Skip to main content
SpringerLink
Log in

Evaluation of intervertebral disc using T2 mapping sequences in patients undergoing O2–O3 chemiodiscolysis: an instrumental study with clinical correlation

  • Spinal Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

To assess the MRI modifications of the intervertebral disc (IVD) treated by chemiodiscolysis using T2 mapping sequences.

Methods

Thirty sciatica patients (17 males, 13 females, mean age 47.52 years) were enrolled for percutaneous CT-guided O2–O3 chemiodiscolysis treatment. As a control group, we enrolled 30 patients who were treated by CT-guided periradicular injections. All patients were submitted to clinical (using VAS and Oswestry Disability index (ODI)) and imaging studies to evaluate the intervertebral disc area (IDA) and T2 mapping values of the IVD before and at 1-month follow-up.

Results

In the study group, pre-treatment IDA mean values were 20.47 ± 1.62 cm2, with significant reduction at the follow-up (P < 0.05). Mean pre-treatment T2 relaxation time values were 38.80 ± 4.51 ms, 44.05 ± 0.91 ms, and 45.45 ± 14.11 ms for anterior annulus fibrosus, nucleus pulposus (NP), and posterior annulus fibrosus, respectively, with significant increase at the level of the NP (P < 0.05) at the follow-up. Mean pre-treatment ODI and VAS scores were 21.5 ± 10.6 and 8.5 ± 0.57, with significant improvement at the post-treatment follow-up (P < 0.05). In the control group, despite clinical improvement, we did not find significant IVA reduction nor significant T2 values change after treatment. Correlation analysis of T2 mapping relaxation time values showed significant correlation of NP T2 mapping value with both the reduction of IDA (0.81, P < 0.001) and the improvement of VAS and ODI scores (0.86, P < 0.001) at 1 month. In the control group, we did not find any statistically significant correlation.

Conclusions

T2 mapping may be a useful indicator to predict disc shrinkage and the clinical response to CT-guided O2–O3 injection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig 3

Similar content being viewed by others

References

  1. Ezeldin M, Leonardi M, Princiotta C et al (2018) Percutaneous ozone nucleolysis for lumbar disc herniation. 1231–1241

    Article  Google Scholar 

  2. Cui YZ, Yang XH, Liu PF, Wang B, Chen WJ (2016) Preliminary study on diagnosis of lumbar disc degeneration with magnetic resonance T1p, T2 mapping and DWI quantitative detection technologies. Eur Rev Med Pharmacol Sci 20:3344–3350

    PubMed  Google Scholar 

  3. Foltz MH, Kage CC, Johnson CP (2017) Noninvasive assessment of biochemical and mechanical properties of lumbar discs through quantitative magnetic resonance imaging in asymptomatic volunteers. 139:1–7. https://doi.org/10.1115/1.4037549

  4. Ch B (2009) Parametric T2 and T2 * mapping techniques to visualize intervertebral discs in patients with low back pain - initial results on the clinical use with 3.0 Tesla MRI. 2009

  5. Muto M, Giurazza F, Silva RP, Guarnieri G (2016) Rational approach, technique and selection criteria treating lumbar disk herniations by oxygen-ozone therapy. Interv Neuroradiol 22:736–740. https://doi.org/10.1177/1591019916659266

    Article  PubMed  PubMed Central  Google Scholar 

  6. Giurazza F, Guarnieri G, Murphy KJ, Muto M (2017) Intradiscal O2O3 : rationale, injection technique, short- and long-term outcomes for the treatment of low back pain due to disc herniation. Can Assoc Radiol J 68:171–177. https://doi.org/10.1016/j.carj.2016.12.007

    Article  PubMed  Google Scholar 

  7. Martin J (2010) Standards of practice : quality assurance guidelines for percutaneous treatments of intervertebral discs. https://doi.org/10.1007/s00270-010-9952-5

    Article  Google Scholar 

  8. Ogon I, Takebayashi T, Takashima H, Tanimoto K, Ida K, Yoshimoto M, Fujiwara H, Kubo T, Yamashita T (2015) Analysis of chronic low back pain with magnetic resonance imaging T2 mapping of lumbar intervertebral disc. J Orthop Sci 20:295–301. https://doi.org/10.1007/s00776-014-0686-0

    Article  PubMed  Google Scholar 

  9. Ogon I, Takebayashi T, Takashima H, et al (2019) Analysis of neuropathic pain using magnetic resonance imaging T2 mapping of intervertebral disc in chronic low back pain

