Comparison with Magnetic Resonance Three-Dimensional Sequence for Lumbar Nerve Root with Intervertebral Foramen

Hiroyuki Takashima,Tsuneo Takebayashi,Hiroki Shishido,Mitsunori Yoshimoto,Rui Imamura,Yoshihiro Akatsuka,Yoshinori Terashima,Hiroyoshi Fujiwara,Masateru Nagae,Toshikazu Kubo,Toshihiko Yamashita 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.1

Study Design: Prospective study based on magnetic resonance (MR) imaging of the lumbar spinal root of the intervertebral foramen. Purpose: This study was to compare MR three-dimensional (3D) sequences for the evaluation of the lumbar spinal root of the intervertebral foramen. Overview of Literature: The diagnosis of spinal disorders by MR imaging is commonly performed using two-dimensional T1- and T2-weighted images, whereas 3D MR images can be used for acquiring further detailed data using thin slices with multi-planar reconstruction. Methods: On twenty healthy volunteers, we investigated the contrast-to-noise ratio (CNR) of the lumbar spinal root of the intervertebral foramen with a 3D balanced sequence. The sequences used were the fast imaging employing steady state acquisition and the coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC). COSMIC can be used with or without fat suppression (FS). We compared these sequence to determine the optimized visualization sequence for the lumbar spinal root of the intervertebral foramen. Results: For the CNR between the nerve root and the peripheral tissue, these were no significant differences between the sequences at the entry of foramen. There was a significant difference and the highest CNR was seen with COSMIC-FS for the intra- and extraforamen. Conclusions: In this study, the findings suggest that the COSMIC-FS sequences should be used for the internal or external foramen for spinal root disorders.

Is the Lipid Content of the Psoas Major Correlated with Chronic Low Back Pain and Spinopelvic Alignment? A Magnetic Resonance Spectroscopic Study

Ogon Izaya,Hiroyuki Takashima,Tomonori Morita,Tsutomu Oshigiri,Yoshinori Terashima,Mitsunori Yoshimoto,Makoto Emori,Atsushi Teramoto,Tsuneo Takebayashi,Toshihiko Yamashita 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

Study Design: Cross-sectional observational study.Purpose: This study aimed to analyze any potential associations of extramyocellular lipid (EMCL) and intramyocellular lipid (IMCL) contents with (1) the intensity of low back pain (LBP); (2) age, cross-sectional area (CSA), and fatty infiltration (FI) of the psoas major; and (3) spinopelvic parameters.Overview of Literature: The psoas major has clinically relevant function; however, the association of this muscle with chronic LBP is controversial. Magnetic resonance spectroscopy enables a detailed analysis of the composition of muscular fat tissues such as its EMCL and IMCL contents.Methods: The study population comprised 40 patients (19 males, 21 females; mean age, 61.7±2.4 years). Possible correlations of LBP Visual Analog Scale (VAS) scores, age, CSA, FI, and spinopelvic parameters with EMCL and IMCL contents of the psoas major were assessed.Results: No association was identified between the EMCL and IMCL contents and LBP VAS scores (<i>r</i>=0.05, <i>p</i>=0.79 and <i>r</i>=0.06, <i>p</i>=0.75, respectively). The EMCL content correlated with age (<i>r</i>=0.47, <i>p</i><0.01), body mass index (BMI) (<i>r</i>=0.44, <i>p</i><0.01), CSA (<i>r</i>=−0.59, <i>p</i>< 0.01), and FI (<i>r</i>=0.49, <i>p</i><0.01). EMCL content showed a significant negative correlation with sacral slope (SS) (<i>r</i>=−0.43, <i>p</i><0.05) and positive correlation with pelvic tilt (PT) (<i>r</i>=0.56, <i>p</i><0.01).Conclusions: EMCL content correlated with age, BMI, CSA, and FI of the psoas major, while IMCL content had no correlation. This study found correlations between SS and PT and EMCL content of the psoas major, but no correlations were found between spinopelvic parameters and IMCL content of the psoas major.

