Weishaupt D, Zanetti M, Hodler J, Min K, Fuchs B, Pfirrmann C,
Departments of Radiology (D.W., M.Z., J.H.) and Orthopaedic Surgery
(K.M., B.F., C.W.A.P., N.B.), Orthopaedic University Hospital Balgrist,
Zurich, Switzerland. Received February 29, 2000.
PURPOSE: To investigate the predictive value of magnetic
resonance (MR) imaging of abnormalities of the lumbar intervertebral
disks, particularly with adjacent endplate changes, ! to predict
symptomatic disk derangement, with discography as the standard.
MATERIALS AND METHODS: Fifty patients aged 28-50 years with
chronic low back pain and without radicular leg pain underwent prospective
clinical examination and sagittal T1- and T2-weighted and transverse
T2-weighted MR imaging. Subsequently, patients underwent lumbar
discography with a pain provocation test (116 disks). MR images
were evaluated for disk degeneration, a high-signal-intensity zone,
and endplate abnormalities. Results of pain provocation at discography
were rated independently of the image findings as concordant or
as nonconcordant or painless. Sensitivity, specificity, positive
predictive value (PPV), and negative predictive value (NPV) were
calculated to assess the clinical relevance of MR abnormalities.
RESULTS: Normal disks on MR images were generally not painful
at provocative discography (NPV, 98%). Disk degeneration (sensitivity,
98%; specificity, 59%; PPV, 63%) and a high-signal-in! tensity zone
(sensitivity, 27%; specificity, 85%; PPV, 56%) were not helpful
in the identification of symptomatic disk derangement. When only
moderate and severe type I and type II endplate abnormalities were
considered abnormal, all injected disks caused concordant pain with
provocation (sensitivity, 38%; specificity, 100%; PPV, 100%).
CONCLUSION: Moderate and severe endplate abnormalities appear
be useful in the prediction of painful disk derangement in patients
with symptomatic low back pain.