T2 shine-through phenomena in diffusion-weighted MR imaging of lumbar discs after oxygen-ozone discolysis: a randomized, double-blind trial with steroid and O2-O3 discolysis versus steroid only.
OBJECTIVE
To evaluate the discal morpho-structural changes as predictive sign in the clinical outcome after Ozone Therapy in lumbar disc herniation using the T2 shine-through effect in DWI.


METHODS
One hundred and fifty-four patients suffering from lumbosciatica (89 men and 65 women; range 23-62 years) were included in 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 anesthetic. The remaining 77 patients (Study Group) underwent the same treatment with the addiction of oxygen-ozone (O2-O3). During the coming 6 months, an 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. χ (2) test, Student's t test and analysis of covariance were used for comparison of variables.


RESULTS
In the Study Group, 58 over 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 the 6 months of follow-up (P < 0.05). Moreover, in the same group was present a statistically significant discs' shrinkage in the sixth month of follow-up (P < 0.05) as showed by IDVA.


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.
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, University of L'Aquila, 67100, L'Aquila, Italy. marco-perri@tiscali.it.
Marco
M
Perri
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, University of L'Aquila, 67100, L'Aquila, Italy. Giuseppe.grattacaso@hotmail.it.
Giuseppe
G
Grattacaso
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, University of L'Aquila, 67100, L'Aquila, Italy. valeria.ditunno@yahoo.it.
Valeria
V
di Tunno
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, University of L'Aquila, 67100, L'Aquila, Italy. claudia.marsecano@gmail.com.
Claudia
C
Marsecano
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, University of L'Aquila, 67100, L'Aquila, Italy. antoniogennarelli@alice.it.
Antonio
A
Gennarelli
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, University of L'Aquila, 67100, L'Aquila, Italy. giulia.mik@libero.it.
Giulia
G
Michelini
Department of Biotechnological and Applied Clinical Sciences, Division of Neuroradiology, University of L'Aquila, 67100, L'Aquila, Italy. alessandra.splendiani@univaq.it.
Alessandra
A
Splendiani
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, University of L'Aquila, 67100, L'Aquila, Italy. Ernesto.dicesre@cc.univaq.it.
Ernesto
E
Di Cesare
Department of Biotechnological and Applied Clinical Sciences, Division of Radiology, University of L'Aquila, 67100, L'Aquila, Italy. carlo.masciocchi@cc.univaq.it.
Carlo
C
Masciocchi
Department of Biotechnological and Applied Clinical Sciences, Division of Neuroradiology, University of L'Aquila, 67100, L'Aquila, Italy. Massimo.gallucci@cc.univaq.it.
Massimo
M
Gallucci
D000328:Adult; D001623:Betamethasone / Q000627:therapeutic use*; D038524:Diffusion Magnetic Resonance Imaging; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D007404:Intervertebral Disc Chemolysis; D007405:Intervertebral Disc Displacement / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008297:Male; D010100:Oxygen / Q000627:therapeutic use*; D010126:Ozone / Q000627:therapeutic use*; D011446:Prospective Studies
D005938:Glucocorticoids; D010126:Ozone; D001623:Betamethasone; D010100:Oxygen
Apparent diffusion coefficient; Chemiodiscolysis with oxygen–ozone mixture; Diffusion-weighted imaging (DWI); Lumbar disc herniation; Percutaneous discolysis