A new four-area method for evaluating biochemical changes in lumbar facet joint degeneration at T2* mapping

A new four-area method for evaluating biochemical changes in lumbar facet joint degeneration at T2* mapping | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A new four-area method for evaluating biochemical changes in lumbar facet joint degeneration at T2* mapping Yi Ding, Shidong Ruan, Liping Liu, Xiaodong Zhang, Rongchun Chen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4064806/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 May, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 11 You are reading this latest preprint version Abstract Purpose To investigate the diagnostic efficacy of a new four-area method for evaluating biochemical changes in lumbar facet joint (LFJ) degeneration at T2* mapping. Methods Fifty-eight patients with low back pain underwent standard MRI protocols and axial T2* mapping. Morphological evaluation of LFJ was performed on T2-weighted imaging according to Weishaupt grading system. T2* value of LFJ was measured at T2* mapping using all-inclusive and four-area methods, respectively. Inter-observer reliability for continuous and categorical variables were respectively evaluated using Pearson correlation coefficient and Kappa value. For evaluating the correlation between continuous variables and ordered categorical variables, one way ANOVA or Kruskal-Wallis test was used. Results In the analyses of both all-inclusive and four-area methods, the mean T2* value of grade 0 LFJ was higher than those of grade I, grade II and grade III LFJ, and a downward trend of T2* value was observed as the grade of LFJ rised except grade III. The mean T2* values of LFJ obtained by all-inclusive method were higher than those obtained by four-area method, except grade 0 LFJ. Besides, four-area method had a perfect inter-observer reliability with PCC of 0.992 (p = 0.000), higher than that of all-inclusive method with PCC of 0.943 (p < 0.001). Conclusions Being more reproducible and accurate than conventional all-inclusive method in the measurement of T2* value, the new four-area method can be used in evaluating biochemical changes in LFJ degeneration at T2* mapping. magnetic resonance imaging T2* mapping lumbar facet joint Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Low back pain is a musculoskeletal disorder that affects up to 60–80% of the population at some point during their lifetime, resulting in considerable negative impacts on quality of life and social economy 1–4 . Lumbar facet joint (LFJ) degeneration is regarded as common cause of low back pain 5–7 . Chronic low back pain related to LFJ degeneration is often resulted from the degeneration, osteoarthritis, and effusion of small joints, which are closely related the damage and degeneration of small joint cartilage 5–7 . Thus, it is critical to accurately and objectively evaluate the status of LFJ cartilage in a reproducible manner. With the development of MRI protocols over the past two decades, researchers have recently shown increased interests in biochemical quantitative imaging techniques 8–11 . Among which T2* value generated from T2* mapping reflects the “true” transverse relaxation time and decrease with an increase in cartilage degeneration 12 13 . It has been widely used in clinical research on the degeneration of joint cartilage such as hip, knees, ankles, shoulders, and palm fingers 13–16 , and has been proved to be effective to detect degenerative changes in LFJ 8 . In contrast to other large joints of the extremities, LFJ is relatively small with a narrow joint cavity. It is difficult to distinguish the effusion from the LFJ cartilage by the traditional all-inclusive measuring method 8 9 . Therefore, the water content in the joint cavity can directly affect the T2* value generated from T2* mapping, resulting errors in the quantitative evaluation of the cartilage and the final experimental results. To reduce the effect of the effusion in the joint cavity on the measurement of T2* value, we proposed a new four-area method. Briefly, four round regions of interest (ROI) were drawn at the four different regions of the LFJ cartilage, and T2* values obtained from the four ROIs were averaged to obtain the final result. Thus, the aim of this study was to investigate the diagnostic efficacy of a new four-area method for evaluating biochemical changes in LFJ degeneration at T2* mapping. Methods This retrospective study had received the institutional review board approval, and was performed with waiver of informed consent. Patient population Patients suffering from low back pain and other impairments originating from lumbar spine who had undergone standard MRI protocols and axial T2* mapping between January 1, 2020 to June 1, 2023 were included in this study. Exclusion criteria: ( 1 ) patients with lumbar tuberculosis or other infections, multiple myeloma or other malignant tumors, or concomitant skeletal-rheumatoid disease involving the facet joints; ( 2 ) poor image quality of MRI for further analysis. Patient information was anonymized and de-identified prior to analysis. Image acquisition and analysis Patients were scanned using a 3.0 T MRI unit (Tim Trio, Siemens Medical Solutions, Erlangen, Germany) with a dedicated 8-channel spine coil. Axial T2* mapping used the following parameters: fast spin echo, repetition time 575 ms, echo time 4.2, 11.3, 18.5, 25.6, 32.7 ms, field of view 160×160 mm, voxel size 0.4×0.4×4.0mm, interslice gap 0.3 mm, number of slices 15, examination time 3 min 41 sec. Morphological evaluation of LFJ degeneration was performed on T2-weighted imaging (T2WI) according to Weishaupt grading system 17 : grade 0, normal facet joint space (2–4 mm width); grade 1, mild degenerative disease, narrowing of the facet joint space (< 2 mm) and/or small osteophytes and/or mild hypertrophy of the articular process; grade 2, moderate degenerative disease, narrowing of the facet joint space