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研究生(外文):In-Lin, Chiou
論文名稱(外文):The Correlation Investigation of Modic Change and LumbarSpine Degeneration by Magnetic Resonance Imaging
指導教授(外文):Chi-Long, Juang
中文關鍵詞:脊椎退化Modic 變化磁振造影T2 弛豫時間圖像Dixon 方法
外文關鍵詞:Spine DegenerativeModic ChangesMagnetic Resonance ImagingT2 MapsDixon Method
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椎體退化性變化又稱作 Modic 變化,是一種發生在相鄰的椎間盤軟骨終板之退行性變化。這些病灶可使用磁振造影(MRI)加以偵測,MRI 是一種非侵入性及無輻射性又可以精確的偵測脊椎型態的影像診斷技術。此外脊椎周圍肌肉的功用,在於維持脊椎在身體的中心並維持椎體的穩定性;當這些肌肉發生功能變異或萎縮時,就會造成脊椎不穩定並進一步產生下背痛。儘管 Modic 變化和脊椎周圍肌肉的穩定性都與下背痛有關,但它們之間的相關性卻還不清楚。
本研究之志願受試者分別為 29 位下背痛且需要 MRI 掃描者及 30 位健康無下背痛者,年齡為 30 至 85 歲。受試者之椎間盤退化等級參考歐氏下背痛量表及他們的 T2 值進行評估;Modic 變化則由桃園敏盛醫院資深放射科醫師與放射師各一名,獨立進行 T1 及 T2 加權影像的判讀;待周邊肌肉之脂肪/水比值以 Dixon 方法取得之後,所有經過後處理的數據再以 PASW 18.0 統計軟體進行相關性分析。
結果發現無 Modic 變化者 39 位,Modic 變化第 I 型(MC1)者 6 位,Modic 變化第 II 型(MC2)者 11 位及 Modic 變化第 III 型(MC3)者 3 位。統計分析結果,髓核 T2 值與 Modic 變化呈現低相關性(rho = -0.104, P = 0.432),肌肉之脂肪/水的比率則呈現較高相關性(rho = 0.338, P = 0.009)。髓核 T2 值和脂肪/水的比率可以區別有無椎間盤軟骨終板的退化,是腰椎退化發展的重要指標。

Vertebral degenerative bone marrow changes also known as Modic changes, are degenerative changes adjacent to the cartilaginous endplates of the inter-vertebral discs. These lesions are visible in Magnetic Resonance Imaging (MRI), which provides a non-invasive and no radiation precise morphologic evaluation of the lumbar spine. In addition, the function of disc surrounding muscle is to remain the spine at center and keep the stability of inter-body. When dysfunction or atrophy happened in this muscle, the consequential spinal instability will also generate low back pain (LBP). Even though both of them associated with LBP, the correlation between them is still unclear.
In this study, fifty-nine subjects aged from 30 to 85 were divided into two groups, one consist 29 participants with LBP and required spine MRI measurement, and the other one consist 30 healthy volunteers. Degeneration grade of inter-vertebral discs of each subject were evaluated by Oswestry Low-Back-Pain disability questionnaire and their T2 Maps. Modic changes were evaluated by one senior radiologist and one senior radiographer independently by the T1 and T2 weighted images of the subject. After the fat/water ratios were obtained from Dixon method, all the post-processed data were then statistically analyzed by PASW 18.0 software.
The image analysis results showed there were 39 subjects without Modic changes, 6 with Modic changes type I, 11 with Modic changes type II and 3 with Modic changes type III. Statistical analysis results indicated the nucleus T2 value had low correlation (rho = -0.104, P = 0.432) with Modic changes types. However, the fat/water ratio of paraspinal muscle showed a high correlation (rho = 0.338, P = 0.009) with Modic changes. In conclusion, T2 values of the nucleus pulposus and fat/water ratio of paraspinal muscle provided the ability to grade the endplate cartilage degradation, and are the important indicators of the degenerative evolution of lumbar spine.
