title: Signal intensity loss of the intervertebral discs in the cervical spine of young patients on fluid sensitive sequences.
abstract: OBJECTIVE
  To evaluate the signal intensity (SI) of the intervertebral discs of the cervical spine on magnetic resonance (MR) fluid sensitive sequences, and correlate this to secondary signs of degeneration on MR and radiographs as well as to age.
  
  
  METHODS
  A total of 265 patients aged ≥16 with back pain (≥3-months, <2-year, onset <45-years) from the SPondyloArthritis Caught Early (SPACE) cohort were included. Sagittal 1.5 T MR images and lateral radiographs of the cervical spine were independently evaluated by two readers for: SI of the intervertebral discs using a grading system based of Pfirrmann (grade 1 normal/bright SI; 2 inhomogeneous/bright SI; 3 inhomogeneous/mildly decreased SI; 4 inhomogeneous/markedly decreased SI; 5 signal void), disc herniation and Modic changes (MRI) and disc space narrowing, osteophytes and sclerosis (radiograph). Readers were blinded for clinical information. Descriptive statistics were used for characteristics and prevalence of findings, and regression analysis was used for age and grades.
  
  
  RESULTS
  Of 265 patients (36% male, mean age 30), 221 (83%) patients had 1 to 6 discs (median 4) with decreased SI. Of 1,590 discs, 737 (46%) were grade 1; 711 (45%) grade 2; 133 (8%) grade 3; 8 (1%) grade 4 and 1 (0%) grade 5. Secondary signs of degeneration were rare and seen predominantly in C5-C7 and appear to be related to signal loss grade 3 and 4.
  
  
  CONCLUSIONS
  Low signal intensity of intervertebral discs in absence of secondary degenerative signs in the cervical spine on fluid sensitive MR images might be pre-existing and part of the natural course.
authors.affiliation: Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands. f.de_bruin@lumc.nl.
authors.forename: F
authors.initials: F
authors.lastname: de Bruin
authors.affiliation: Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Ter Horst
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van den Berg
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: de Hooge
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: van Gaalen
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: K M
authors.initials: KM
authors.lastname: Fagerli
authors.affiliation: Department of Rheumatology, Amsterdam Medical Center, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Landewé
authors.affiliation: Department of Rheumatology, Groene Hartziekenhuis, Gouda, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Oosterhout
authors.affiliation: Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: J L
authors.initials: JL
authors.lastname: Bloem
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van der Heijde
authors.affiliation: Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, PO box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Reijnierse
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000473:pathology*; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000166:cytology / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000473:pathology*; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D059629:Signal-To-Noise Ratio; D055815:Young Adult
keywords: Cervical spine; Fluid sensitive MR; Signal intensity of intervertebral discs