  10. Steppan J, Meaders T, Muto M, Murphy KJ (2010) A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs. J Vasc Interv Radiol. https://doi.org/10.1016/j.jvir.2009.12.393

    Article  Google Scholar 

  11. Murphy K, Muto M, Steppan J et al (2015) Treatment of contained herniated lumbar discs with ozone and corticosteroid: a pilot clinical study. Can Assoc Radiol J:1–8. https://doi.org/10.1016/j.carj.2015.01.003

    Article  Google Scholar 

  12. Murphy K, Elias G, Steppan J et al (2016) Percutaneous treatment of herniated lumbar discs with ozone: investigation of the mechanisms of action. J Vasc Interv Radiol 27:1242–1250.e3. https://doi.org/10.1016/j.jvir.2016.04.012

    Article  PubMed  Google Scholar 

  13. Muto M (2013) Interventional neuroradiology of the spine: clinical features, diagnosis and therapy

  14. Borrelli E (2011) Mechanism of action of oxygen ozone therapy in the treatment of disc herniation and low back pain. https://doi.org/10.1007/978-3-211-99370-5

    Google Scholar 

  15. Gallucci M, Limbucci N, Zugaro L et al (2007) Sciatica: treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only. Radiology. https://doi.org/10.1148/radiol.2423051934

    Article  Google Scholar 

  16. Alexandre A, Corò L, Azuelos A et al (2005) Intradiscal injection of oxygen-ozone gas mixture for the treatment of cervical disc herniations. Acta Neurochir Suppl

  17. Zhang Y, Jiang J, Ding T, Wang J (2013) Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of. 26:317–322. https://doi.org/10.3233/BMR-130386

    Article  Google Scholar 

  18. Muto M, Andreula C, Leonardi M (2004) Treatment of herniated lumbar disc by intradiscal and intraforaminal oxygen-ozone (O2-O3) injection. J Neuroradiol. https://doi.org/10.1016/S0150-9861(04)96989-1

    Article  CAS  Google Scholar 

  19. Lehnert T, Naguib NNN, Wutzler S, Nour-Eldin NE, Bauer RW, Kerl JM, Vogl TJ, Balzer JO (2012) Analysis of disk volume before and after CT-guided intradiscal and periganglionic ozone–oxygen herniation. JVIR 23:1430–1436. https://doi.org/10.1016/j.jvir.2012.07.029

    Article  PubMed  Google Scholar 

  20. Perri M, Marsecano C, Varrassi M, Giordano AV, Splendiani A, Cesare E, Masciocchi C, Gallucci M (2016) Indications and efficacy of O2–O3 intradiscal versus steroid intraforaminal injection in different types of disco vertebral pathologies: a prospective randomized double-blind trial with 517 patients. Radiol Med 121:463–471. https://doi.org/10.1007/s11547-015-0598-x

    Article  PubMed  Google Scholar 

  21. Perri M, Grattacaso G, Di Tunno V, Marsecano C, Ernesto Di Cesare AS, Gallucci M MRI DWI/ADC signal predicts shrinkage of lumbar disc herniation after O2–O3 discolysis. https://doi.org/10.1177/1971400915576658

    Article  Google Scholar 

  22. Niu XK, Bhetuwal A, Yang HF (2015) Diffusion-weighted imaging for pretreatment evaluation and prediction of treatment effect in patients undergoing CT-guided injection for lumbar disc herniation. Korean J Radiol 16:874–880. https://doi.org/10.3348/kjr.2015.16.4.874

    Article  PubMed  PubMed Central  Google Scholar 

  23. Paul CPL, Smit TH, de Graaf M et al (2018) Quantitative MRI in early intervertebral disc degeneration: T1rho correlates better than T2 and ADC with biomechanics, histology and matrix content. PLoS One 13. https://doi.org/10.1371/journal.pone.0191442

    Article  Google Scholar 

  24. Zhang X, Yang L, Gao F et al (2015) Comparison of T1ρ and T2* relaxation mapping in patients with different grades of disc degeneration at 3T MR. Med Sci Monit 21:1934–1941. https://doi.org/10.12659/MSM.894406

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ishikawa T, Watanabe A, Kamoda H (2018) Evaluation of lumbar intervertebral disc degeneration ising T1ρ and T2 magnetic

  26. Bruno F, Arrigoni F, Palumbo P, Natella R, Maggialetti N, Reginelli A, Splendiani A, di Cesare E, Brunese L, Guglielmi G, Giovagnoni A, Masciocchi C, Barile A (2019) New advances in MRI diagnosis of degenerative osteoarthropathy of the peripheral joints. Radiol Med:1–7. https://doi.org/10.1007/s11547-019-01003-1

