Special Poster Session 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

DeVa (Decay Variance): A Novel Score Calculated via Postprocessing the Changes in Signal Intensity of an Intervertebral Disc in a T2* Multi-Echo Magnetic Resonance Image can Quantify Painful and Degenerate Lumbar Vertebral Discs (115323)

Stone Sima 1 , Alisha Sial 1 2 3 , Suhani Sharma 1 , Dheera Dananthakrishnan 4 , Jeff Kuan 5 , Ashish Diwan 1 2 3
  1. Spine Labs, St George and Sutherland Clinical School, Sydney, NSW, Australia
  2. Spine Service at St George and Sutherland Clinical School, Sydney, NSW, Australia
  3. Spinal Unit, Discipline of Orthopaedic Surgery, School of Medicine, University of Adelaide, Adelaide, Australia
  4. Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA
  5. St George Hospital, Kogarah Imaging Centre, Kogarah, NSW, Australia

Introduction: Low back pain (LBP) is a leading cause of disability globally, often associated with intervertebral disc (IVD) degeneration. Traditional diagnostic methods, like T2-weighted MRI, provide qualitative assessments but lack precision.A novel MRI postprocessing technique termed Decay Variance (DeVa), utilizing a T2* multi-echo gradient echo (MR-GRE) sequence has bee developed and provides a more precise quantification of the heterogeneous composition of the intervertebral disc (IVD) by analyzing the variance in decay times within a voxel from MRI data collected at multiple echo times (figure 1). Initial in silico exploratory simulations demonstrated that elevated DeVa scores correlate with reduced concentrations of water and glycosaminoglycans—well-established markers of disc health. A confirmatory animal model study using rabbits confirmed that DeVa more strongly correlated with the histological extent of degeneration compared to traditional qualitative grading methods and T2 mapping-derived relaxation rates. Furthermore, DeVa calculation was less computationally intensive and more efficient [1]. This study aims to clinically validate DeVa for assessing IVD health and explore its correlation with pain severity.

Methods: A cross-sectional cohort study included 77 chronic LBP patients and 8 asymptomatic controls. Participants underwent standard T2-weighted and T2* 2D FLASH multi-echo MRI sequences. DeVa scores, both worst and sum of all discs, were recorded. Disc degeneration was evaluated based on disc bulge, stenosis, high-intensity zones, and Pfirrmann grade. Pain severity was measured using a numerical rating scale (NRS). Pearson correlation, t-tests, and Gardner-Altman estimation plots were used to assess relationships between DeVa scores, disc degeneration, and pain.

Results: There was no significant difference in age and sex between patients with chronic LBP and healthy controls. DeVa scores correlated strongly with Pfirrmann grade (r = 0.692, p < 0.001) (figure 2). Higher DeVa scores were observed in discs with bulge, stenosis, or high-intensity zones (p < 0.001). Moderate correlations were found between worst DeVa scores and pain severity (r = 0.296, p < 0.01), as well as total DeVa scores and pain (r = 0.323, p < 0.005). Chronic LBP patients had significantly higher worst (1.38 ± 0.26 vs. 1.10 ± 0.29, p < 0.005) and total (5.39 ± 0.75 vs. 4.65 ± 0.61, p<0.0.1) DeVa scores compared to controls, even in cases without severe degeneration (Pfirrmann  3 with no stenosis) on standard MRI (figure 3a and 3b, respectively).

Conclusion: The DeVa technique provides a quantitative, non-invasive assessment of IVD degeneration, correlating strongly with disc health and pain.Ultimately, the DeVa technique represents a significant advancement in the field of spinal imaging. It offers a non-invasive, quantitative approach to assess degeneration and pain. DeVa is more sensntive compared to traditional MRI making it a promising tool for identifying pain-generating discs and guiding personalized treatment for chronic LBP. This potentially opens new pathways for better selecting participants in trials of therapeutics aimed at IVD regeneration. However, future research should include a larger control group and a more diverse patient population from primary care settings to validate the technique further.

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Figure 1

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Figure 2

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Figure 3a and 3b

  1. 1. Sheldrick, K., Chamoli, U., Masuda, K., Miyazaki, S., Kato, K., & Diwan, A. D. (2019). A novel magnetic resonance imaging postprocessing technique for the assessment of intervertebral disc degeneration—Correlation with histological grading in a rabbit disc degeneration model. JOR spine, 2(3), e1060.