and/or moderate osteophytes and/or moderate hypertrophy of the articular process and/or mild subarticular bone erosions; and grade 3, severe degenerative disease, narrowing of the facet joint space and/or large osteophytes and/or severe hypertrophy of the articular process and/or severe subarticular bone erosions and/or subchondral cysts. Image analysis was performed by one radiologist and one spine surgeon to evaluate inter-observer reliability. For the measurement of T2* value of LFJ, ROI was primarily delineated on first echo anatomical image and copied to the corresponding T2* mapping image using two methods. All-inclusive method: a ROI was drawn including both the superior and the lower articular process cartilage, and the joint cavity (Fig. 1 ). Four-area method: two round ROIs were drawn at the front and last points of both the superior and the lower articular process cartilage, and the other two round ROIs were drawn at the two tertile points between the front and last points. T2* values obtained from the four ROIs were averaged to obtain the final result (Fig. 1 ). The measurement of T2* value using two methods was performed by one radiologist and one spine surgeon to evaluate inter-observer reliability. The values measured by the two observers were averaged to make the final T2* values for each method. Statistical analysis Shapiro-Wilk test was used to determine whether the continuous variables accord with normal distribution. Continuous variables were presented as means and SD (normal distribution), or as medians and quartiles (non-normal distribution). Inter-observer reliability for continuous and categorical variables were respectively evaluated using intraclass correlation coefficient (ICC) and Kappa value, interpreted as follows: 0-0.3, weak agreement; 0.3–0.5, moderate agreement; 0.5–0.7, substantial agreement; 0.7–1.0, almost perfect agreement. For evaluating the correlation between continuous variables and ordered categorical variables, one way ANOVA (normal distribution with equal variance) or Kruskal-Wallis test (non-normal distribution), and Spearman rank test were used. All reported p values were two-sided. A p value of < 0.05 was considered statistically significant. All statistical analyses were performed using R-4.2.3 ( https://www.r-project.org ). Results Morphological evaluation of LFJ We included 580 LFJs from 58 patients (32 males, 26 females; mean age, 46.9 ± 13.9 years; range, 19–79 years) in this study. Weishaupt grading results of LFJ were summarized in Table 1 . Three hundred and ninety-five LFJs were graded with the same results by two observers, accounting for 68.1% of the total number of LFJs. Inter-observer reliability for morphological evaluation of LFJ was moderate with Kappa value of 0.431 (p < 0.001). Table 1 Weishaupt grading results of LFJ Observer 2 Total (%) 0 (%) I (%) II (%) III (%) Observer 1 0 (%) 38 (6.6) 14 (2.4) 0 0 52 (9.0) I (%) 18 (3.1) 271 (46.7) 73 (12.6) 3 (0.5) 365 (62.9) II (%) 3 (0.5) 55 (9.5) 58 (10.0) 6 (1.0) 122 (21.0) III (%) 1 (0.2) 7 (1.2) 5 (0.9) 28 (4.8) 41 (7.1) Total (%) 60 (10.3) 347 (59.8) 136 (23.4) 37 (6.4) 580 LFJ, lumbar facet joint T2* values of LFJ Ten LFJs were excluded due to severe degeneration, joint fusion or poor imaging quality. Finally, 570 LFJs were included in the analysis of T2* value (Fig. 2 – 4 ) (supplementary material 1). Four-area method (ICC = 0.992 [0.99, 0.993], p < 0.001) had a better inter-observer reliability than all-inclusive method (ICC = 0.942 [0.931, 0.951], p < 0.001) in the measurement of T2* value. Inter-method consistency for the measurement of T2* values using the two methods was also almost perfect (ICC = 0.823 [0.795, 0.848], p < 0.001). In the analysis of the all-inclusive method, a downward trend of T2* value was observed as the grade of LFJ raised except grade III (Fig. 5 ). The mean T2* value of grade 0 LFJ was significantly higher than those of grade I (p < 0.001) and grade II LFJ (p < 0.001), and was higher than that of grade III LFJ but not reaching a significant difference (p = 0.178). No significant difference was observed between the mean T2* values of grade I and II LFJ (p = 0.484), grade I and III LFJ (p = 0.833), grade II and III LFJ (p = 0.833). A weak correlation was observed between T2* value and LFJ grade (rho = -0.132, p = 0.002) (Table 2 ). Table 2 T2* values of LFJ obtained by all-inclusive and four-area methods Grade LFJ (%) T2* value A (quartile, ms) T2* value B (quartile, ms) 0 48 (8.4) 21.32 (18.27, 26.05) 21.55 (18.2, 26.72) I 335 (58.8) 18.33 (15.47, 22.16) 17.94 (15.45, 21.67) II 161 (28.2) 17.99 (15.18, 20.97) 17.28 (14.65, 20.38) III 26 (4.6) 18.29 (15.07, 25.47) 18.25 (15.22, 22.41) p value / < 0.001 < 0.001 rho (p value) / -0.132 (0.002) -0.17 (0.002) LFJ, lumbar facet joint; T2* value A, T2* value obtained by all-inclusive method; T2* value B, T2* value obtained by four-area method In the analysis of the four-area method, a downward trend of T2* value was observed as the grade of LFJ raised except grade III (Fig. 5 ). The mean T2* value of grade 0 LFJ was significantly higher than those of grade I (p < 0.001), grade II LFJ (p < 0.001) and grade III LFJ (p = 0.028). No significant difference was observed between the mean T2* values of grade I and II LFJ (p = 0.168), grade I and III LFJ (p = 0.947), grade II and III LFJ (p = 0.919). A weak correlation was observed between T2* value and LFJ grade (rho = -0.17, p < 0.001) (Table 2 ). Discussion As the only synovial joint in spine, facet joint has a complete synovial joint structure including joint capsule and cavity, effusion, joint cartilage and other tissues. The main compositions of cartilage are cartilage cells, water, proteoglycan and collagen fiber. Pathologic changes of joint cartilage during degeneration are initially characterized by increase in water content, early loss of proteoglycan, alterations in the size and arrangement of collagen fiber, and gradually followed by softening and disappearance