Imaging Analysis of the High-Intensity Zone on Lumbar Spine Magnetic Resonance Images: Classification, Features and Correlation with Low Back Pain

Abstract

Aim Early studies suggested that the high-intensity zone (HIZ) on lumbar MRI was a diagnostic sign of painful internal disc disruption (IDD). However, recent studies have questioned its diagnostic value. This study is conducted to explore imaging features of HIZ and to investigate the correlation between these characteristics and low back pain (LBP), further studying the predictive value of HIZ. Methods A retrospective study of 1188 cases was performed. MR images were read and analyzed by two experienced, blinded radiologists. Results A total of 575 (48.4%) individuals exhibited HIZ. The prevalence of posterior HIZ (32.3%) was significantly higher than that of anterior HIZ (23.6%; P < 0.01). Round type was the most common shape (61.0%) on sagittal view. Only 37 HIZs (4.6%) were identified on axial views. A total of 263 HIZ discs (32.5%) were found to have additional diagnostic signs of IDD, which is difficult to distinguish from the annulus fibrosus. In subjects with consecutive slides showing HIZ, the incidence of LBP was significantly higher than in single-slide HIZ individuals (58.0% vs 48.6%, P < 0.05). Conclusion MRI-visualized HIZ is a highly valuable method of screening for lumbar IDD. It is demonstrated that consecutive-slide HIZ was a more reliable indicator for discogenic LBP than single-slide HIZ.

The Role of IL-6 and TMEM100 in Lumbar Discogenic Pain and the Mechanism of the Glycine-Serine-Threonine Metabolic Axis: A Metabolomic and Molecular Biology Study

“…The High-Intensity Zone (HIZ) findings explain that changes in certain metabolites in the intervertebral disc are the direct cause of discogenic pain. 19 Nonetheless, this finding has not been effectively validated in metabolite validation and molecular level studies. This study established a rat discogenic pain model by injection of PBS to disc-puncture IDD model to induce pain.…”

Degenerative Lumbar Spine Disease: Imaging and Biomechanics

“…The visibility of HIZ on several slices seems a reliable indicator for CLBP compared with patients with HIZ visible on only one slice. 24 Slight edema of the anterior vertebral margin is sometimes visible (or sclerosis on radiographs/CT) and must not Fig. 2 Lateral radiograph centered at L3-L4 and L4-L5 levels in an 80year-old patient.…”

“…The visibility of HIZ on several slices seems a reliable indicator for CLBP compared with patients with HIZ visible on only one slice. 24…”

Expression of GADD45G and CAPRIN1 in Human Nucleus Pulposus: Implications for Intervertebral Disc Degeneration

“…Recent epidemiological and clinical studies have reported that intervertebral disc (IVD) degeneration is associated with the occurrence of LBP [ 2 , 3 , 4 , 5 ]. Clinically, IVD degeneration is well assessed using magnetic resonance imaging (MRI), and its severity and characteristic findings are reported to be associated with discogenic LBP [ 6 , 7 ].…”