Degeneration of the intervetebral lumbar disc is often associated with back pain (17). MRI studies often show marrow changes adjacent to the endplates in patients with degenerative lumbar disc disease (18,19). Modic et al. (19) showed that hyperemic bone marrow changes (type 1 pattern) may progress to conversion of red to yellow marrow changes (type 2 pattern). Lusins et al. compared SPECT bone scintigraphy and lumbar MRI in detecting endplate changes in 48 patients with back pain and MRI disc degenerative changes (20). Thirty-seven patients had increased activity of the endplates seen in SPECT scintigraphy and type I and type II MRI marrow endplate changes. However, 10 patients had abnormal SPECT scintigraphy despite normal MRI marrow endplates. The authors postulated that the increased activity seen with SPECT imaging is attributable to marrow changes and that the marrow changes can be identified by SPECT imaging prior to being seen on MRI.
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