High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging

Abstract

The prevalence, validity and reliability of high-intensity zones in the annulus fibrosus seen on T2-weighted magnetic resonance images of patients with intractable low-back pain were determined. This sign was readily recognized by two independent observers. It occurred in 28% of 500 patients undergoing magnetic resonance imaging for back pain. The presence of a high-intensity zone correlated significantly with the presence of Grade 4 annular disruption and with reproduction of the patient's pain. Its sensitivity as a sign of either annular disruption or pain was modest but its specificity was high, and its positive predictive value for a severely disrupted, symptomatic disc was 86%. This sign is diagnostic of painful internal disc disruption.

MRI histogram analysis enables objective and continuous classification of intervertebral disc degeneration

“…Hypothetically, such leakage could be characterized by a region of high signal intensity in the otherwise low signal AF. One example of such high signal intensity in the IVD are High Intensity Zones (HIZ) which represents annular fissures [22]. Hypothetically, due to the common sub-voxel size of annulus fissures, only a minority of these fissures are fully visualized in MR images.…”

The pathogenesis and clinical significance of a high-intensity zone (HIZ) of lumbar intervertebral disc on MR imaging in the patient with discogenic low back pain

“…The high signal contained within the annulus of a disc, separated from the nucleus pulposus, on lumbar spine MRI was termed as the HIZ by Aprill and Bogduk [1] in 1992. They correlated the finding with computed tomography discography and found that it had a positive predictive value of 86% for a severely disrupted, painful disc on awake discography.…”

“…According to the original study by Aprill and Bogduk [1], the HIZ was localized in midline within the posterior annulus (Fig. 1).…”

“…Recently, there has been interest in the presence of an area of high intensity zone (HIZ) within the posterior annulus seen on T2-weighted, sagittally oriented MRI sequence [1]. Some investigators [8,16] believed that the presence of a HIZ was closely associated with a concordant pain response on awake discography, but others [2,9,11] disagreed.…”

Discogenic pain in acute nonspecific low-back pain

“…High-intensity zone in the posterior annulus of the intervertebral disc on T2-weighted MR images High-intensity zones [2] in the posterior annulus of the intervertebral disc considered to reflect symptomatic intervertebral disc disorder were observed in 12 patients (30%). The zone was consistent with the enhanced region in the Gd-DTPA enhanced T1-weighted MR images in all patients.…”