Quantitative Assessment of Lumbar Intervertebral Disc Degeneration and Its Correlation with Clinical Symptoms: A Study Utilizing Ultrashort Time-of-Echo and T2 Mapping as Biomarkers

Background: Lumbar cartilage endplate (CEP) structures show low signal intensity on conventional magnetic resonance imaging (MRI), making them hard to observe and quantify. This often results in poor correlation between conventional MRI findings and low back pain (LBP) symptoms and provides inadequate guidance for clinical decisions. Methods: The study included Twenty-five healthy volunteers and forty-one patients with LBP. Quantitative MRI techniques—Ultrashort Echo Time (UTE) T2* mapping and T2 mapping are employed to evaluate lumbar intervertebral disc degeneration (IVDD) and LBP symptoms. Pfirrmann and Rajasekaran grading systems and the Oswestry Disability Index (ODI) served as reference standards. Regions of interest (ROIs) for the nucleus pulposus (NP), upper CEP, and lower CEP were outlined in UTE Two echo subtracting images and transferred to UTE images fused with 3D water sequence images and T2 mapping images. UTE-T2* and T2 mapping values were automatically calculated. Cohen’s kappa, Spearman’s rank correlation, and Kruskal–Wallis tests were used, with significance set at p < 0.05. Results: Spearman’s rank correlation revealed that UTE‑T2* and T2 values for upper CEP, lower CEP, and NP negatively correlated with Pfirrmann and Rajasekaran grades (P < 0.001) . The Kruskal–Wallis test showed significant differences in values between Pfirrmann grades II, III, IV, and V (P < 0.001) . ODI was negatively correlated with T2* and T2 values of the lower CEP (P < 0.001) and positively with Pfirrmann grade ( r = 0.2, P = 0.003) . Conclusion: Quantitative MRI methods for T2* values and T2 mapping are associated with grade of degeneration and ODI index and are more effective for assessing CEP damage and LBP symptoms than conventional MRI sequence.