of cartilage 18 . T2* mapping is sensitive to the migration rate of water molecule and the amount of water 16 , and thus can reflect the changes in biochemical composition in cartilage. In previous studies that used T2* mapping in quantitative assessment of LFJ, T2* value was obtained by drawing a ROI including both the upper and lower articular process cartilage, and the joint cavity 8 9 . We called this method as all-inclusive method. However, it is difficult to distinguish the effusion from the LFJ cartilage. The water content in the joint cavity can directly affect the T2* value, causing errors in the quantitative evaluation of the cartilage and the final study results. The higher mean T2* value of grade III LFJ compared with grade II LFJ in our study supported this hypothesis. To reduce the effect of the effusion in the joint cavity on the measurement of T2* value, we proposed a new four-area method. Our results showed that both all-inclusive method and four-area method had an almost perfect agreement in the measurement of T2* values. The ICC of four-area method was higher than that of all-inclusive method, indicating that four-area method had a better reproducibility. In addition, inter-method consistency for the measurement of T2* values using the two methods also had an almost perfect agreement with ICC of 0.823. In order to explore the ability of four-area method to identify LFJ with different Weishaupt grade, one way ANOVA or Kruskal-Wallis test was used to compare their T2* values. We found that the mean T2* value of grade 0 LFJ was significantly higher than those of grade I (p < 0.001), grade II LFJ (p < 0.001) and grade III LFJ (p = 0.028). While in the analysis of the all-inclusive method, the mean T2* value of grade 0 LFJ was higher than that of grade III LFJ but not reaching a significant difference (p = 0.178). These results suggest that four-area method was more effective than all-inclusive method in the evaluation of biochemical changes of LFJ. An important finding of this study was that the T2* values obtained by all-inclusive method were higher than those obtained by four-area method, except grade 0 LFJ. Normal cartilage structure and absence of joint effusion in grade 0 LFJ are possible explanations, resulting in consistent T2* values obtained by both methods. In contrast, LFJs of grade I, II, and III have different degrees of cartilage degeneration accompanied by various amount of joint effusion. Lower T2* values obtained by four-area method indicated that this new method was less influenced by joint effusion and more accurate than all-inclusive method in the measurement of T2* value. The subjects we collected in this study were outpatient patients referred for low back pain. Chronic low back pain related to LFJ degeneration is often resulted from the degeneration, osteoarthritis, and effusion of joints, which are closely related the damage and degeneration of joint cartilage. Although LFJ degeneration is regarded as common causes of low back pain, it also can be caused by many other reasons 6 7 19 . Thus, accurately determining the direct cause of low back pain play an important role in the planning of treatment. As the level of T2* value can reflect the degree of LFJ degeneration, it may be useful to help clinicians determine whether the pain comes from LFJ or other reasons. Our results showed that the proposed new four-area method was more reproducible and accurate than conventional all-inclusive method in the measurement of T2* value. Thus, it can be used in evaluating biochemical changes in LFJ degeneration at T2* mapping and help clinicians in the management of low back pain. Several limitations in the current study. First, there was no histopathological assessment of LFJ degeneration. This is difficult to achieve in humans, and further experimental research on animals is needed. Secondly, the imaging time of all participants was uncertain, ignoring the diurnal variation of facet joints as confirmed by prior studies. Thirdly, the number of participants was relatively small. Further investigation is necessary to assess whether our results would be obtained with a larger number of participants. Conclusions Being more reproducible and accurate than conventional all-inclusive method in the measurement of T2* value, the new four-area method can be used in evaluating biochemical changes in LFJ degeneration at T2* mapping. Declarations Ethics approval and consent to participate: This retrospective study had received the institutional review board approval from Ganzhou People's Hospital. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was obtained from all participants. Consent for publication: Written informed consent was obtained from the patient for publication of this study and accompanying images. Availability of data and material: Data is provided within the supplementary information files. Competing interests: All authors disclosed no competing interest. Funding：This study was funded by Natural Science Foundation of Shandong Province (Youth Program ZR2022QH345) and Jiangxi Provincial Health Technology Project (202311842). Authors' contributions：Guarantors of integrity of entire study, S.X.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, Y.D., S.R.; statistical analysis, Y.D., S.R.; and manuscript editing, Y.D., S.R., S.X.. 