The Advancement and Utility of Multimodal Imaging in the Diagnosis of Degenerative Disc Disease

Introduction: Degenerative disc disease (DDD) is a prevalent condition impacting the spine, often leading to debilitating pain and disability. While current standard imaging techniques have limitations, accurate diagnosis and early intervention remain critical for effective management. Emerging advanced imaging techniques offer promising avenues for enhanced early detection and intervention in DDD.

Methods: We conducted a comprehensive review of advanced imaging modalities, including T2 Star (T2*) mapping, T1ρ and T2 relaxation mapping, sodium MRI, glycosaminoglycan chemical exchange saturation transfer (GagCEST), MR Spectroscopy (MRS), and 18F-fluorodeoxyglucose (FDG) PET/CT, using PubMed and Google Scholar databases from 2000 to 2023. Review articles and scientific studies were compiled from the databases using the COVIDENCE platform. Studies were then assessed for quality, relevance, and potential bias to derive broader conclusions about the standing knowledge.

Results: Our analysis revealed promising outcomes with these advanced imaging methods. T2* mapping demonstrated high sensitivity in assessing cartilage degeneration, while T1ρ and T2 relaxation mapping offered precise evaluation of proteoglycan content. Sodium MRI exhibited potential in quantifying water content and proteoglycans. GagCEST provided direct quantification of glycosaminoglycans. MRS displayed the ability to detect metabolic changes, and FDG PET/CT demonstrated its capacity to identify hidden sources of inflammation and pain associated with DDD. These techniques offer valuable insights into the pathophysiology of DDD and its early stages, enabling a more precise diagnosis.

Conclusion : Advanced imaging techniques hold significant promise in revolutionizing the diagnosis and early intervention in DDD. By allowing for the identification of biochemical and metabolic changes that precede gross morphological alterations, these methods offer the potential to transform clinical practice. Early detection of DDD using advanced imaging can lead to more targeted and minimally invasive interventions, ultimately improving patient outcomes. If integrated into clinical practice, these techniques could have a meaningful impact on the field of spine surgery and the quality of life for individuals with DDD.