Modic classification
Use for different endplate marrow degenerative changes (which is postulated to result from same pathological process, but at different stages) in lumbar spine MR imaging.
Modic degenerative changes often accompanies disk degenerative disease (DDD)
The Modic change can be of mix type 1 and 2, type 2 and 3.
Modic type
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T1w
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T2w
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Pathology
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1
(oedema)
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Hypointense
 |
Hyperintense
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Oedema & Inflammation
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2
(fat)
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Hyperintense
 |
Iso/Slight
Hyperintense
|
Marrow ischaemia, thus red marrow converts to
fatty yellow marrow
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3
(sclerosis)
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Hypointense
 |
Hypointense
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Subchondral sclerosis
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Note:
Disciitis can mimic
Modic 1 degenerative change, when the adjacent bone marrows from the inflamed/infected
disk is inflamed
Look at 3 things:
(1) Whether the intervertebral disk shows corresponding degenerative change (disk dessication) or shows inflammed (disciitis)
(1) Whether the intervertebral disk shows corresponding degenerative change (disk dessication) or shows inflammed (disciitis)
(2) Whether the bone or adjacent structures points to infection eg bone erosion, abscess formation
(3) Last but not least, correlate clinically - Lab changes, Clinical history
Endplates
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Intervertebral disk
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Others
|
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Modic 1
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Low T1w, High T2w
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Iso/Low T2w
Usually dessicated (modic change accompanies
disk degenerative disease)
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Clinically non-toxic
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Diskiitis
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Same as above, but with features of diskiitis
ie bone erosion
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High T2w
Inflammed disk
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Presence of inflammation / abscess in
adjacent structures (eg paraspinal, epidural abscess)
Clinical and laboratory findings of infection
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