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Supplementary Files supplementarymaterial1.xlsx Cite Share Download PDF Status: Published Journal Publication published 15 May, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 05 Feb, 2025 Reviews received at journal 20 Jan, 2025 Reviewers agreed at journal 11 Jan, 2025 Reviews received at journal 27 Sep, 2024 Reviewers agreed at journal 07 Sep, 2024 Reviewers agreed at journal 04 Sep, 2024 Reviewers invited by journal 14 Jun, 2024 Editor assigned by journal 11 Jun, 2024 Editor invited by journal 18 Mar, 2024 Submission checks completed at journal 18 Mar, 2024 First submitted to journal 10 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4064806","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280790643,"identity":"4daa9e68-11d2-486e-b7eb-a7528f40b8dd","order_by":0,"name":"Yi Ding","email":"","orcid":"","institution":"Ganzhou People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Ding","suffix":""},{"id":280790644,"identity":"e18aae4a-264b-4363-a2f9-aba60a9b6594","order_by":1,"name":"Shidong Ruan","email":"","orcid":"","institution":"Liaocheng People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shidong","middleName":"","lastName":"Ruan","suffix":""},{"id":280790645,"identity":"a6c57fdf-e2a0-48bf-8986-acc35c433dd7","order_by":2,"name":"Liping Liu","email":"","orcid":"","institution":"Ganzhou People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liping","middleName":"","lastName":"Liu","suffix":""},{"id":280790646,"identity":"c820bbbd-00cb-4029-8ab9-ab9da7be2581","order_by":3,"name":"Xiaodong Zhang","email":"","orcid":"","institution":"Ganzhou People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaodong","middleName":"","lastName":"Zhang","suffix":""},{"id":280790647,"identity":"26e573c3-8115-4e56-9533-2333ad780639","order_by":4,"name":"Rongchun Chen","email":"","orcid":"","institution":"Ganzhou People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Rongchun","middleName":"","lastName":"Chen","suffix":""},{"id":280790648,"identity":"8d89de41-9bf8-46c6-9c43-ceb255968e60","order_by":5,"name":"Qin Chen","email":"","orcid":"","institution":"Ganzhou People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qin","middleName":"","lastName":"Chen","suffix":""},{"id":280790649,"identity":"a8cd60ce-d58e-4d32-9854-209cb72872d2","order_by":6,"name":"Shuaishuai Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIie2PsUoDQRCG51i4ajXtCsr5CBMWjoALFj6GzS6BtTnbkCLFQeDSCGkPBH0FxRcIDKQ6TJtAirWxTnnFFW4sxbtol2I/dmCL/2PmBwgEjhHhR8MCgO0/Y8V7jJH7u+Iqe342iy0eVGCveKKPghSu+KXoMpLHh/7ONVszn/FUmIK4JA4IE3XbpuC2kj75aUqKrdDvdzylk4WDpb3P2xSRoTA5+ceWQo+uvHKqMcqpVUnKTNa6IfNMUSF0zLicchRdCqyz1CfJvHxvKW44sgMKru1o4FvLV4qHA11ZLnwp1B1dknL4tqkbunhaVf1NPVbXvTmR201U+2G/o/8XDwQCgcAPvgBv/l7ZRh/zlQAAAABJRU5ErkJggg==","orcid":"","institution":"Shandong Provincial Hospital Affiliated to Shandong First Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Shuaishuai","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2024-03-10 12:00:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4064806/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4064806/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-025-08737-2","type":"published","date":"2025-05-15T15:57:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53192634,"identity":"87733c20-6ce0-486e-87cb-73f5335b0d26","added_by":"auto","created_at":"2024-03-21 17:50:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":772726,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of T2* value of lumbar facet joint using all-inclusive method (A). Region of interest was primarily delineated on first echo anatomical image (left) and copied to the corresponding T2* mapping image (right). A ROI was drawn including both the upper and lower articular process cartilage, and the joint cavity. Measurement of T2* value of lumbar facet joint using four-area method (B). Two round ROIs were drawn at the front and last points of cartilage area, and the other two round ROIs were drawn at the two tertile points between the front and last points (left). ROIs were then copied to the corresponding T2* mapping image (right).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4064806/v1/91d2a9e644f22bde41801e5d.png"},{"id":53192633,"identity":"e069df79-5365-49e2-9da6-1d515d2dfec6","added_by":"auto","created_at":"2024-03-21 17:50:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":986317,"visible":true,"origin":"","legend":"\u003cp\u003eA 52-year-old male patient with low back pain showed bilateral grade 0 lumbar facet joint. Measurement of T2* value using all-inclusive method (A), and four-area method (B), respectively.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4064806/v1/bd8ff2753e58282dd50f1b65.png"},{"id":53192631,"identity":"26622776-f891-4596-8610-7f15c7c6a82b","added_by":"auto","created_at":"2024-03-21 17:50:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":955218,"visible":true,"origin":"","legend":"\u003cp\u003eA 39-year-old male patient with low back pain showed bilateral grade I lumbar facet joint.Measurement of T2* value using all-inclusive method (A), and four-area method (B), respectively.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4064806/v1/a2fb3f2bd1901dc85cdb8694.png"},{"id":53192943,"identity":"3f295403-133f-4d18-b905-2f823863260e","added_by":"auto","created_at":"2024-03-21 17:58:54","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1054221,"visible":true,"origin":"","legend":"\u003cp\u003eA 65-year-old female patient with low back pain showed left grade III lumbar facet jointand right grade II lumbar facet joint. Measurement of T2* value using all-inclusive method (A), and four-area method (B), respectively.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4064806/v1/5b167d98045825c47bbf82e9.png"},{"id":53192637,"identity":"0ef31a10-0481-4cf8-9c70-716cfb951ad5","added_by":"auto","created_at":"2024-03-21 17:50:54","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":124199,"visible":true,"origin":"","legend":"\u003cp\u003eA downward trend of T2* value was observed as the grade of lumbar facet joint raised except grade III.Measurement of T2* value used all-inclusive method (A), and four-area method (B), respectively.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-4064806/v1/31aa96a35ca1a72e7ee8a4b5.png"},{"id":83067866,"identity":"91d61da8-774f-44ab-bff1-975b115a819a","added_by":"auto","created_at":"2025-05-19 16:07:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4826544,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4064806/v1/1843fef7-6475-40e1-8421-578b40d55c48.pdf"},{"id":53192636,"identity":"1ed600b2-81ae-437a-9293-fb30246f917e","added_by":"auto","created_at":"2024-03-21 17:50:54","extension":"xlsx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":47802,"visible":true,"origin":"","legend":"","description":"","filename":"supplementarymaterial1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4064806/v1/27024f15a868eed882a28d92.