Changes in shape and signal intensity of high intensity zone in lumbar intervertebral discs on magnetic resonance images: a longitudinal study / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate changes over time in the shape and signal intensity of high intensity zone (HIZ) in the lumbar intervertebral discs on magnetic resonance images in patients with low back pain.</p><p><b>METHODS</b>The imaging data were collected from 27 patients with low back pain, who underwent lumbar magnetic resonance (MR) imaging examinations that identified HIZ lesions and received follow-up MR examinations at least 1.5 years later over the period from January 2009 to January 2017. The initial and follow-up MR T2WI images of the patients were read by two experienced radiologists to categorize the changes in the shape of the HIZ lesions into enlarged, unchanged, shrunk, and disappeared. The volume and signal/cerebrospinal fluid signal intensity (T2/CSF) ratio of the HIZ were measured on sagittal MR images using ImageJ software.</p><p><b>RESULTS</b>Of the 43 HIZ lesions found in the initial examinations, 22 (51.2%) remained unchanged in the follow-up examinations, 10 (21.3%) were enlarged, 9 (20.9%) shrank, and 2 (23.3%) disappeared. The follow-up examinations revealed 4 new HIZ lesions in the intervertebral discs. The volumes of these lesions did not vary significantly in the follow-up examinations (=0.653), but the T2/CSF ratio was significantly higher in the follow-up than in the initial examinations (=0.043).</p><p><b>CONCLUSIONS</b>After observation for an average of 3 years and 3 months, most of the HIZ lesions in the lumbar intervertebral discs of the patients with low back pain remained stable in shape, but their signal intensity on MR images increased.</p>

Treatment of Targeted Percutanous Ozone Ablation on Lumbar Disc Herniation with High Intensity Zone in Lumbar Disc Annulus Fibrosus / 现代生物医学进展

Objective:To observe the clinical effects of targeted percutanous ozone ablation on lumbar disc herniation (LDH) patients with high intensity zone (HIZ) in lumbar disc annulus fibrosus on MRI T2 weighted imaging.Methods:136 LDH patients with HIZ in lumbar disc annulus fibrosus on MRI T2 were divided into two groups according to therapy methods.In group A,75 patients were injected with 2 ～5 mL of 40 μg/mL mixture of O3 and O2 after targeted percutanous puncturing under the guidance of X-Ray machine with C-type arm.In group B,61 patients were treated with conservative treatment.MacNab score criterion and Oswestry disability index (ODI) were used in assessment of the efficacy.Results:Except 24 patients,all the other cases were followed up for 18 ～ 44 months.At the postoperative 1st,2nd,3rd,6th,9th,12th and 18th month,according to MacNab score criterion,the effective rates were respectively 88.00 ％,90.67 ％,93.33 ％,89.39 ％,84.85 ％,78.13 ％ and 73.44 ％ in group A and respectively 68.85 ％,62.30 ％ 55.74 ％,61.82 ％,58.12 ％,54.17 ％ and 47.92 ％ in group B.There were significant differences between two groups at the same time point (P＜0.05).At the postoperative 12th and 18th month,ODI was lower in group A,and there was no significant difference between two time points (P＞0.05).But it was significant different with that preoperatively and in group B at the same time point (P＜0.05).Conclusion:Targeted percutanous ozone ablation is an effective method with stable clinical efficacy in treating LDH with HIZ in lumbar disc annulus fibrosus on MRI T2 weighted imaging.

Analysis of the effect of surgical treatment of low back pain patients with Modic change or high intensity zone on MRI of the lumbar spine / 重庆医学

Objective To explore the effect of surgical treatment of low back pain patients with Modic change or high intensity zone(HIZ) on MRI of the lumbar spine .Methods 32 cases with intervertebral disc herniation underwent posterior lumbar inter-body fusion and 17 cases with lumbar discogenic pain underwent radiofrequency ablation from March 2011 to July 2012 were retro-spectively reviewed .For intervertebral disc herniation patients ,all patients were divided into two groups :groupