Abstract
BACKGROUND: Damage to the cartilage endplate (CEP) plays a crucial role in the progression of intervertebral disc (IVD) degeneration. This study aims to evaluate the application value of MRI Volumetric interpolated breath-hold examination (VIBE) sequences in visualizing and assessing CEP damage in low back pain (LBP) patients, and to explore the correlation between CEP damage and IVD degeneration. METHODS: We recruited 96 LBP patients (35 males and 61 females) and performed sagittal T2-weighted imaging (T2-WI) TSE, T1-weighted imaging (T1-WI) TSE, conventional VIBE, and VIBE e-dixon sequence scans. The Pfirrmann grade for IVDs, endplate defect grades for CEPs, and the total endplate score (TEPS) were evaluated. Likert scales were employed to assess the image quality of the two VIBE sequences. Inter-observer consistency for image quality and TEPS of both VIBE sequences was tested using intraclass correlation coefficients (ICC). TEPS results showing higher correlation were chosen to analyze the relationship between TEPS and age. Partial correlation analysis was conducted to assess the relationship between TEPS and Pfirrmann grading while controlling for influencing factors. Subgroup analysis was performed for patients aged ≤50 years and > 50 years. RESULTS: The conventional VIBE sequence provided superior image quality for CEP clarity compared to VIBE e-dixon sequences (3.29±0.70 vs 2.58 ± 0.61, p < 0.001). The conventional VIBE sequence also demonstrated higher interobserver consistency in image quality (ICC: 0.668–0.767 vs 0.078–0.404, p < 0.001) and TEPS assessment (ICC: 0.685 vs 0.443, p < 0.001). TEPS from conventional VIBE sequences correlated significantly with Pfirrmann grades across all disc levels (r = 0.675, p < 0.001) and with age (r = 0.557, p < 0.001). After controlling for age, the partial correlation between TEPS and Pfirrmann grading remained significant (r = 0.664, p < 0.001). Subgroup analysis showed a stronger correlation between TEPS and IVD degeneration in younger patients (≤50 years, r = 0.650, p < 0.001) compared to older patients ( > 50 years, r = 0.610, p < 0.001). CONCLUSION: The conventional VIBE sequence generates high-contrast images of the CEP and demonstrates significant potential in assessing CEP damage in LBP patients and its relationship with lumbar IVD degeneration. Its stability and accuracy support its feasibility for clinical application, potentially offering a new, non-invasive method for CEP evaluation. CLINICAL TRIAL NUMBER: Not applicable.