中文摘要 I
Abstract III
致謝 V
目錄 VI
圖目錄 VIII
表目錄 X
第一章 緒論 1
1.1 研究動機 1
1.2 研究目的 2
第二章 研究背景 3
2.1 脊椎基本構造 3
2.2 下背痛(low back pain) 7
2.3 脊椎周圍肌肉基本構造 8
2.4 Modic 變化 9
2.5 腰椎退化評估方法 10
2.6 磁振原理 13
第三章 材料與方法 23
3.1 研究設計 23
3.2 Dixon 方法之效益評估 24
3.3 受試者主要排除及納入條件 28
3.4 人體試驗程序 29
3.5 儀器 30
3.6 磁振造影掃描參數之設定 31
3.7 資料分析 34
3.8 統計方法 35
3.9 人體試驗流程 35
第四章 結果與討論 36
4.1 不同油水比例之假體的掃描結果 36
4.2 假體之相位校正結果 41
4.3 受試者基本特性 43
4.4 椎間盤髓核 T2 值分析 46
4.5 髓核 T2 值之椎間盤退化等級 50
4.6 腰椎周圍肌肉組織的 F/W 值 52
4.7 髓核 T2 值和腰椎周圍肌肉 F / W 值與 Modic 變化相關性分析 56
第五章 結論 57
參考文獻 58
附件一:下背痛患者 T2 值數據…………………………………………63
附件二:下背痛患者 F/W 值數據………………………………………64
附件三:健康受試者 T2 值數據…………………………………………65
附件四:健康受試者 F/W 值數據………………………………………66

1.Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of Degenerative Disk Disease. Radiology 1988;168:177-186.
2.Krzysztof S, Howard A, Koichi M, Gunnar A and Gabriella CS. The Effects of Age, Gender, Ethnicity, and Spinal Level on the Rate of Intervertebral Disc Degeneration. A Review of 1712 Intervertebral Discs. Spine 2011;36(17):1333–1339.
3.Charlotte LY, Per K, Tom B and Claus M. Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Modic changes. BioMed Central Musculoskeletal Disorders 2008;9:5
4.Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI Assessment of Lumbar Intervertebral Disc Degeneration with Lumbar Degenerative Disease Using the Pfirrmann Grading Systems. PLoS ONE 2012;7(12):e48074
5.Permutt Z, Le TA, Peterson MR, Seki E, Brenner DA, Sirlin C, and Loomba R. Correlation between liver histology and novel magnetic resonance imaging in adult patients with non-alcoholic fatty liver disease - MRI accurately quantifies hepatic steatosis in NAFLD. Aliment Pharmacol and Therapeutis 2012;36(1):22-29.
6.Wei S, Xiuqun G, Jessica W, and Ye Jin. Comparison among T1-Weighted Magnetic Resonance Imaging, Modified Dixon Method, and Magnetic Resonance Spectroscopy in Measuring Bone Marrow Fat. Journal of Obesity 2013;(2013),Article ID,298675:1-6.
7.Anderson JE. The Back. In: Grant's Atlas of Anatomy. 8th ed. Baltimore: Willams & Wilkins, 1983;501-523.
8.Raj PP. Intervertebral disc: anatomy-physiology-pathophysiology-treatment. Pain Pract 2008;8:18-44.
9.Robert C John PH, and Charles RN; 李玉菁等編譯。人體解剖學 2000;161-163。
10.Urban JP, Smith S, Fairbank JC. Nutrition of the Intervertebral Disc. Spine 2004;29(23):2700-2709.
11.Kubaszewski T, Nowakowski A, Gasik R Łabędź W. Intraobserver and interobserver reproducibility of the novel transcription method for selection of potential nerve root compression in MRI Study in degenerative disease of the lumbar spine. Medical Science Monitor 2013;19:216-221.
12.Koes BW, van Tulder MW, Ostelo R, Kim Burton A, Waddell G. Clinical Guidelines for The Management of Low Back Pain in Primary Care: an International Comparison. Spine 2001;26(22):2504-2513.
13.Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. British Medical Journal 2006;332:1430-1434
14.林頌凱,張煥禎。下背痛的診斷與治療。基層醫學 2004;19:282-287。
15.de Roos A, Kressel H, Spritzer C and Dalinka M. MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. American Journal of Roentgenology 1987;149(3):531-534.
16.Modic MT, Steinberg PM, Ross JS, Masaryk TJ and Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166:193-199.
17.Braithwaite I, White J, Saifuddin A, Renton P, and Taylor BA. Vertebral end-plate(Modic)changes on lumbar spine MRI:correlation with pain reproduction at lumbar discography. European Spine Journal 1998;7:363-368.
