The Clinical Significance of the High-Intensity Zone on Lumbar Spine Magnetic Resonance Imaging

Jj, Rankine; Gill, KP; Ce, Hutchinson; Er, Ross; Jb, Williamson

doi:10.1097/00007632-199909150-00009

Cited by 65 publications

(32 citation statements)

References 23 publications

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“…The importance of HIZ in discogenic low back pain (LBP) remains therefore unclear. Pressure controlled discography (PCD), now criterion standard, has not been used in the majority of the numerous studies correlating HIZ and discogenic pain [1][2][3][4][5][6][7][9][10][11][12][13][14][15][16] making previous results dubiousm, since discography without pressure registration can induce false positive responses [17,18].…”

Section: Introductionmentioning

confidence: 99%

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

Hebelka

Hansson

2012

Eur Spine J

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Purpose The aims were to investigate if the detection of high-intensity zones (HIZ) is affected by axial load, and to study the correlation between HIZ and discogenic pain provoked with pressure controlled discography (PCD). Methods 41 consecutive patients with chronic low back pain, referred for discography, were included. Each patient underwent PCD, CT, MRI, and axial loaded MRI (alMRI) within 24 h. 35 patients completed all MRI sequences (140 discs). The detection of HIZ was compared between conventional MRI and alMRI. PCD was performed in 119 of the discs examined at MRI. Provoked pain at PCD was classified into four categories (none/unfamiliar/similar/ exact), with the patients' daily pain as reference, and correlated with presence of HIZ. Results AlMRI did not affect the detection of HIZ compared with conventional MRI. No significant correlation between HIZ and the 4-graded pain response at discography was found (p = 0.34), neither when combining similarly/exactly reproduced pain (p = 0.08). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HIZ in detecting discs with exactly reproduced pain were 49, 69, 39 and 76 %. When combining similarly/exactly reproduced pain, PPV was higher but still only 70 %. Conclusions The detection of HIZ was not influenced by axial load. With strict PCD, discogenic pain can neither be confirmed when having HIZ (PPV 39 %) nor ruled out in discs without HIZ (NPV 76 %). Larger PCD studies including quantification of HIZ at conventional and alMRI are needed, before any dynamic component affected by axial load can be ruled out completely.

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Section: Introductionmentioning

confidence: 99%

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

Hebelka

Hansson

2012

Eur Spine J

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“…Most studies suggest that there is a strong correlation between annular HIZ on lumbar MR images and the results of provocative discography in patients with LBP [3][4][5]. For examples, Peng et al [6] have harvested 11 specimens of lumbar intervertebral discs containing HIZs in the posterior annulus for histological examinations, and have demonstrated that the HIZs in the patients with low back pain (LBP) represent the in-growth of the vascularized granulation tissue into the tears in the posterior part of the painful disk.…”

Section: Discussionmentioning

confidence: 99%

“…However, many studies since then either support or question the hypothesis [2,4,5,7,15], and the sensitivity and specificity of HIZ for LBP are both at variance. Therefore, HIZ may be a part of lumbar MR image for some people, but it is certainly not the whole story.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with discography, MR scan is considered more sensitive and a noninvasive procedure. In the following decades, a series of correlative researches have been carried out in symptomatic and/or asymptomatic patients [2][3][4][5][6][7][8][9][10][11]. Nevertheless, few studies are performed to describe the three-dimensional distribution of HIZ, especially the correlation between low back pain and the spatial distribution of HIZ on lumbar MR images.…”

Section: Introductionmentioning

confidence: 99%

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High-intensity zone (HIZ) of lumbar intervertebral disc on T2-weighted magnetic resonance images: spatial distribution, and correlation of distribution with low back pain (LBP)

Wang

2012

Eur Spine J

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Objectives To analyze the three-dimensional distribution of high-intensity zone (HIZ) in lumbar disks and to assess the correlation between low back pain (LBP) and spatial distribution of HIZs. Methods Clinical records and lumbar MRIs of 623 patients (337 males and 286 females, age 50.10 ± 15.38 years) were selected and reviewed. Baseline characteristics and 3D localization were performed and recorded by two radiologists in a blind fashion. Results Among the 623 patients, 200 exhibited an HIZ in at least one disk. HIZs were more frequently seen in the inferior part of annulus fibrosus (superior-middle-inferior ratio 39:59:140, P \ 0.001). One hundred and eighty-one HIZs (76.1%) occurred at L4/5 and/or L5/S1. The prevalence of multi-segmental HIZ was 16.5%. Among the 33 patients with multi-segmental HIZs, 24 exhibited HIZs in adjacent disks. The LBP rate of HIZ patients was significantly higher than that of patients who exhibited no HIZ (57.5 vs. 47.8%, P \ 0.05). There was no evidence for a correlation between LBP and spatial distribution of HIZ in disk (P [ 0.05). The incidence of LBP was slightly higher when the HIZ disk level was lower or when there were HIZs exhibited in more disks; however, the difference was statistically insignificant (P [ 0.05). Conclusions High-intensity zones occurred frequently at lower segments, inferior part of annulus fibrosus, and single disk.

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“…Focal hyperintensity on T2W MRI in posterior annulus of the IVD is described as High Intensity Zone (HIZ). HIZ is highly indicative of disc annular tear; some authors [18][19][20] consider it as a reliable marker for a painful disc while others [21][22][23] do not. HIZ was seen in 22% cases of the study population correlating with studies done by Yong et al [16] who found it in 24.6%.…”

Section: Spectrum and Prevalence Of Degenerative Changes Seen On Mri mentioning

confidence: 99%

Spectrum and Prevalence of degenerative changes seen on Mri of Lumbosacral Spine in Patients with Low Back Pain

Angam¹,

Ahmed²,

Thakkallapelli³

et al. 2017

IOSR JDMS

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The Clinical Significance of the High-Intensity Zone on Lumbar Spine Magnetic Resonance Imaging

Abstract: A high-intensity zone is a common finding in patients in whom low back and leg pain are investigated, but the presence of a high-intensity zone does not define a group of patients with particular clinical features.

Cited by 65 publications

References 23 publications

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

HIZ’s relation to axial load and low back pain: investigated with axial loaded MRI and pressure controlled discography

High-intensity zone (HIZ) of lumbar intervertebral disc on T2-weighted magnetic resonance images: spatial distribution, and correlation of distribution with low back pain (LBP)

Spectrum and Prevalence of degenerative changes seen on Mri of Lumbosacral Spine in Patients with Low Back Pain

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