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 Table of Contents  
LETTER TO EDITOR
Year : 2015  |  Volume : 3  |  Issue : 2  |  Page : 79-80

High signal intervertebral disc in T1-weighted magnetic resonance imaging


1 Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
2 Department of Radiology, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
3 Department of Emergency Medicine, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Date of Web Publication23-Oct-2015

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524. 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-2585.158519

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How to cite this article:
Agrawal A, Hegde KV, Reddy UV, Kumar SS, Rao MG. High signal intervertebral disc in T1-weighted magnetic resonance imaging. J Orthop Allied Sci 2015;3:79-80

How to cite this URL:
Agrawal A, Hegde KV, Reddy UV, Kumar SS, Rao MG. High signal intervertebral disc in T1-weighted magnetic resonance imaging. J Orthop Allied Sci [serial online] 2015 [cited 2019 May 19];3:79-80. Available from: http://www.joas.in/text.asp?2015/3/2/79/158519

Dear Sir,

A normal intervertebral disc is described as a homogeneous structure on magnetic resonance imaging (MRI), which is isointense to muscle on T1-weighted (T1W) and because of the water content becomes hyperintense on T2W images.[1],[2],[3] Most of the studies describe believe that because of immobile protons in calcium and complete maturity of calcium intervertebral disc calcification (IDC) appears signal void (dark) on T1W images (cortical bone).[4] Uncommonly IDC can be seen as high signal intensity on T1W images, probably due to the presence of mobile protons (liquid state or milk of calcium) in calcium.[4],[5],[6],[7],[8] A 60-year-oldgentlemen presented with the history of road traffic accident hit by four wheeler. There was no history of loss of consciousness; vomiting; ear, nose, and throat (ENT) bleed; or seizures. However, the patient was complaining of persistent neck which was made worse by neck movements. There was no radiation of pain. There were motor or sensory symptoms. Bowel and bladder functions were normal. There was no significant past medical history. The patient was examined with cervical spine radiograph and it showed fracture of anterior osteophyte at C2–3 and C3–4 level, bridging osteophytes, and hyperdensities in the intervertebral disc space at C4–5 level [Figure 1]. MRI of the cervical spine, T1W, T2W, and fluid-attenuated inversion recovery (FLAIR) images showed hyperintense signals in the C4–5 disc space with apparently normal spinal cord [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. Based on MRI imaging, hemorrhage in the disc space was suspected; however, as there was significant evidence of calcification on radiographs, the patient was further planned for CT of the cervical spine. CT cervical confirmed the presence of calcification in the C4–5 disc space [Figure 3]a and [Figure 3]b. The patient was managed conservatively, he improved in his neck pain and doing well at follow-up.
Figure 1: Radiograph of the cervical spine lateral showing diffuse degenerative changes, fracture of the C2–3 and C5–6 anterior osteophyte, C4–5 bridging osteophytes, and intervertebral disc calcification

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Figure 2: Magnetic resonance imaging (MRI) cervical spine (a and b) T1-weighted (T1W), (c) T2W, and (d) fluid-attenuated inversion recovery (FLAIR) images showing hyperintense C4–5 intervertebral disc

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Figure 3a and Figure 3b: Computed tomography (CT) scan cervical confirmed that the hyperintense appearance of intervertebral disc was due to extensive calcification

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Chondrocalcinosis or IDC is characterized by the deposition of hydroxyapatite or calcium pyrophosphate dihydrate crystals within annulus fibrosus and/or nucleus pulposus of the intervertebral disc.[9] In a review it was noted that the IDC was described as early as 1,838 in anatomy textbooks and on radiographs in 1922.[10] On conventional radiography, the prevalence of IDC in the general adult population reported as 5–6% with [10],[11] which had noticed higher in cadaver studies [12],[13] and on histological examination of surgically retrieved disc materials.[14] IDC needs to be differentiated with many other disease conditions (e. g., hemochromatosis, chondrocalcinosis, hyperparathyroidism, poliomyelitis, acromegaly, amyloidosis, AIDS, multiple myeloma, myelofibrosis, Waldenstrom macroglobulinemia, and metastasis) which can lead to disc calcification and where the disc can appear hyperintense on T1W images.[10], 11, [15],[16],[17],[18],[19] Plain radiography has been recommended to identify intradiscal calcification.[2],[20] The present case illustrates that hyperintense appearance of intervertebral disc on MRI can be misleading (particularly in presence of history of trauma) and need careful assessment and supportive investigations to differentiate hemorrhage from age-related changes particularly calcification.