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A new four-area method for evaluating biochemical changes in lumbar facet joint degeneration at T2* mapping","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLow back pain is a musculoskeletal disorder that affects up to 60\u0026ndash;80% of the population at some point during their lifetime, resulting in considerable negative impacts on quality of life and social economy\u003csup\u003e1\u0026ndash;4\u003c/sup\u003e. Lumbar facet joint (LFJ) degeneration is regarded as common cause of low back pain\u003csup\u003e5\u0026ndash;7\u003c/sup\u003e. Chronic low back pain related to LFJ degeneration is often resulted from the degeneration, osteoarthritis, and effusion of small joints, which are closely related the damage and degeneration of small joint cartilage\u003csup\u003e5\u0026ndash;7\u003c/sup\u003e. Thus, it is critical to accurately and objectively evaluate the status of LFJ cartilage in a reproducible manner.\u003c/p\u003e \u003cp\u003eWith the development of MRI protocols over the past two decades, researchers have recently shown increased interests in biochemical quantitative imaging techniques\u003csup\u003e8\u0026ndash;11\u003c/sup\u003e. Among which T2* value generated from T2* mapping reflects the \u0026ldquo;true\u0026rdquo; transverse relaxation time and decrease with an increase in cartilage degeneration\u003csup\u003e12 13\u003c/sup\u003e. It has been widely used in clinical research on the degeneration of joint cartilage such as hip, knees, ankles, shoulders, and palm fingers\u003csup\u003e13\u0026ndash;16\u003c/sup\u003e, and has been proved to be effective to detect degenerative changes in LFJ\u003csup\u003e8\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn contrast to other large joints of the extremities, LFJ is relatively small with a narrow joint cavity. It is difficult to distinguish the effusion from the LFJ cartilage by the traditional all-inclusive measuring method\u003csup\u003e8 9\u003c/sup\u003e. Therefore, the water content in the joint cavity can directly affect the T2* value generated from T2* mapping, resulting errors in the quantitative evaluation of the cartilage and the final experimental results. To reduce the effect of the effusion in the joint cavity on the measurement of T2* value, we proposed a new four-area method. Briefly, four round regions of interest (ROI) were drawn at the four different regions of the LFJ cartilage, and T2* values obtained from the four ROIs were averaged to obtain the final result.\u003c/p\u003e \u003cp\u003eThus, the aim of this study was to investigate the diagnostic efficacy of a new four-area method for evaluating biochemical changes in LFJ degeneration at T2* mapping.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This retrospective study had received the institutional review board approval, and was performed with waiver of informed consent.\u003c/p\u003e \u003cp\u003ePatient population\u003c/p\u003e \u003cp\u003ePatients suffering from low back pain and other impairments originating from lumbar spine who had undergone standard MRI protocols and axial T2* mapping between January 1, 2020 to June 1, 2023 were included in this study. Exclusion criteria: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) patients with lumbar tuberculosis or other infections, multiple myeloma or other malignant tumors, or concomitant skeletal-rheumatoid disease involving the facet joints; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) poor image quality of MRI for further analysis. Patient information was anonymized and de-identified prior to analysis.\u003c/p\u003e \u003cp\u003eImage acquisition and analysis\u003c/p\u003e \u003cp\u003ePatients were scanned using a 3.0 T MRI unit (Tim Trio, Siemens Medical Solutions, Erlangen, Germany) with a dedicated 8-channel spine coil. Axial T2* mapping used the following parameters: fast spin echo, repetition time 575 ms, echo time 4.2, 11.3, 18.5, 25.6, 32.7 ms, field of view 160\u0026times;160 mm, voxel size 0.4\u0026times;0.4\u0026times;4.0mm, interslice gap 0.3 mm, number of slices 15, examination time 3 min 41 sec.\u003c/p\u003e \u003cp\u003eMorphological evaluation of LFJ degeneration was performed on T2-weighted imaging (T2WI) according to Weishaupt grading system\u003csup\u003e17\u003c/sup\u003e: grade 0, normal facet joint space (2\u0026ndash;4 mm width); grade 1, mild degenerative disease, narrowing of the facet joint space (\u0026lt;\u0026thinsp;2 mm) and/or small osteophytes and/or mild hypertrophy of the articular process; grade 2, moderate degenerative disease, narrowing of the facet joint space and/or moderate osteophytes and/or moderate hypertrophy of the articular process and/or mild subarticular bone erosions; and grade 3, severe degenerative disease, narrowing of the facet joint space and/or large osteophytes and/or severe hypertrophy of the articular process and/or severe subarticular bone erosions and/or subchondral cysts. Image analysis was performed by one radiologist and one spine surgeon to evaluate inter-observer reliability.\u003c/p\u003e \u003cp\u003eFor the measurement of T2* value of LFJ, ROI was primarily delineated on first echo anatomical image and copied to the corresponding T2* mapping image using two methods. All-inclusive method: a ROI was drawn including both the superior and the lower articular process cartilage, and the joint cavity (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Four-area method: two round ROIs were drawn at the front and last points of both the superior and the lower articular process cartilage, and the other two round ROIs were drawn at the two tertile points between the front and last points. T2* values obtained from the four ROIs were averaged to obtain the final result (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The measurement of T2* value using two methods was performed by one radiologist and one spine surgeon to evaluate inter-observer reliability. The values measured by the two observers were averaged to make the final T2* values for each method.