Relevance between Schmorl’s Node and Lumbar Intervertebral Disc Degeneration Quantified with Magnetic Resonance Imaging T2 Mapping in Chronic Low Back Pain

Ogon Izaya,Takashima Hiroyuki,Morita Tomonori,Oshigiri Tsutomu,Terashima Yoshinori,Yoshimoto Mitsunori,Fukushi Ryunosuke,Fujimoto Shutaro,Emori Makoto,Teramoto Atsushi,Takebayashi Tsuneo,Yamashita Tos 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.5

Study Design: Cross-sectional study.Purpose: The purpose of this study was to elucidate the relevance among Schmorl’s node (SN), chronic low back pain (CLBP), and intervertebral disc degeneration (IVDD) with the use of magnetic resonance imaging T2 mapping.Overview of Literature: SN may be combined with CLBP and/or IVDD; however, their relationship has not been determined to date.Methods: A total of 105 subjects were included (48 men and 57 women; mean age, 63.2±2.7 years; range, 22–84 years). We analyzed five functional spinal unit levels (L1–S1) and evaluated the T2 values of the anterior annulus fibrosus (AF), nucleus pulposus, and posterior AF. We compared the low back pain (LBP) Visual Analog Scale (VAS) scores and the T2 values in each decade with or without SN.Results: There were no remarkable differences in SN prevalence rate regarding age decade or gender. SNs were more prevalent in the upper 2 levels (70.3%). LBP VAS scores with and without SN were 64.7±4.3 mm and 61.9±2.8 mm, respectively, with no significant differences between the groups (p =0.62). The T2 values of anterior AF with SN were significantly lower than those without SN in patients in their 50s, 60s, 70s, and 80s (p <0.01).Conclusions: SN presence is not itself a risk factor for CLBP; however, it indicates IVDD of the anterior AF in subjects with SN who are ≥50 years old.

Magnetic Resonance Spectroscopic Analysis of Multifidus Muscle Lipid Contents and Association with Nociceptive Pain in Chronic Low Back Pain

Ogon Izaya,Iba Kouske,Takashima Hiroyuki,Yoshimoto Mitsunori,Morita Tomonori,Oshigiri Tsutomu,Terashima Yoshinori,Emori Makoto,Teramoto Atsushi,Takebayashi Tsuneo,Yamashita Toshihiko 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.4

Study Design: Cross-sectional study.Purpose: This study aimed to analyze the differences in the lipid contents in chronic low back pain (CLBP) patients with nociceptive pain (NocP) and neuropathic pain (NeP) using magnetic resonance spectroscopy (MRS) of the multifidus muscle (Mm).Overview of Literature: Early identification of the pain characteristics with CLBP is important because specific treatment approaches are required, depending on NocP and NeP.Methods: The participants were 50 patients with CLBP (23 men and 27 women; mean age, 63.1±17.8 years; range, 41–79 years). We compared the Visual Analog Scale (VAS) scores, intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs) of the Mm in NocP and NeP groups, as evaluated with the Japanese NeP screening questionnaire.Results: The patients were categorized into the NocP (n=32) and NeP (n=18) groups. The mean VAS score of the NocP group was 59.3±3.1 mm and that of the NeP group was 73.6±4.6 mm. The mean VAS score was significantly higher in the NeP group as compared to that in the NocP group (p<0.01). As per the analysis of covariance for the VAS score, the mean IMCL levels of the Mm in the NocP and NeP groups were 722.3 mmol/L (95% confidence interval [CI], 611.4–833.1) and 484.8 mmol/L (95% CI, 381.1–588.5), respectively. The mean IMCL level was significantly higher in the NocP group than in the NeP group (p<0.05). The mean EMCL levels of the Mm for the NocP and NeP groups were 6,022.9 mmol/L (95% CI, 4,510.6–7,535.2) and 5,558.1 mmol/L (95% CI, 4,298.3–6,817.9), respectively; however, the difference was not significant (p=0.72).Conclusions: The results indicated an association between the IMCL level of the Mm and NocP. Our results suggest that MRS of the Mm might be beneficial for the assessment of CLBP as well as appropriate targeted analgesic therapies.

