| Objective:To investigate influence of type 2 diabetes on the degenerative changes of lumbar intervertebral disc was further investigated using MR T2 mapping sequence.Materials and Methods:The clinical and MRI imaging data of 35 patients with type 2diabetes mellitus and low back pain（experimental group）and 20 patients with low back pain only（control group）were prospectively studied.The clinical data included age,gender,and history of hypertension,diabetes,low back pain,lower extremity radiating pain,etc.Pfirrmann grading was performed on sagittal images on T2WI,and areas of interest were delineated for nucleus pulposus（NP）,anterior annulus fibrosus（AAF）and posterior annulus fibrosus（PAF）on T2 mapping pseudo-color images with Philips post-processing workstation.T2 values of NP,anterior and posterior annulus fibrosus were measured.Chi-square test was used to analyze the clinical data of sex,smoking and hypertension.Age was analyzed using nonparametric tests.Independent sample t test and nonparametric test were used to analyze the T2 values of different grades and different lumbar disc layers.Spearman correlation analysis was used to analyze the course of disease and blood glucose control,and correlation coefficient was used to indicate the degree.P<0.05 was considered statistically significant.Results:1.There were no significant differences in gender distribution,age and other basic clinical data between the experimental group and the control group（P>0.05）.2.Pfirrmann grading of 206 lumbar discs were with the following results:36（17.5%）were grade I,126（61.2%）were grade II,and 44（21.4%）were grade III.3.For all discs in general,in Pfirrmann grade I and II,there was a significant difference in T2 value of annulus fibrosus between the control group and the experimental group（P<0.05）.However,there was no significant difference in T2 value of NP（P>0.05）.In Pfirrmann grade III,there was no significant difference in T2 values of annulus fibrosus and NP between the control group and the experimental group.4.For the differences among the layers of discs,1)In Pfirrmann gradeⅠ,there were no significant differences in T2values of annulus fibrosus and NP at the level of L1/2 and L4/5 between the control group and the experimental group（P>0.05）.At the level of L2/3 and L3/4 of intervertebral disc,there were significant differences in T2 values of PAF between the control group and the experimental group（P=0.036,0.023）,but no significant differences in T2 values of APF and NP（P>0.05）.At the level of L5/S1 of intervertebral disc,there were significant differences in T2values of annulus fibrosus and NP between the control group and the experimental group（P=0.032,0.01,0.005）.2)In Pfirrmann grade II,there were significant differences in T2values of annulus fibrosus at the level of L1/2 and L4/5 between the control group and the experimental group P<0.05).At the level of L2/3 and L3/4 of intervertebral disc,there were significant differences between the control group and the experimental group in T2 values of annulus fibrosus and NP（P<0.05）.At the L5/S1 level of intervertebral disc,there was a significant difference in T2values of PAF between the control group and the experimental group（P=0.012）,but no significant difference in T2values of APF and NP between the control group and the experimental group（P>0.05）.3)In Pfirrmann grade III,there were significant differences in the mean values of T2in the NP between the control group and the experimental group at the intervertebral disc L5/S1 level（P=0.001）,and no significant differences in the mean values of T2in the annulus fibrosus and NP between the control group and the experimental group at the rest L1/2-L5/S1 level（P>0.05）.5.Spearman correlation analysis was conducted among the patient’s disease course and blood glucose control status and the T2value of the lumbar intervertebral disc NP and annulus fibrosus.The results showed that the disease course and blood glucose control status were significantly correlated with the T2value of the annulus fibrosus of the patient（P<0.05）,but not significantly correlated with the T2value of the NP（P>0.05）.In Pfirrmann gradeⅠ,the course of disease was significantly correlated with the T2 value of AAF and NP（P=0.021,0.029）,but was not significantly correlated with the T2value of PAF（P>0.05）.The blood glucose control was significantly correlated with the T2value of lumbar disc annulus（including AAF and PAF）and NP（P=0.025,0.023.0.026）.In Pfirrmann grade II,the course of disease was significantly correlated with the T2values of the annulus fibrosus and NP（P=0.000,0.000,0.012<0.05）.There was a significant correlation between blood glucose control and the T2value of the annulus fibrosus（P=0.000,0.000）,but not with the mean value of T2in the NP（P>0.05）.In Pfirrmann grade III,there was no significant correlation between the course of the disease and the control of the blood glucose and the T2values of the annulus fibrosus and NP.Conclusion:T2values measured using MR T2 mapping can objectively and directly reflect that type 2 diabetes can aggravate the degree of lumbar intervertebral disc degeneration to a certain extent.The longer the course of diabetes,the worse the control of blood sugar,the more severe the degree of lumbar disc degeneration. |
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