MAGNETIC RESONANCE IMAGING FINDINGS AND HISTOPATHOLOGY OF THE HERNIATED CERVICAL INTERVERTEBRAL DISC

Abstract

To investigate the histological findings for a herniated cervical intervertebral disc that produces a high intensity signal on MR images.

Fifty-five herniated cervical intervertebral discs harvested from 49 patients were histologically and immunohistochemically examined. Herniated cervical intervertebral discs with a high intensity signal on axial T2 MR images were classified as a globular, linear, or mosaic type. The specimens were embedded with paraffin using standard procedures. Serial 4 μm thick cryostat sagittal sections were prepared for HE, toluidine blue, PAS, and Elastica van Gieson staining as well as immunohistochemical study. The monoclonal antibodies used were specific for human CD68, IL-1β, and TNF-α.

Preoperative axial T2 MR images indicated that 3 discs had no high intensity signal and 52 discs had a high intensity signal; 22 discs were globular, 20 were linear, and 10 were mosaic. Histopathologically, high intensity signal areas in globular discs consisted of nucleus pulposus surrounded by macrophages. These macrophages and the chondrocytes around them expressed IL-1β and TNF-α. Almost all of the patients with a globular disc, had had severe radicular pain. For the linear disc patients, the fissure was observed consistent with the high intensity signal. A substance that would produce positive results for PAS staining was rarely observed.

The current histological study suggests that a globular type of disc with a high intensity signal on an axial T2 MR image consisted of a nucleus pulposus. Results demonstrated that, in these herniated discs, infiltrated macrophages and chondrocytes expressed inflammatory cytokines, and these reactions were associated with radicular pain. In contrast, linear and mosaic discs showed no obvious substance corresponding with the high-intensity zone, but the fissure was observed. It appears that a high-intensity zone for a linear or mosaic type of disc suggested of a fluid-filled area and/or mucoid fluid.