title: Association of lumbar arterial stenosis with low back symptoms: a cross-sectional study using two-dimensional time-of-flight magnetic resonance angiography.
abstract: BACKGROUND
  Recent studies indicate that diminished blood flow may cause low back symptoms and intervertebral disc degeneration.
  
  
  OBJECTIVE
  To explore the association between lumbar arterial stenosis as detected by two-dimensional time-of-flight magnetic resonance angiography (2D TOF-MRA) and lumbar pain symptoms in an occupational cohort of middle-aged Finnish males.
  
  
  METHODS
  228 male subjects aged 36 to 55 years (mean 47 years) were imaged with 2D TOF-MRA. Additionally, 20 randomly selected subjects were scanned with contrast-enhanced MRA (ceMRA). In each subject, the first (L1) to fourth (L4) segmental lumbar arteries were evaluated for lumbar artery stenosis using a dichotomic scale. One subject was excluded because of poor image quality, reducing the study population to 227 subjects. Logistic regression analysis was used to evaluate the association between arterial stenosis in 2D TOF-MRA and low back pain and sciatica symptoms (intensity, duration, frequency).
  
  
  RESULTS
  Comparing 2D TOF-MRA and ceMRA images, the kappa value (95% confidence interval) was 0.52 (0.31-0.73). The intraobserver reliability kappa value for 2D TOF-MRA was 0.85 (0.77-0.92), and interobserver kappa was 0.57 (0.49-0.65). The sensitivity of 2D TOF-MRA in detecting stenosis was 0.58, the accuracy 0.89, and the specificity 0.94. In 97 (43%) subjects all arteries were normal, whereas 130 (57%) had at least one stenosed artery. The left L4 artery was most often affected. The degree of arterial stenosis was associated with intensity of low back and sciatic pain, and sciatica pain duration during the past 3 months.
  
  
  CONCLUSIONS
  2D TOF-MRA is an acceptable imaging method for arterial stenosis compared to ceMRA. Arterial stenosis was associated with subjective pain symptoms, indicating a role of decreased nutrition in spinal disorders.
authors.affiliation: Institute of Clinical Sciences, Department of Physical and Rehabilitation Medicine, University of Oulu, Oulu, Finland. atkorkia@paju.oulu.fi
authors.forename: A
authors.initials: A
authors.lastname: Korkiakoski
authors.forename: J
authors.initials: J
authors.lastname: Niinimäki
authors.forename: J
authors.initials: J
authors.lastname: Karppinen
authors.forename: R
authors.initials: R
authors.lastname: Korpelainen
authors.forename: M
authors.initials: M
authors.lastname: Haapea
authors.forename: A
authors.initials: A
authors.lastname: Natri
authors.forename: O
authors.initials: O
authors.lastname: Tervonen
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005387:Finland; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016015:Logistic Models; D017116:Low Back Pain / Q000209:etiology* / Q000503:physiopathology; D008161:Lumbosacral Region / Q000098:blood supply*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement