Measurement of vertebral endplate bone marrow lesion (Modic change) composition with water-fat MRI and relationship to patient-reported outcome measures

Eur Spine J. 2021 Sep;30(9):2549-2556. doi: 10.1007/s00586-021-06738-y. Epub 2021 Feb 6.


Purpose: Vertebral endplate bone marrow lesions ("Modic changes", MC) are associated with chronic low back pain (CLBP). Bone marrow composition in MC is poorly understood. The goals of this study were to: (1) measure bone marrow fat fraction (BMF) in CLBP patients with MC using water-fat MRI and (2) assess the relationship between BMF measurements and patient-reported clinical characteristics.

Methods: In this cross-sectional study, 42 CLBP patients (men, n = 21; age, 48 ± 12.4 years) and 18 asymptomatic controls (men, n = 10; 42.7 ± 12.8 years) underwent 3 T MRI between January 2016 and July 2018. Imaging consisted of T1- and T2-weighted sequences to evaluate MC and spoiled gradient-recalled echo sequence with asymmetric echoes and least-squares fitting to measure BMF. BMF was compared between vertebrae with and without MC using mixed effects models. The relationship between the BMF measurements and patient-reported disability scores was examined using regression.

Results: Twenty-seven subjects (26 CLBP, 1 control) had MC, and MC presence coincided with significantly altered BMF. In MC 1, BMF was lower than endplates without MC (absolute difference -22.3%; p < 0.001); in MC 2, BMF was higher (absolute difference 21.0%; p < 0.001). Absolute BMF differences between affected and unaffected marrow were larger in patients with greater disability (p = 0.029-0.032) and were not associated with pain (p = 0.49-0.83).

Conclusion: BMF is significantly altered in MC. Water-fat MRI enables BMF measurements that may eventually form the basis for quantitative assessments of MC severity and progression.

Keywords: Bone marrow; Chronic low back pain; Endplate; Magnetic resonance imaging phenotypes; Modic changes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Bone Marrow* / diagnostic imaging
  • Cross-Sectional Studies
  • Humans
  • Lumbar Vertebrae
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Patient Reported Outcome Measures
  • Water*


  • Water