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eShapiro-Wilk test was used to determine whether the continuous variables accord with normal distribution. Continuous variables were presented as means and SD (normal distribution), or as medians and quartiles (non-normal distribution). Inter-observer reliability for continuous and categorical variables were respectively evaluated using intraclass correlation coefficient (ICC) and Kappa value, interpreted as follows: 0-0.3, weak agreement; 0.3\u0026ndash;0.5, moderate agreement; 0.5\u0026ndash;0.7, substantial agreement; 0.7\u0026ndash;1.0, almost perfect agreement. For evaluating the correlation between continuous variables and ordered categorical variables, one way ANOVA (normal distribution with equal variance) or Kruskal-Wallis test (non-normal distribution), and Spearman rank test were used.\u003c/p\u003e \u003cp\u003eAll reported p values were two-sided. A p value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant. All statistical analyses were performed using R-4.2.3 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.r-project.org\u003c/span\u003e\u003cspan address=\"https://www.r-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eMorphological evaluation of LFJ\u003c/p\u003e \u003cp\u003eWe included 580 LFJs from 58 patients (32 males, 26 females; mean age, 46.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9 years; range, 19\u0026ndash;79 years) in this study.\u003c/p\u003e \u003cp\u003eWeishaupt grading results of LFJ were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Three hundred and ninety-five LFJs were graded with the same results by two observers, accounting for 68.1% of the total number of LFJs. Inter-observer reliability for morphological evaluation of LFJ was moderate with Kappa value of 0.431 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eWeishaupt grading results of LFJ\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eObserver 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eI (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eII (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIII (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eObserver 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e52 (9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e271 (46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e365 (62.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e122 (21.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e41 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e347 (59.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e136 (23.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e580\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eLFJ, lumbar facet joint\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eT2* values of LFJ\u003c/p\u003e \u003cp\u003eTen LFJs were excluded due to severe degeneration, joint fusion or poor imaging quality. Finally, 570 LFJs were included in the analysis of T2* value (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) (supplementary material 1).\u003c/p\u003e \u003cp\u003eFour-area method (ICC\u0026thinsp;=\u0026thinsp;0.992 [0.99, 0.993], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) had a better inter-observer reliability than all-inclusive method (ICC\u0026thinsp;=\u0026thinsp;0.942 [0.931, 0.951], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in the measurement of T2* value. Inter-method consistency for the measurement of T2* values using the two methods was also almost perfect (ICC\u0026thinsp;=\u0026thinsp;0.823 [0.795, 0.848], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIn the analysis of the all-inclusive method, a downward trend of T2* value was observed as the grade of LFJ raised except grade III (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The mean T2* value of grade 0 LFJ was significantly higher than those of grade I (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and grade II LFJ (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and was higher than that of grade III LFJ but not reaching a significant difference (p\u0026thinsp;=\u0026thinsp;0.178). No significant difference was observed between the mean T2* values of grade I and II LFJ (p\u0026thinsp;=\u0026thinsp;0.484), grade I and III LFJ (p\u0026thinsp;=\u0026thinsp;0.833), grade II and III LFJ (p\u0026thinsp;=\u0026thinsp;0.833). A weak correlation was observed between T2* value and LFJ grade (rho = -0.132, p\u0026thinsp;=\u0026thinsp;0.002) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eT2* values of LFJ obtained by all-inclusive and four-area methods\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLFJ (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT2* value A (quartile, ms)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT2* value B (quartile, ms)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.32 (18.27, 26.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.55 (18.2, 26.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e335 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.33 (15.47, 22.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.94 (15.45, 21.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e161 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.99 (15.18, 20.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.28 (14.65, 20.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.29 (15.07, 25.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.25 (15.22, 22.