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

Peng, Baogan; Hou, Shuxun; Wu, Wenwen; Zhang, Chunli; Yang, Yi

doi:10.1007/s00586-005-0892-8

Cited by 190 publications

(166 citation statements)

References 19 publications

(19 reference statements)

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“…Therefore, a detailed analysis and clear visualization of HIZ may be hampered by limited spatial resolution often restricted by the MRI slice thickness width. This might be a reason to the inconclusive research where some studies show HIZ being closely related to pain [23,24], and other studies do not [25,26]. Nonetheless, the ''invisible'' fissures and loss of water and collagen concentration in the NP may be identified by histogram analysis as an increase of intermediate histogram This study would have benefitted from including more individuals with IVDs of Pfirrmann grade 1 and 5, to statistically determine correlation between histogram features and IVD degeneration in terms of Pfirrmann grade.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Purpose Magnetic resonance imaging (MRI) is the best diagnostic imaging method for low back pain. However, the technique is currently not utilized in its full capacity, often failing to depict painful intervertebral discs (IVDs), potentially due to the rough degeneration classification system used clinically today. MR image histograms, which reflect the IVD heterogeneity, may offer sensitive imaging biomarkers for IVD degeneration classification. This study investigates the feasibility of using histogram analysis as means of objective and continuous grading of IVD degeneration. Methods Forty-nine IVDs in ten low back pain patients (six males, 25-69 years) were examined with MRI (T2-weighted images and T2-maps). Each IVD was semi-automatically segmented on three mid-sagittal slices. Histogram features of the IVD were extracted from the defined regions of interest and correlated to Pfirrmann grade. Results Both T2-weighted images and T2-maps displayed similar histogram features. Histograms of well-hydrated IVDs displayed two separate peaks, representing annulus fibrosus and nucleus pulposus. Degenerated IVDs displayed decreased peak separation, where the separation was shown to correlate strongly with Pfirrmann grade (P \ 0.05). In addition, some degenerated IVDs within the same Pfirrmann grade displayed diametrically different histogram appearances. Conclusions Histogram features correlated well with IVD degeneration, suggesting that IVD histogram analysis is a suitable tool for objective and continuous IVD degeneration classification. As histogram analysis revealed IVD heterogeneity, it may be a clinical tool for characterization of regional IVD degeneration effects. To elucidate the usefulness of histogram analysis in patient management, IVD histogram features between asymptomatic and symptomatic individuals needs to be compared.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…After surgery, contrast-enhanced MR is used to distinguish scar tissue from recurrent herniation (17,18). There has also been some recent interest in the high intensity zone in the posterior annulus seen in T2-weighted images (19,20). Stabler et al (21) have shown that a band-like contrast enhancement of the disc correlated with vascularization, often seen as a consequence of annular tears, and corresponded to pain, even in the absence of stenosis.…”

Section: Visualization Of Intervertebral Disc Degeneration In Mr Imagmentioning

confidence: 99%

Magnetic resonance imaging and spectroscopy of the intervertebral disc

Majumdar

2006

NMR in Biomedicine

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Intervertebral disc disease is an emerging health concern and has a considerable negative effect on the economy and on society. MRI has a critical role in assessing the disc, but it is still a challenge to objectively correlate disc health and pain with images. In this paper, a review of MR disc imaging techniques including grading, relaxation time measurements, diffusion, and contrast perfusion is presented. In addition, high-resolution magic-angle spinning methods to correlate in vitro disc degeneration (with pain, etc) are discussed. With the potential for gaining morphological and biochemical information, MRI shows promise for quantitative assessment of disc health.

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“…The intervertebral disc is the largest avascular tissue in the body, undergoes more extensive changes with age and degeneration than any other tissue [1,2], and is associated with low back pain [3][4][5]. The intervertebral disc has three distinct anatomical regions: the central nucleus pulposus (NP), the fibrocartilaginous annulus fibrosus, and, superiorly and inferiorly, two cartilaginous endplates (CEP).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of intervertebral disc cartilaginous endplate structure using magnetic resonance imaging

et al. 2013

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Purpose The cartilaginous endplate (CEP) is a thin layer of hyaline cartilage positioned between the vertebral endplate and nucleus pulposus (NP) that functions both as a mechanical barrier and as a gateway for nutrient transport into the disc. Despite its critical role in disc nutrition and degeneration, the morphology of the CEP has not been well characterized. The objective of this study was to visualize and report observations of the CEP three-dimensional morphology, and quantify CEP thickness using an MRI FLASH (fast low-angle shot) pulse sequence. Methods MR imaging of ex vivo human cadaveric lumbar spine segments (N = 17) was performed in a 7T MRI scanner with sequence parameters that were selected by utilizing highresolution T1 mapping, and an analytical MRI signal model to optimize image contrast between CEP and NP. The CEP thickness at five locations along the mid-sagittal AP direction (center, 5 mm, 10 mm off-center towards anterior and posterior) was measured, and analyzed using two-way ANOVA and a post hoc Bonferonni test. For further investigation, six in vivo volunteers were imaged with a similar sequence in a 3T MRI scanner. In addition, decalcified and undecalcified histology was performed, which confirmed that the FLASH sequence successfully detected the CEP. Results CEP thickness determined by MRI in the midsagittal plane across all lumbar disc levels and locations was 0.77 ± 0.24 mm ex vivo. The CEP thickness was not different across disc levels, but was thinner toward the center of the disc. Conclusions This study demonstrates the potential of MRI FLASH imaging for structural quantification of the CEP geometry, which may be developed as a technique to evaluate changes in the CEP with disc degeneration in future applications.

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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

Abstract: Keywords Discogenic low back pain AE High-intensity zone AE Lumbar intervertebral disc AE Discography Eur Spine J (2006) 15: 583-587

Cited by 190 publications

References 19 publications

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

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

Magnetic resonance imaging and spectroscopy of the intervertebral disc

Evaluation of intervertebral disc cartilaginous endplate structure using magnetic resonance imaging

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