighted (T1WIs) and T2-weighted images (T2WIs) in identifying cartilaginous endplate failure (CEF), and to propose a modified Rajasekaran classification based on the FS-PD-TSE sequence.

Methods: Thirty-one lumbar disc herniation (LDH) cases were enrolled. Totally, 155 discs and 310 endplates were evaluated by MRI with T1W, T2W, and FS-PD-TSE sequences. Disc degeneration (DD), LDH grades, and the total endplate score (TEPS) of CEF were evaluated. Chi-square, Spearman rank correlation analysis, and multiclass logistic regression were used to compared the sensitivity in diagnosing CEF. A modified Rajasekaran classification based on FS-PD-TSE sequence was established to diagnose CEF. The multiclass logistic regression model was used to analyse the relationship between modified Rajasekaran classification and DD and LDH.

Results: There were 117 (75.5%) segments with CEF in T1WIs, 115 (74.2%) in T2WIs, and 127 (81.9%) in FS-PD-TSE, respectively. Chi-square test showed FS-PD-TSE images were more sensitive than T1WIs and T2WIs (P < 0.05). Spearman rank correlation analysis revealed a significant correlation between TEPS and LDH and DD in T1WIs, T2WIs, and FS-PD-TSE images (P < 0.05). A multiclass logistic regression model showed that the incidence of DD and LDH significantly increased accordingly with increases in modified Rajasekaran classification (P < 0.05).

Conclusion: The FS-PD-TSE sequence has high diagnostic value for lumbar CEF. CEF is a risk factor for LDH. The new classification for lumbar CEF based on the FS-PD-TSE sequence has good predictive ability for LDH and DD. These slides can be retrieved under Electronic Supplementary Material.