 
  References Top

1.
Mirowitz SA. Pitfalls, variants, and artifacts in body MR imaging. St. Louis, Missour: Mosby; 1996.  Back to cited text no. 1
    
2.
Nakamura M, Shiokawa S, Miyazaki Y, Kita H, Setoguchi K, Kawahata K, et al. Diffuse intervertebral disk calcification in a patient with rheumatoid arthritis. J Med Invest 2000;47:152-4.  Back to cited text no. 2
    
3.
Alaee AR, Daghighi MH, Pourisa M. High signal intervertebral disc in T1W MRI. Iran J Radiol 2009;6:107-9.  Back to cited text no. 3
    
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Tyrrell PN, Davies AM, Evans N, Jubb RW. Signal changes in the intervertebral discs on MRI of the thoracolumbar spine in ankylosing spondylitis. Clin Radiol 1995;50:377-83.  Back to cited text no. 4
    
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Bangert BA, Modic MT, Ross JS, Obuchowski NA, Perl J, Ruggieri PM, et al. Hyperintense disks on T1-weighted MR images: Correlation with calcification. Radiology 1995;195:437-43.  Back to cited text no. 5
    
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Major NM, Helms CA, Genant HK. Calcification demonstrated as high signal intensity on T1-weighted MR images of the disks of the lumbar spine. Radiology 1993;189:494-6.  Back to cited text no. 6
    
7.
Malghem J, Lecouvet FE, François R, Vande Berg BC, Duprez T, Cosnard G, et al. High signal intensity of intervertebral calcified disks on T1-weighted MR images resulting from fat content. Skeletal Radiol 2005;34:80-6.  Back to cited text no. 7
    
8.
Henkelman RM, Watts JF, Kucharczyk W. High signal intensity in MR images of calcified brain tissue. Radiology 1991;179:199-206.  Back to cited text no. 8
    
9.
Aktafi I, Akgün K, Çakmak B. Intervertebral disc calcification in elderly. Turk J Geriatr 2007;10:37-9.  Back to cited text no. 9
    
10.
Weinberger A, Myers AR. Intervertebral disc calcification in adults: A review. Semin Arthritis Rheum 1978;8:69-75.  Back to cited text no. 10
[PUBMED]    
11.
Andres TL, Trainer TD. Intervertebral chondrocalcinosis: A coincidental finding possibly related to previous surgery. Arch Pathol Lab Med 1980;104:269-71.  Back to cited text no. 11
[PUBMED]    
12.
Chanchairujira K, Chung CB, Kim JY, Papakonstantinou O, Lee MH, Clopton P, et al. Intervertebral disk calcification of the spine in an elderly population: Radiographic prevalence, location, and distribution and correlation with spinal degeneration. Radiology 2004;230:499-503.  Back to cited text no. 12
    
13.
Cheng XG, Brys P, Nijs J, Nicholson P, Jiang Y, Baert AL, et al. Radiological prevalence of lumbar intervertebral disc calcification in the elderly: An autopsy study. Skeletal Radiol 1996;25:231-5.  Back to cited text no. 13
    
14.
Ellman MH, Vazques LT, Brown NL, Mandel N. Calcium pyrophosphate dihydrate deposition in lumbar disc fibrocartilage. J Rheumatol 1981;8:955-8.  Back to cited text no. 14
[PUBMED]    
15.
Dussault RG, Kaye JJ. Intervertebral disk calcification associated with spine fusion. Radiol 1977;125:57-61.  Back to cited text no. 15
    
16.
Martel W, Holt JF, Cassidy JT. Roentgenologic manifestations of juvenile rheumatoid arthritis. Am J Roentgenol Radium Ther Nucl Med 1962;88:400-23.  Back to cited text no. 16
[PUBMED]    
17.
Moulopoulos LA, Dimopoulos MA, Varma DG, Manning JT, Johnston DA, Leeds NE, et al. Waldenström macroglobulinemia: MR imaging of the spine and CT of the abdomen and pelvis. Radiology 1993;188:669-73.  Back to cited text no. 17
    
18.
Remedios PA, Colletti PM, Raval JK, Benson RC, Chak LY, Boswell WD Jr, et al. Magnetic resonance imaging of bone after radiation. Magn Reson Imaging 1988;6:301-4.  Back to cited text no. 18
    
19.
Rosenthal DI, Hayes CW, Rosen B, Mayo-Smith W, Goodsitt MM. Fatty replacement of spinal bone marrow due to radiation: Demonstration by dual energy quantitative CT and MR imaging. J Comput Assist Tomogr 1989;13:463-5.  Back to cited text no. 19
    
20.
Vignaux O, Sarrazin JL, Cordoliani YS, Cosnard G. Hypersignal of the intervertebral disks in T1-weighted spin-echo MRI sequences. J Radiol 1994;75:363-7.  Back to cited text no. 20
    


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