Multifidus Muscles Lipid Content Is Associated with Intervertebral Disc Degeneration: A Quantitative Magnetic Resonance Imaging Study

Izaya Ogon,Tsuneo Takebayashi,Hiroyuki Takashima,Tomonori Morita,Tsutomu Oshigiri,Yoshinori Terashima,Mitsunori Yoshimoto,Toshihiko Yamashita 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.4

Study Design: Cross-sectional study. Purpose: To determine the association between fatty degeneration of the multifidus muscle (Mm) and intervertebral disc degeneration (IVDD) using quantitative magnetic resonance imaging (MRI). Overview of Literature: Few studies have reported on quantitative MRI analysis of the relation between the Mm and IVDD. Methods: The subjects with chronic low back pain comprised 45 patients (19 males, 26 females; mean age, 63.8±2.0 years; range, 41–79 years). We analyzed the intramyocellular lipids (IMCL) and extramyocellular lipids (EMCL) of the Mm using magnetic resonance spectroscopy. The T2 values of the anterior annulus fibrosus (AF), nucleus pulposus (NP), and posterior AF were evaluated using MRI T2 mapping. We compared the possible correlations of IMCL and EMCL of the Mm with the T2 values of anterior AF, NP, and posterior AF. Results: There was a significant negative correlation between IMCL and T2 values of the anterior AF (r=−0.65, p<0.01). There were no significant correlations between the IMCL and T2 values of NP (r=−0.16, p=0.30) and posterior AF (r=0.07, p=0.62). There were no significant correlations between the EMCL and T2 values of the anterior AF (r=−0.11, p=0.46), NP (r=0.15, p=0.32), and posterior AF (r=0.07, p=0.66). After adjustment for age and sex using multiple linear regression analysis, there was a significant negative correlation between the IMCL and T2 values of anterior AF (standardized partial regression coefficient=−0.65, p<0.01). Conclusions: The results indicated that IMCL of the Mm might be accompanied with anterior AF degeneration. Therapeutic exercises using IMCL of the Mm as evaluation index might have the potential to identify novel targets for the treatment and prevention of IVDD.

The novel latex agglutination turbidimetric immunoassay system for simultaneous measurements of calprotectin and hemoglobin in feces

( Sakiko Hiraoka ),( Shiho Takashima ),( Toshihiro Inokuchi ),( Asuka Nakarai ),( Masahiro Takahara ),( Keita Harada ),( Yasuhiro Seki ),( Katsunori Watanabe ),( Jun Kato ),( Hiroyuki Okada ) 대한장연구학회 2019 Intestinal Research Vol.17 No.2

Background/Aims: Fecal calprotectin (Fcal) as well as the fecal immunochemical test (FIT) are useful biomarkers for detecting activity and mucosal healing in inflammatory bowel diseases. Here, we report the performance of simultaneous measurements of Fcal and FIT for ulcerative colitis (UC) patients using the newly-developed latex agglutination turbidimetric immunoassay (LATIA) system. Methods: Fcal and hemoglobin were measured by the LATIA system in 152 UC patients who underwent colonoscopy. Fcal was also quantified with a conventional enzyme-linked immunosorbent assay (ELISA). Fecal markers were evaluated in conjunction with the mucosal status of UC, which was assessed via the Mayo endoscopic subscore (MES) classification. Results: The LATIA system could quantify calprotectin and hemoglobin simultaneously with the same fecal samples within 10 minutes. The values of the Fcal-LATIA closely correlated with those of the Fcal-ELISA (Spearman rank correlation coefficient, r=0.84; P<0.0001). The values of Fcal for each assay and the FIT all significantly correlated with the MESs (Spearman rank correlation coefficient, Fcal-LATIA: r=0.58, Fcal-ELISA: r=0.55, and FIT: r=0.72). The mucosal healing predictability (determined by an MES of 0 alone) of the Fcal-LATIA, Fcal-ELISA, and FIT-LATIA with the cutoffs determined by receiver operating characteristic curve analysis was 0.79, 0.78, and 0.92 for sensitivity, respectively, and 0.78, 0.69, and 0.73 for specificity, respectively. Conclusions: The performance of the novel Fcal-LATIA was equivalent to that of the conventional Fcal assay. Simultaneous measurements with FITs would promote the clinical relevance of fecal biomarkers in UC. (Intest Res 2019;17:202-209)

