• Niek Djuric, Xiaoyu Yang, Abdelilah El Barzouhi, Ostelo Raymond W J G RWJG Department of Epidemiology, VU Medical Center, Amsterdam, The Netherlands. Dep, Duinen Sjoerd G van SGV Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Nijeholt Geert J Lycklama À GJLÀ Haaglanden Medical Center, the Hague, The Netherlands., Bas F W van der Kallen, Wilco C Peul, and Vleggeert-Lankamp Carmen L A CLA Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands..
• Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
• Spine. 2019 Jun 15; 44 (12): E742-E748.

Study DesignRetrospective observational histological study.ObjectiveTo evaluate the reliability of gadolinium enhancement as a marker for inflammation by associating gadolinium enhancement findings with the degree of inflammation as measured by macrophage infiltration in disc material retrieved during disc surgery in patients with sciatica.Summary Of Background DataDisc inflammation often occurs in sciatica patients, a noninvasive tool that is used to assess disc inflammation is Gadolinium enhanced MR imaging.MethodsDisc tissue was retrieved from patients in the Sciatica trial (N = 119), a multicenter randomized controlled trial in patients with sciatica. Disc tissue was embedded in paraffin and stained with hematoxylin and CD68. Tissue samples were categorized as mild (0-10 macrophages/cm), moderate (10-100 macrophages/cm), and considerable (>100 macrophages/cm) inflammation. Of the 119 MRIs, 96 were additionally performed with contrast-enhanced gadolinium.ResultsSeventy-four patients showed gadolinium enhancement of the disc herniation and 26 of the nerve root. Degree of inflammation by macrophages was not associated with gadolinium enhancement of nerve roots or herniated discs. These results did not change if the patient groups with and without Modic type 2 changes were evaluated separately. Furthermore, no associations were observed between gadolinium enhancement and presence of Modic type 2 changes.ConclusionThis study found gadolinium enhanced MRI findings to be unreliable as an indicator for inflammation of disc herniation or nerve root in patients with sciatica.Level Of Evidence2.

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