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003erho (p value)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.132 (0.002)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.17 (0.002)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eLFJ, lumbar facet joint; T2* value A, T2* value obtained by all-inclusive method; T2* value B,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eT2* value obtained by four-area method\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the analysis of the four-area method, a downward trend of T2* value was observed as the grade of LFJ raised except grade III (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The mean T2* value of grade 0 LFJ was significantly higher than those of grade I (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), grade II LFJ (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and grade III LFJ (p\u0026thinsp;=\u0026thinsp;0.028). No significant difference was observed between the mean T2* values of grade I and II LFJ (p\u0026thinsp;=\u0026thinsp;0.168), grade I and III LFJ (p\u0026thinsp;=\u0026thinsp;0.947), grade II and III LFJ (p\u0026thinsp;=\u0026thinsp;0.919). A weak correlation was observed between T2* value and LFJ grade (rho = -0.17, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAs the only synovial joint in spine, facet joint has a complete synovial joint structure including joint capsule and cavity, effusion, joint cartilage and other tissues. The main compositions of cartilage are cartilage cells, water, proteoglycan and collagen fiber. Pathologic changes of joint cartilage during degeneration are initially characterized by increase in water content, early loss of proteoglycan, alterations in the size and arrangement of collagen fiber, and gradually followed by softening and disappearance of cartilage\u003csup\u003e18\u003c/sup\u003e. T2* mapping is sensitive to the migration rate of water molecule and the amount of water \u003csup\u003e16\u003c/sup\u003e, and thus can reflect the changes in biochemical composition in cartilage.\u003c/p\u003e \u003cp\u003eIn previous studies that used T2* mapping in quantitative assessment of LFJ, T2* value was obtained by drawing a ROI including both the upper and lower articular process cartilage, and the joint cavity\u003csup\u003e8 9\u003c/sup\u003e. We called this method as all-inclusive method. However, it is difficult to distinguish the effusion from the LFJ cartilage. The water content in the joint cavity can directly affect the T2* value, causing errors in the quantitative evaluation of the cartilage and the final study results. The higher mean T2* value of grade III LFJ compared with grade II LFJ in our study supported this hypothesis. To reduce the effect of the effusion in the joint cavity on the measurement of T2* value, we proposed a new four-area method.\u003c/p\u003e \u003cp\u003eOur results showed that both all-inclusive method and four-area method had an almost perfect agreement in the measurement of T2* values. The ICC of four-area method was higher than that of all-inclusive method, indicating that four-area method had a better reproducibility. In addition, inter-method consistency for the measurement of T2* values using the two methods also had an almost perfect agreement with ICC of 0.823. In order to explore the ability of four-area method to identify LFJ with different Weishaupt grade, one way ANOVA or Kruskal-Wallis test was used to compare their T2* values. We found that the mean T2* value of grade 0 LFJ was significantly higher than those of grade I (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), grade II LFJ (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and grade III LFJ (p\u0026thinsp;=\u0026thinsp;0.028). While in the analysis of the all-inclusive method, the mean T2* value of grade 0 LFJ was higher than that of grade III LFJ but not reaching a significant difference (p\u0026thinsp;=\u0026thinsp;0.178). These results suggest that four-area method was more effective than all-inclusive method in the evaluation of biochemical changes of LFJ.\u003c/p\u003e \u003cp\u003eAn important finding of this study was that the T2* values obtained by all-inclusive method were higher than those obtained by four-area method, except grade 0 LFJ. Normal cartilage structure and absence of joint effusion in grade 0 LFJ are possible explanations, resulting in consistent T2* values obtained by both methods. In contrast, LFJs of grade I, II, and III have different degrees of cartilage degeneration accompanied by various amount of joint effusion. Lower T2* values obtained by four-area method indicated that this new method was less influenced by joint effusion and more accurate than all-inclusive method in the measurement of T2* value.\u003c/p\u003e \u003cp\u003eThe subjects we collected in this study were outpatient patients referred for low back pain. Chronic low back pain related to LFJ degeneration is often resulted from the degeneration, osteoarthritis, and effusion of joints, which are closely related the damage and degeneration of joint cartilage. Although LFJ degeneration is regarded as common causes of low back pain, it also can be caused by many other reasons\u003csup\u003e6 7 19\u003c/sup\u003e. Thus, accurately determining the direct cause of low back pain play an important role in the planning of treatment. As the level of T2* value can reflect the degree of LFJ degeneration, it may be useful to help clinicians determine whether the pain comes from LFJ or other reasons. Our results showed that the proposed new four-area method was more reproducible and accurate than conventional all-inclusive method in the measurement of T2* value. Thus, it can be used in evaluating biochemical changes in LFJ degeneration at T2* mapping and help clinicians in the management of low back pain.