Original Research Degenerative Endplate Changes of the Lumbosacral Spine: Dynamic Contrast-Enhanced MRI Profiles Related to Age, Sex, and Spinal Level Vasiliki Savvopoulou, MD, 1 Thomas G. Maris, PhD, 2 Andreas Koureas, MD, 1 Athanasios Gouliamos, MD, 1 and Lia A. Moulopoulos, MD 1 * Purpose: To investigate differences in perfusion profiles between degenerative endplate marrow changes and nor- mal vertebral marrow in relation to spinal level, age, and sex with dynamic contrast-enhanced magnetic resonance imaging (DCE MRI). Materials and Methods: Ninety-two consecutive patients referred for evaluation of low back pain or sciatica, with- out history of malignant or chronic disease, underwent conventional and DCE MRI of the lumbosacral spine. Fifty-two of them demonstrated degenerative endplate marrow changes. Regions of interest were placed on sites of normal marrow (group A) and degenerative changes (group B) on subtracted images. Fitted time-intensity curves (fTICs) were generated and evaluated for curve pat- tern. Both groups were stratified into upper (L1-L2) and lower (L3-I1) levels, males and females younger or older than 50 years. Perfusion parameters were calculated and statistically compared for both groups and subgroups. Receiver operator curve (ROC) analysis was also performed. Results: Two fTIC patterns were identified. Perfusion pa- rameters of degenerative changes and normal marrow dif- fered significantly, even when groups were stratified for spinal level, age, and sex (P < 0.05). A time to peak value >108 seconds was characteristic for degenerative changes with sensitivity 69.5% and specificity 84.6%. Conclusion: DCE MRI profiles of degenerative endplate marrow changes of the lumbosacral spine differ signifi- cantly from normal marrow regardless of spinal level, age, or sex. Key Words: DCE MRI; bone marrow; lumbar spine; disc disease; degeneration J. Magn. Reson. Imaging 2011;33:382–389. V C 2011 Wiley-Liss, Inc. SPINAL ENDPLATE bone marrow changes that accompany degenerative disc disease represent a spectrum of marrow degeneration (1,2). Type 1 changes (low signal intensity on T1-weighted [T1W] and high on T2W-magnetic resonance [MR images]) are seen during the active or inflammatory stage, while type 2 changes (high signal intensity on T1W- and T2W-MR images) appear later and are related to fatty marrow replacement. Recent studies indicate that type 2 changes are not as stable as previously considered and may convert back to type 1. Both types may also con- vert to normal marrow (3–5). Type 3 changes (low signal intensity on T1W- and T2W-MR images) represent the endstage with bone sclerosis or fibrosis (1). Because of their association with low back pain and, possibly spinal instability, there is continued research on endplate changes pathophysiology (3–8). Dynamic contrast-enhanced (DCE) MRI has been widely applied to the investigation of bone marrow disorders and normal marrow, as it may depict subtle changes of contrast kinetics which reflect alterations in microcirculation. Since normal marrow perfusion varies between upper and lower lumbar vertebrae, young and old subjects, men and women, we under- took this DCE MRI study to look for differences between perfusion profiles of degenerative changes and normal marrow in relation to spinal level, age, and sex in a search for an underlying process respon- sible for their development (9–12). MATERIALS AND METHODS Study Population Ninety-two consecutive patients (age range 15–78 years, mean age 46.2 years, 38 men, 54 women) referred to our institution for evaluation of low back pain or sciatica underwent conventional and DCE MRI of the lumbosacral spine. Subjects with a history of malignancy, hematologic or other systemic disor- ders, long-term medication, body mass index >28 kg/ m 2 and vertebral fractures were not enrolled in the study. All 92 patients served for DCE MRI study of sites of normal bone marrow (group A). Fifty-two of 1 Department of Radiology, Areteion Hospital, Medical School, University of Athens, Athens, Greece. 2 Department of Medical Physics, Faculty of Medicine, University Hospital of Crete, Stavrakia GR71201, Heraklion, Crete, Greece. *Address reprint requests to: L.A.M., Department of Radiology, Are- teion Hospital, 76 Vasilissis Sofias Street, 11528 Athens, Medical School, University of Athens, Greece. E-mail: lia1312@otenet.gr Received July 6, 2010; Accepted October 20, 2010. DOI 10.1002/jmri.22444 View this article online at wileyonlinelibrary.com. JOURNAL OF MAGNETIC RESONANCE IMAGING 33:382–389 (2011) V C 2011 Wiley-Liss, Inc. 382