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


METHODS
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.
Biotechnological and Applied Clinical Sciences Department, University of L'Aquila, Italy.
Marco
M
Perri
Biotechnological and Applied Clinical Sciences Department, University of L'Aquila, Italy.
Giuseppe
G
Grattacaso
Biotechnological and Applied Clinical Sciences Department, University of L'Aquila, Italy.
Valeria
V
Di Tunno
Biotechnological and Applied Clinical Sciences Department, University of L'Aquila, Italy.
Claudia
C
Marsecano
Biotechnological and Applied Clinical Sciences Department, University of L'Aquila, Italy.
Ernesto
E
Di Cesare
Biotechnological and Applied Clinical Sciences Department, University of L'Aquila, Italy alessandra.splendiani@cc.univaq.it.
Alessandra
A
Splendiani
Biotechnological and Applied Clinical Sciences Department, University of L'Aquila, Italy.
Massimo
M
Gallucci
D000328:Adult; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007404:Intervertebral Disc Chemolysis / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000473:pathology* / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000627:therapeutic use*; D010126:Ozone / Q000627:therapeutic use*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult
D004338:Drug Combinations; D010126:Ozone; D010100:Oxygen
Chemiodiscolysis with oxygen–ozone mixture; Diffusion weighted imaging/Apparent diffusion coefficient (DWI/ADC); Lumbar disk herniation