Factors associated with lumbar disc high-intensity zone (HIZ) on T2-weighted magnetic resonance image: a retrospective s
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(2018) 13:307
RESEARCH ARTICLE
Open Access
Factors associated with lumbar disc highintensity zone (HIZ) on T2-weighted magnetic resonance image: a retrospective study of 3185 discs in 637 patients Zi-Xuan Wang1* and You-Gu Hu2
Abstract Background: It is well known that internal disc disruption (IDD) is accelerated by factors such as aging and injury. High- intensity zone (HIZ) on lumbar MRI is usually considered a marker of painful IDD. However, many painful IDD show no HIZ. This suggests that the risk factors of HIZ may be different to these of IDD. The purpose was to clarify the correlation between the HIZ on lumbar MR and the factors, including gender, age, body weight, and low back pain (LBP). Methods: Characteristics were obtained from the medical record. The MR images, biplanar post-discography radiographs, and post-discography CT images were reviewed and rated by two experienced radiologists in a blinded fashion. Results: Annular HIZ correlated significantly with age (OR = 1.011), body weight (OR = 1.022), and LBP symptom (OR = 1.527). The lowest two HIZ prevalence rates were in the second and the third decades (11.54% and 7.84%). The highest prevalence was in the sixth decade (38.03%). The body weight was positively associated with the HIZ prevalence. There was a significant difference in HIZ prevalence between symptomatic and asymptomatic patients (36.16% vs. 26.96%, P < 0.05). All the HIZ discs exhibited grade 3 or grade 4 disruptions, but only 9 discs (9/16, 8 exhibited grade 4 annular tears) were detected with exact pain reproduction. Conclusions: It is demonstrated that the presence of HIZ on lumbar MR image was associated with aging, high body weight, and low back pain symptom. HIZ sign indicated a part of the natural history of disc degeneration but was not an actual source of low back pain. Keywords: Intervertebral disc, MRI, High-intensity zone, Low back pain
Background Discogenic low back pain (LBP) is a symptom of internal disc disruption (IDD) [1]. This condition is characterized by disruption of the internal architecture of the disc, which can be demonstrated by computed tomography (CT)/discography [2]. In 1992, Aprill and Bogduk [3] reported a diagnostic sign of painful lumbar disc, high- intensity zone (HIZ), on T2-weighted magnetic resonance (MR) images and considered that * Correspondence: [email protected] 1 Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao 266000, Shandong, People’s Republic of China Full list of author information is available at the end of the article
the HIZ, when present, is pathognomonic of an internally annulus disrupted and symptomatic intervertebral disc. HIZ is analogous to the radial fissures extending from a nucleus pulposus to the outer annulus as described by Ross et al. [4], which enhanced on injection of gadolinium-DTPA, a behavior taken to indicate inflammation, neovascularization, and which has been shown clinically to correspond to granulation tissue in HIZ disc taken from disc operation by Peng and Hou et al. [5]. In t
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