18.Rahme R, Moussa R. The Modic Vertebral Endplate and Marrow Changes: Pathologic Significance and Relation to Low Back Pain and Segmental Instability of the Lumbar Spine. American Journal of Neuroradiology 2008;29:838-842
19.劉伊珊,林亞蓉,楊靜蘭,王淑芬。下背痛患者理學檢查之信度探討。物理治療 2009;34:29-41。
20.Nouh MR. Spinal fusion-hardware construct:Basic concepts and imaging review. World Journal of Radiology 2012;4(5):193-207
21.Manchikanti L, Glaser SE, Wolfer L, Derby R, Cohen SP. Systematic review of lumbar discography as a diagnostic test for chronic low back pain. Pain Physician Journal 2009;12:541-559.
22.O'Neill C, Kurgansky M, Kaiser J, Lau W. Accuracy of MRI for diagnosis of discogenic pain. Pain Physician Journal 2008;11:311-326
23.Hashemi RH, Bradley WG, Lisanti CJ. MRI the basics. Lippincott Williams & Wilkins. 2006;17-39.
24.Hashemi RH, Bradley J, William G, Lisanti C. Basic Concepts:T1, T2, and T2*. In: MRI The Basics. 2 ed. Philadelphia: Lippincott Williams and Wilkins. 2003;41-48.
25.Hashemi RH, Bradley J, William G, Lisanti C. Basic Concepts:TR, TE, and Tissue Contrast. In: MRI The Basics. 2 ed. Philadelphia: Lippincott Williams and Wilkins. 2003;49-57.
26.Tibiletti M, Galbusera F, Ciavarro C and Brayda-Bruno M. Is the Transport of a Gadolinium-Based Contrast Agent Decreased in a Degenerated or Aged Disc? A Post Contrast MRI Study. PLoS ONE 2013;8(10):e76697.
27.Lee JM, Nam KH, Lee IS, Park SK, Choi BK and Han IH. Modic Degenerative Marrow Changes in the Thoracic Spine: A Single Center Experience. Journal of Korean Neurosurgical Society. 2013;54:34-37.
28.Sørlie A, Moholdt V, Kvistad KA, Nygaard ØP, Ingebrigtsen T, Iversen T, Kloster R and Solberg TK. Modic type I changes and recovery of back pain after lumbar microdiscectomy. European Spine Journal 2012;21:2252-2258.
29.Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS and Manniche C. Rest versus exercise as treatment for patients with low back pain and Modic changes. a randomized controlled clinical trial. BioMed Central Medicine 2012;10:22.
30.Keller A, Boyle E, Skog TA, Cassidy JD, Holter EB. Are Modic Changes Prognostic for Recovery in a Cohort of Patients with Non-Specific Low Back Pain? European Spine Journal 2012;21:418-424.
31.Wilkens P, Storheim K, Scheel I, Berg L and Espeland A. No Effect of 6-Month Intake of Glucosamine Sulfate on Modic Changes or High Intensity Zones in The Lumbar Spine: Sub-Group Analysis of a Randomized Controlled Trial. BioMed Central Medicine 2012;11:13.
32.Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Jensen TS and Manniche C. Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI. European Spine Journal 2012;21:2271-2279.
33.Kerttula L, Luoma K, Vehmas T, Grönblad M and Kaapa E. Modic type I change may predict rapid progressive, deforming disc degeneration: a prospective 1-year follow-up study. European Spine Journal 2012;21:1135-1142.
34.Albert HB, Briggs AM, Kent P, Byrhagen A, Hansen C, Kjaergaard K. The Prevalence of MRI-Defined Spinal Pathoanatomies and Their Association with Modic changes in Individuals Seeking Care for Low Back Pain. European Spine Journal 2011;20:1355-1362.
35.Jensen TS, Kjaer P, Korsholm L, Bendix T, Sorensen JS, anniche C and Leboeuf-Yde C. Predictors of new vertebral endplate signal (Modic) changes in the general population. European Spine Journal 2010;19(1):129-135.
36.Ohtori S, Koshi T, Yamashita M, Yamauchi K, Inoue G, Suzuki M, Takaso M, Orita S, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Nakamura J, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H and Takahashi K. Existence of pyogenic spondylitis in Modic type 1 change without other signs of infection: 2-year follow-up. European Spine Journal 2010;19:1200-1205.
