Measurement of vertebral endplate bone marrow lesion (Modic change) composition with water-fat MRI and relationship to patient-reported outcome measures

Purpose Vertebral endplate bone marrow lesions (Modic changes, MC) are associated with chronic low back pain (CLBP). Bone marrow composition in MC is poorly understood. The goals of this study were to: (1) measure bone marrow fat fraction (BMF) in CLBP patients with MC using water-fat MRI and (2) assess the relationship between BMF measurements and patient-reported clinical characteristics. Methods In this cross-sectional study, 42 CLBP patients (men, n = 21; age, 48 +/- 12.4 years) and 18 asymptomatic controls (men, n = 10; 42.7 +/- 12.8 years) underwent 3 T MRI between January 2016 and July 2018. Imaging consisted of T-1- and T-2-weighted sequences to evaluate MC and spoiled gradient-recalled echo sequence with asymmetric echoes and least-squares fitting to measure BMF. BMF was compared between vertebrae with and without MC using mixed effects models. The relationship between the BMF measurements and patient-reported disability scores was examined using regression. Results Twenty-seven subjects (26 CLBP, 1 control) had MC, and MC presence coincided with significantly altered BMF. In MC 1, BMF was lower than endplates without MC (absolute difference -22.3%; p < 0.001); in MC 2, BMF was higher (absolute difference 21.0%; p < 0.001). Absolute BMF differences between affected and unaffected marrow were larger in patients with greater disability (p = 0.029-0.032) and were not associated with pain (p = 0.49-0.83). Conclusion BMF is significantly altered in MC. Water-fat MRI enables BMF measurements that may eventually form the basis for quantitative assessments of MC severity and progression.

Automated summary

In patients with chronic low back pain and vertebral endplate bone marrow lesions, bone marrow fat fraction (BMF) is significantly altered, with higher values in affected areas and lower values in unaffected areas. The absolute differences in BMF were associated with patient disability but not with pain levels. Water-fat MRI can provide valuable insights into the severity and progression of Modic changes.