Schellhas KP, Pollei SR, Gundry CR, Heithoff KB.
Kindly sent in by Trevor Baylis
Center for Diagnostic Imaging, St. Louis Park, Minnesota, USA.
STUDY DESIGN: This study correlated a specific lumbar disc
abnormality described as the high-intensity zone observed on high-field
magnetic resonance imaging with discography.
OBJECTIVES: To analyze the significance of high-intensity
zones in lumbar discs of symptomatic patients with low back/radicular
SUMMARY OF BACKGROUND DATA: Aprill and Bogduk described
an 86% incidence of concordantly painful discography in lumbar discs
exhibiting a posterior high-intensity zone on T2-weighted magnetic
resonance imaging studies performed on back pain sufferers. They
assert that the high-intensity zone is a reliable marker of discogenic
pain in symptomatic subjects.
METHODS: Consecutive cases of lumbar spine high-field! magnetic
resonance imaging using T2-weighted images on symptomatic patients
followed by discography at all high-intensity zone levels and at
non-high-intensity zone control levels were reviewed until 100 high-intensity
zone discs in 63 patients were found. Seventeen lifelong asymptomatic
(for low back/radicular pain) adults were also scanned as magnetic
resonance imaging controls. All magnetic resonance scans and discograms
were agreed on by at least two of the radiologist authors.
RESULTS: Eighty-seven of 100 of the high-intensity zone
discs proved concordantly painful at discography. All 87 painful
and concordant discs exhibited abnormal morphology with anular tears
extending either well into or through the outer third of the anulus
fibrosus. Sixty-five of 67 non-high-intensity zone control discs
were nonconcordant and of lower sensation intensity than the high-intensity
zone discs. Only one high-intensity zone was found in the control
CONCLUSIONS: In patients wit! h symptomatic low back pain,
the high-intensity zone is a reliable marker of painful outer anular
PMID: 9122767 [PubMed - indexed for MEDLINE]