Analysis of Neuropathic Pain Using Magnetic Resonance Imaging T2 Mapping of Intervertebral Disc in Chronic Low Back Pain

Izaya Ogon,Tsuneo Takebayashi,Hiroyuki Takashima,Tomonori Morita,Noriyuki Iesato,Katsumasa Tanimoto,Yoshinori Terashima,Mitsunori Yoshimoto,Toshihiko Yamashita 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: Cross sectional study. Purpose: The study aimed to analyze mechanisms underlying chronic low back pain (CLBP) using magnetic resonance imaging (MRI) T2 mapping of the intervertebral disc (IVD). Overview of Literature: MRI T2 mapping utilizes the T2 values for quantifying moisture content and collagen sequence breakdown. We previously used MRI T2 mapping for quantifying the extent of IVD degeneration (IVDD) and showed a correlation between the degeneration of the posterior annulus fibrosus (AF) and CLBP. Methods: We enrolled 40 patients with CLBP (17 males, 23 females; mean age, 50.8±1.6 years; range, 22–60 years). IVDs were categorized as the anterior AF, nucleus pulposus (NP), and posterior AF, and T2 value for each disc was measured. T2 values, assessed using the Japanese neuropathic pain (NeP) screening questionnaire, of the NeP and nociceptive pain (NocP) groups were compared. Results: T2 values of the NocP and NeP groups were 64.7±5.6 ms and 58.1±2.3 ms for the anterior AF; 67.0±4.6 ms and 59.6±2.1 ms for NP; and 70.7±4.6 ms and 51.0±1.2 ms for the posterior AF, respectively. T2 values for IVDD were significantly lower in the NeP group than those in the NocP group (p<0.01). Conclusions: The results indicate a correlation between the degeneration of posterior AF and NeP. MRI T2 mapping may be beneficial for detecting NeP caused by IVDD and can help formulate targeted analgesic therapies.

Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn’s disease

Sakiko Hiraoka,Shiho Takashima,Yoshitaka Kondo,Toshihiro Inokuchi,Yuusaku Sugihara,Masahiro Takahara,Seiji Kawano,Keita Harada,Wakayama Medical University,Hiroyuki Okada 대한장연구학회 2018 Intestinal Research Vol.16 No.1

Background/Aims: The efficacy of anti-tumor necrosis factor α (anti-TNFα) antibodies for postoperative Crohn’s disease(CD) in patients who were treated with these agents prior to surgery is largely unknown. Methods: CD patients who underwentintestinal resection and received anti-TNFα agents after surgery were divided into 2 groups according to the presence orabsence of preoperative anti-TNFα treatment: anti-TNFα restart group or anti-TNFα naïve group. Endoscopic recurrence aftersurgery was examined according to the preoperative conditions, including administration of anti-TNFα agents before surgery. Results: Thirty-six patients received anti-TNFα antibody after surgery: 22 in the anti-TNFα restart group and 14 in the anti-TNFα naïve group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than inthe anti-TNFα naïve group (68% vs. 14% , P <0.001). Multivariate analysis revealed the following significant risk factors of endoscopicrecurrence after surgery: anti-TNF restart group (odds ratio [OR], 28.10; 95% CI, 3.08−722.00), age at diagnosis <23 years(OR, 24.30; 95% CI, 1.67−1,312.00), serum albumin concentration at surgery <3.3 g/dL (OR, 34.10; 95% CI, 1.72–2,804.00), andpresence of inflammation outside of the surgical site (OR, 21.40; 95% CI, 1.02−2,150.00). Treatment intensification for patientswith endoscopic recurrence in the anti-TNFα restart group showed limited responses, with only 1 of 12 patients achieving endoscopicremission. Conclusions: The efficacy of restarting anti-TNFα antibody treatment after surgery was limited, and treatmentintensification or a change to different classes of biologics should be considered for those patients.

