APPENDIX: MRI IMAGING MEASURES
MRI Finding
Definition
Endplate changes16
Type I
Type II
Type III
Facet hypertrophy
Mild
Moderate
Severe
Annular fissure
Disc height
narrowing18
Disc dessication
Mild
Moderate
Severe
Disk bulging
Spondylolisthesis
Disc protrusion19
Central canal stenosis
Mild
Moderate
Severe
Disc extrusions19
Nerve root
impingement
Lateral recess
stenosis
Low T1 and high T2 (endplate edema)
Threshold for
incident change at
any spinal level
None vs. any endplate
changes
None vs. type I
endplate change
High T1 and low to intermediate T2 (fatty change)
Low T1 and low T2 (sclerosis)
Mild hypertrophy with minimal or no neural
foramen encroachment
Moderate hypertrophy with moderate neural
foramen or canal
encroachment
Extensive hypertrophy with severe neural
foramen or canal encroachment
Focal hyperintensity of the annulus on T2weighted image17.
Decrease in disc height compared with expected
height of a hydrated disc at the same level
Mild diffuse decrease in signal or focal moderate
or severe decrease <1⁄3 of disc area on sagittal
image.
Moderate diffuse decrease in signal or focal
moderate or severe decrease 1⁄3–2⁄3 of disc
area on sagittal image.
Severe diffuse decrease (no residual high T2
signal) >2⁄3 of disc area on sagittal image.
Circumferential symmetric extension of the disc
beyond the interspace
Displacement of one vertebra atop another in the
sagittal plane
Focal or asymmetric extension of the disc beyond
the interspace with the base against the disc of
origin broader than any other dimension of the
protrusion.
Encroachment on central canal but abundant
cerebrospinal fluid still present around roots
Crowded roots with only small amount of residual
cerebrospinal fluid
No residual cerebrospinal fluid
More extreme extension of the disk of origin
narrower than the diameter of the extruding
material itself or with no connection between the
material and the disk
Contact/displacement/compression of nerve root
and or thecal sac20
Narrowing of the lateral recess graded
subjectively as normal, mild, moderate, or severe
None/mild vs.
moderate/severe
None vs. any fissure
None vs. any
narrowing
None/mild vs.
moderate/severe
None vs. any bulging
Any new or worsened
spondylolisthesis
None vs. any
protrusion
None/mild vs.
moderate/severe
None vs. any extrusion
None vs. any
impingement
None vs. any
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