Musculoskeletal imaging: Modic changes: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Musculoskeletal imaging: Modic changes

Sample item

Lumbar MRI of a patient with chronic back pain shows vertebral endplate marrow that is low on T1 and high on T2 weighted images. Which Modic type is this, and what does it represent?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Modic type 1, marrow oedema with fibrovascular replacement

Modic type 1 shows low T1 and high T2 signal from marrow oedema and fibrovascular tissue and is associated with active, painful degeneration. Type 2 is high on T1 and T2 from fat, and type 3 is low on both from sclerosis.

Option by option

  • A. Modic type 3, subchondral sclerosis

    Modic type 3 is hypointense on both sequences because of sclerosis.

  • B. Modic type 2, fatty marrow replacement

    Modic type 2 is hyperintense on T1 and T2 because of fatty replacement.

  • C. Modic type 1, marrow oedema with fibrovascular replacement (correct)

    Correct. Low T1 and high T2 endplate signal is Modic type 1 oedema and fibrovascular change.

  • D. Schmorl node, disc herniation into the endplate

    A Schmorl node is a focal endplate indentation filled with disc material, not a band of altered endplate marrow.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, Modic type 1, marrow oedema with fibrovascular replacement. Modic type 1 shows low T1 and high T2 signal from marrow oedema and fibrovascular tissue and is associated with active, painful degeneration.

Why is "Modic type 3, subchondral sclerosis" not the answer?

Modic type 3 is hypointense on both sequences because of sclerosis.

Why is "Modic type 2, fatty marrow replacement" not the answer?

Modic type 2 is hyperintense on T1 and T2 because of fatty replacement.

Why is "Schmorl node, disc herniation into the endplate" not the answer?

A Schmorl node is a focal endplate indentation filled with disc material, not a band of altered endplate marrow.

What concept does this question test?

It tests Musculoskeletal imaging: Modic changes in Radiology. Type 2 is high on T1 and T2 from fat, and type 3 is low on both from sclerosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Musculoskeletal imaging: Modic changes?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.