An Elevated Platelet Count Increases the Risk of Relapse in Ulcerative Colitis Patients with Mucosal Healing

( Asuka Nakarai ),( Jun Kato ),( Sakiko Hiraoka ),( Shiho Takashima ),( Toshihiro Inokuchi ),( Masahiro Takahara ),( Yuusaku Sugihara ),( Keita Harada ),( Hiroyuki Okada ) 대한간학회 2018 Gut and Liver Vol.12 No.4

Background/Aims: Although mucosal healing (MH) has been considered a treatment goal for patients with ulcerative colitis (UC), the risk factors predictive of relapse in patients who achieve MH are unknown. Because the platelet count has been shown to be a marker of inflammation in inflammatory bowel diseases, this study aimed to assess whether the platelet count could predict relapse in UC patients with MH. Methods: A prospective observational study was performed. UC patients with MH were consecutively enrolled in the study and monitored for at least 2 years or until relapse. The correlation between the incidence of relapse and the platelet count at the time of study enrollment was examined. Results: In total, 43 patients were enrolled, and 14 patients (33%) relapsed. The median platelet count at the time of enrollment in the patients who relapsed significantly differed from that in the patients who did not relapse (27.2×104/μL vs 23.8×104/μL, respectively; p=0.016). A platelet count >25.0×104/μL was a significant risk factor for relapse based on a multivariate analysis (hazard ratio, 4.85; 95% confidence interval, 1.07 to 25.28), and according to the Kaplan-Meier analysis, this cutoff could identify patients susceptible to relapse (p=0.041, log-rank test). Conclusions: The platelet count could be used as a predictor of relapse in UC patients with MH. (Gut Liver 2018;12:420-425)

Fecal Immunochemical Test and Fecal Calprotectin Results Show Different Profiles in Disease Monitoring for Ulcerative Colitis

Sakiko Hiraoka,Toshihiro Inokuchi,Asuka Nakarai,Shiho Takashima,Daisuke Takei,Yuusaku Sugihara,Masahiro Takahara,Keita Harada,Hiroyuki Okada,Jun Kato 거트앤리버 소화기연관학회협의회 2018 Gut and Liver Vol.12 No.2

Background/Aims: Both fecal immunochemical test (FIT) and fecal calprotectin (Fcal) results are useful biomarkers for ulcerative colitis (UC). However, the situations in which each marker should be used are largely unknown. Methods: A total of 110 colonoscopy intervals of UC patients were assessed, and correlations between changes in colonoscopic findings and changes in the two aforementioned fecal markers were examined. Results: Among patients with mucosal healing (MH) and negative FIT or Fcal results at the initial colonoscopy, FIT and Fcal findings exhibited accuracies of 93% (38/41) and 79% (26/33), respectively, for predicting the results of the subsequent examination. Among the 24 patients who showed endoscopic activity at the precedent colonoscopy and MH at the subsequent examination, positive-to-negative conversion of FIT and Fcal findings at the subsequent examination was observed in 92% (12/13) and 62% (8/13) of patients, respectively. Among the 43 patients who showed endoscopic activity at both the precedent and subsequent examinations, Fcal findings reflected the change in endoscopic activity better than FIT results (r=0.59, p<0.0001 vs r=0.30, p=0.054). Conclusions: The FIT is useful for confirming MH and the occurrence of relapse. In contrast, Fcal is useful for monitoring the mucosal status of patients with active inflammation.