37.Kuisma M, Karppinen J, Haapea M, Niinimäki J, Ojala1 R, Heliövaara M, Korpelainen R, Kaikkonen K, Taimela S, Natri A and Tervonen O. Are the determinants of vertebral endplate changess and severe disc degeneration in the lumbar spine the same? A magnetic resonance imaging study in middle-aged male workers. BioMed Central Medicine 2008;9:51.
38.Haneder T, Apprich SR, Schmitt B, Michaely HJ,. Schoenberg SO, Friedrich KM, Trattnig S. Assessment of glycosaminoglycan content in intervertebral discs using chemical exchange saturation transfer at 3.0 Tesla: preliminary results in patients with low-back pain. European Journal of Radiology 2013;23(3):861-868.
39.Takashima H, Takebayashi T, Yoshimoto M, Terashima Y, Tsuda H, Ida K, Yamashita T. Correlation Between T2 Relaxation Time and Intervertebral Disk Degeneration. Skeletal Radiology 2012;41(2):163-167.
40.Wang YXJ, Zhao F, Griffith JF, Mok GSP, Leung JCS Ahuja AT and Yuan J. T1rho and T2 relaxation times for lumbar disc degeneration: an in vivo comparative study at 3.0-Tesla MRI. European Journal of Radiology 2013;23(1):228-234.
41.Niu G, Yang J, Wang R, Dang S, Wu EX, Guo Y. MR Imaging Assessment of Lumbar Intervertebral Disk Degeneration and Age-Related Changes: Apparent Diffusion Coefficient versus T2 Quantitation. American Journal of Neuroradiology 2011;32:1617-1623.
42.Welsch GH, Trattnig S, Sluga TP, Bohndorf K, Goed S, Stelzeneder D and Mamisch TC. Parametric T2 and T2* mapping techniques to visualize intervertebral disc degeneration in patients with low back pain: initial results on the clinical use of 3.0 Tesla MRI. Skeletal Radiology 2011;40(5):543-551.
43.Marinelli NL, Haughton VM, Anderson PA. T2 Relaxation Times Correlated with Stage of Lumbar Intervertebral Disk Degeneration and Patient Age. American Journal of Neuroradiology 2010;31:1278-1282.
44.王基誠,黃武達,楊斐適,莊奇容。臺灣應用輻射與同位素雜誌 Taiwanese Journal of Applied Radiation and Isotopes 2010;6:933-938.
45.Blumenkrantz G, Zuo J, Li X, Kornak J, Link T M., Majumdar S. In vivo 3.0-tesla magnetic resonance T1ρ and T2 relaxation mapping in subjects with intervertebral disc degeneration and clinical symptom. Magnetic Resonance in Medicine 2010;63(5):1193-1200.
46.Dixon WT. Simple Proton Spectroscopic Image. Radiology 1984;153:189-194.
47.Glockner JF, Saranathan M, Bayram E and Leea CU. Breath-held MR Cholangiopancreatography (MRCP) using a 3D Dixon fat–water separated balanced steady state free precession sequence. Magnetic Resonance Imaging 2013;31(8):1263-1270.
48.Elliott JM, Walton DM, Rademaker A and Parrish TB. Quantification of cervical spine muscle fat: a comparison between T1-weighted and multi-echo gradient echo imaging using a variable projection algorithm (VARPRO). BioMed Central Medicine 2013;13(30)1471-2342.
49.Low RN, Austin MJ and Ma J. Fast spin-echo triple echo dixon: Initial clinical experience with a novel pulse sequence for simultaneous fat-suppressed and nonfat-suppressed T2-weighted spine magnetic resonance imaging. Journal of Magnetic Resonance Imaging 2011;33:390-400.
50.Eggers H, Brendel B, Duijndam A and Herigault G. Dual-echo Dixon imaging with flexible choice of echo times. Magnetic Resonance in Medicine 2011;65:96-107.
51.Berglund J, Ahlstrom H, Johansson L and Kullberg J. Two-point dixon method with flexible echo times. Magnetic Resonance in Medicine 2011;65:994-1004.
52.Low RN, Ma J and Panchal N. Fast Spin-Echo Triple-Echo Dixon: Initial Clinical Experience with a Novel Pulse Sequence for Fat-Suppressed T2-Weighted Abdominal MR Imaging. Journal of Magnetic Resonance Imaging 2009;30:569-77.
53.林文煌,謝伸裕。磁共振造影、水中稱重和生物電阻法評估體脂肪百分比之研究。國立臺灣師範大學體育研究所碩士論文 1995。

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