    Article  Google Scholar 

  27. Hosalkar HS, Schleich C, Antoch G. T2* mapping of the adult intervertebral lumbar disc: normative data and analysis of diurnal effects. 0–1. https://doi.org/10.1002/jor.24327

    Article  Google Scholar 

  28. Yamabe D, Murakami H, Chokan K, Endo H, Oikawa R, Sawamura S, Doita M (2017) Evaluation of water content in lumbar intervertebral discs and facet joints before and after physiological loading using T2 mapping MRI. Spine (Phila Pa 1976) 42:E1423–E1428. https://doi.org/10.1097/BRS.0000000000002204

    Article  Google Scholar 

  29. Trattnig S, Quirbach S, Marlovits S et al (2010) Quantitative T2 mapping of knee cartilage: differentiation of healthy control cartilage and cartilage repair tissue in the knee with unloading--initial results. Radiology 254:818–826. https://doi.org/10.1148/radiol.09090335

    Article  PubMed  Google Scholar 

  30. Baum T, Joseph GB, Karampinos DC et al (2013) Cartilage and meniscal T2 relaxation time as non-invasive biomarker for knee osteoarthritis and cartilage repair procedures. Osteoarthr Cartil

  31. Fukawa T, Yamaguchi S, Watanabe A, Sasho T, Akagi R, Muramatsu Y, Akatsu Y, Katsuragi J, Endo J, Osone F, Sato Y, Okubo T, Takahashi K (2015) Quantitative assessment of tendon healing by using MR T2 mapping in a rabbit Achilles tendon transection model treated with platelet-rich plasma. Radiology 276:748–755. https://doi.org/10.1148/radiol.2015141544

    Article  PubMed  Google Scholar 

  32. Vlv D, Suhglfwlqj IRU, Ri V, et al. (2013) MR assessment of lumbar disk herniation treated with oxygen-ozone diskolysis: the role of DWI and related ADC versus intervertebral disk volumetric analysis for detecting treatment response. 347–356

  33. Messner A, Stelzeneder D, Trattnig S, Welsch GH, Schinhan M, Apprich S, Brix M, Windhager R, Trattnig S (2017) Does T2 mapping of the posterior annulus fibrosus indicate the presence of lumbar intervertebral disc herniation? A 3.0 Tesla magnetic resonance study. Eur Spine J 26:877–883. https://doi.org/10.1007/s00586-016-4873-x

    Article  PubMed  Google Scholar 

  34. Splendiani A, Puglielli E, De Amicis R et al (2004) Spontaneous resolution of lumbar disk herniation: predictive signs for prognostic evaluation. Neuroradiology 46:916–922. https://doi.org/10.1007/s00234-004-1232-0

    Article  PubMed  Google Scholar 

  35. Perri M, Grattacaso G, di Tunno V et al (2015) T2 shine-through phenomena in diffusion-weighted MR imaging of lumbar discs after oxygen–ozone discolysis: a randomized, double-blind trial with steroid and O 2–O 3 discolysis versus steroid only. Radiol Med 120:941–950. https://doi.org/10.1007/s11547-015-0519-z

    Article  PubMed  Google Scholar 

  36. Bruno F, Smaldone F, Varrassi M et al (2017) MRI findings in lumbar spine following O2-O3 chemiodiscolysis: a long-term follow-up. Interv Neuroradiol 23. https://doi.org/10.1177/1591019917703784

    Article  Google Scholar 

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 1, 67100, L’Aquila, Italy

    Federico Bruno, Pierpaolo Palumbo, Emanuele Tommasino, Giampaolo Bianchi, Marco Varrassi, Francesco Arrigoni, Antonio Barile, Ernesto Di Cesare, Carlo Masciocchi & Alessandra Splendiani

Authors
  1. Federico Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pierpaolo Palumbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emanuele Tommasino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giampaolo Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marco Varrassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Arrigoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antonio Barile
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ernesto Di Cesare
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Carlo Masciocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alessandra Splendiani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federico Bruno.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bruno, F., Palumbo, P., Tommasino, E. et al. Evaluation of intervertebral disc using T2 mapping sequences in patients undergoing O2–O3 chemiodiscolysis: an instrumental study with clinical correlation. Neuroradiology 62, 55–61 (2020). https://doi.org/10.1007/s00234-019-02308-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-019-02308-8

Keywords

Search

Navigation