Image Type

Modic Endplate Changes (Type I, II, III)

1) Description of Measurement

Modic changes describe signal intensity alterations of vertebral body marrow adjacent to degenerated intervertebral discs, reflecting different stages of the degenerative cascade. They are strongly associated with disc degeneration, low-back pain, and segmental instability.

Three distinct patterns are recognized based on MRI signal characteristics.

2) Instructions to Measure

  • Identify vertebral endplates adjacent to symptomatic or degenerated discs.

  • Evaluate marrow signal on:

    • T1-weighted images

    • T2-weighted images

    • Fat-suppressed or STIR sequences

  • Classify the signal pattern at each affected endplate:

    • Type I: T1 hypointense, T2 hyperintense; edema / active inflammation

    • Type II: T1 hyperintense, T2 iso-/hyperintense; fatty marrow replacement

    • Type III: T1 hypointense, T2 hypointense; subchondral sclerosis

  • Record the Modic type, level, and laterality.

3) Normal vs. Pathologic Ranges

  • No signal change: normal endplate

  • Type I: acute degenerative/inflammatory change

  • Type II: Chronic degenerative change

  • Type III: Advanced degenerative change with sclerosis

Key points:

  • Type I often correlates with active pain generators.

  • Type III is least common and reflects end-stage disease.

4) Important References

Modic MT, Steinberg PM, Ross JS, et al. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988 Jan;166(1 Pt 1):193-9. doi: 10.1148/radiology.166.1.3336678.

Jensen TS, Karppinen J, Sorensen JS, et al. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J. 2008 Nov;17(11):1407-22. doi: 10.1007/s00586-008-0770-2.

Hopayian K, Raslan E, Soliman S. The association of modic changes and chronic low back pain: A systematic review. J Orthop. 2022 Nov 17;35:99-106. doi: 10.1016/j.jor.2022.11.003.

5) Other info....

Modic changes often co-localize with Pfirrmann grade IV–V discs and reduced Disc-Height Index.

Type I lesions may respond differently to targeted therapies (e.g., anti-inflammatory strategies).

Report Modic changes in conjunction with:

  • Disc herniation size

  • Segmental alignment

  • Dural sac CSA

Adapted from: Dudli S, Fields AJ, Samartzis D, et al. Pathobiology of Modic changes. Eur Spine J. 2016 Nov;25(11):3723-3734. doi: 10.1007/s00586-016-4459-7.

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