MRI DWI/ADC signal predicts shrinkage of lumbar disc herniation after O2-O3 discolysis

Perri M., Grattacaso G., Di Tunno V., Marsecano C., Di Cesare E., Splendiani A., Gallucci M.

Abstract
PURPOSE:
Evaluate the discal morpho-structural changes as a predictive sign in the clinical outcome after ozone therapy in lumbar disc herniation using the T2-shine through effect in diffusion-weighted imaging (DWI).

METHOD:
One hundred and fifty-four patients suffering from lumbosciatica (89 men and 65 women; age range, 23-62 years) were included, previous MR study performed with FSE-T2 and T2-fat, SE-T1 and DWI sequences, and were randomly assigned to two groups. Seventy-seven patients (control group) underwent conservative treatment with intraforaminal injection of steroid and anaesthetic. The remaining 77 patients (study group) underwent the same treatment with the addition of oxygen-ozone (O2-O3). During the following six months, a MRI follow-up with the same sequences was performed. An intervertebral disc volumetric analysis (IDVA), DWI signal score and post treatment clinical outcome evaluation were performed for an assessment of hernia reduction. χ² test, Student’s t test and analysis of covariance were used for comparison of variables.

RESULTS:
In the study group, 58 of 77 patients had a successful outcome (responders). In the responders group, DWI T2-shine through effect was present during MRI follow-up and in particular in 53 of 77 patients in six months of follow-up (p < 0.05). Moreover, in the same group a statistically significant disc shrinkage was shown by IDVA in sixth months of follow-up (p < 0.05).

CONCLUSIONS:
T2-shine through effect in DWI is present before morphological disc reduction and moreover could be considered as a predictive sign of response to oxygen-ozone treatment.

Fonte: http://www.ncbi.nlm.nih.gov/pubmed

Neuroradiol J. 2015 Apr;28(2):198-204. doi: 10.1177/1971400915576658. Epub 2015 Apr 13.

Ciao Massimo.

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