\u003c/p\u003e \u003cp\u003eSeveral limitations in the current study. First, there was no histopathological assessment of LFJ degeneration. This is difficult to achieve in humans, and further experimental research on animals is needed. Secondly, the imaging time of all participants was uncertain, ignoring the diurnal variation of facet joints as confirmed by prior studies. Thirdly, the number of participants was relatively small. Further investigation is necessary to assess whether our results would be obtained with a larger number of participants.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBeing more reproducible and accurate than conventional all-inclusive method in the measurement of T2* value, the new four-area method can be used in evaluating biochemical changes in LFJ degeneration at T2* mapping.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eEthics approval and consent to participate:\u0026nbsp;This retrospective study had received the institutional review board approval from Ganzhou People\u0026apos;s Hospital.\u0026nbsp;The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Written informed consent was obtained from all participants.\u003c/li\u003e\n \u003cli\u003eConsent for publication: Written informed consent was obtained from the patient for publication of this study and accompanying images.\u003c/li\u003e\n \u003cli\u003eAvailability of data and material:\u0026nbsp;Data is provided within the supplementary information files.\u003c/li\u003e\n \u003cli\u003eCompeting interests:\u0026nbsp;All authors\u0026nbsp;disclosed\u0026nbsp;no competing interest.\u003c/li\u003e\n \u003cli\u003eFunding：This study was funded by\u0026nbsp;Natural Science Foundation of Shandong Province\u0026nbsp;(Youth Program ZR2022QH345) and Jiangxi Provincial Health Technology Project (202311842).\u003c/li\u003e\n \u003cli\u003eAuthors\u0026apos; contributions：Guarantors of integrity of entire study,\u0026nbsp;S.X.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research,\u0026nbsp;Y.D., S.R.; statistical analysis,\u0026nbsp;Y.D., S.R.; and manuscript editing,\u0026nbsp;Y.D., S.R., S.X..\u003c/li\u003e\n \u003cli\u003eAcknowledgements：The authors thank their colleagues of their institute.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAndersson GB. 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[published Online First: 2011/01/27].\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"magnetic resonance imaging, T2* mapping, lumbar facet joint","lastPublishedDoi":"10.21203/rs.3.rs-4064806/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4064806/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo investigate the diagnostic efficacy of a new four-area method for evaluating biochemical changes in lumbar facet joint (LFJ) degeneration at T2* mapping.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eFifty-eight patients with low back pain underwent standard MRI protocols and axial T2* mapping. Morphological evaluation of LFJ was performed on T2-weighted imaging according to Weishaupt grading system. T2* value of LFJ was measured at T2* mapping using all-inclusive and four-area methods, respectively. Inter-observer reliability for continuous and categorical variables were respectively evaluated using Pearson correlation coefficient and Kappa value. For evaluating the correlation between continuous variables and ordered categorical variables, one way ANOVA or Kruskal-Wallis test was used.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the analyses of both all-inclusive and four-area methods, the mean T2* value of grade 0 LFJ was higher than those of grade I, grade II and grade III LFJ, and a downward trend of T2* value was observed as the grade of LFJ rised except grade III. The mean T2* values of LFJ obtained by all-inclusive method were higher than those obtained by four-area method, except grade 0 LFJ. Besides, four-area method had a perfect inter-observer reliability with PCC of 0.992 (p\u0026thinsp;=\u0026thinsp;0.000), higher than that of all-inclusive method with PCC of 0.943 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eBeing more reproducible and accurate than conventional all-inclusive method in the measurement of T2* value, the new four-area method can be used in evaluating biochemical changes in LFJ degeneration at T2* mapping.\u003c/p\u003e","manuscriptTitle":"A new four-area method for evaluating biochemical changes in lumbar facet joint degeneration at T2* mapping","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-21 17:50:49","doi":"10.21203/rs.3.rs-4064806/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-05T11:45:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-21T00:45:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2025-01-11T12:35:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-27T20:34:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314887079552549285609843041036422566552","date":"2024-09-07T05:46:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96977785294934854976897924053596258848","date":"2024-09-04T23:34:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-14T11:46:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-11T05:18:55+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-18T08:27:11+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-18T04:49:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2024-03-10T11:56:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ae3f9c0d-74cf-47ba-8963-2299204d0380","owner":[],"postedDate":"March 21st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T16:02:05+00:00","versionOfRecord":{"articleIdentity":"rs-4064806","link":"https://doi.org/10.1186/s12891-025-08737-2","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2025-05-15 15:57:11","publishedOnDateReadable":"May 15th, 2025"},"versionCreatedAt":"2024-03-21 17:50:49","video":"","vorDoi":"10.1186/s12891-025-08737-2","vorDoiUrl":"https://doi.org/10.1186/s12891-025-08737-2","workflowStages":[]},"version":"v1","identity":"rs-4064806","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4064806","identity":"rs-4064806","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}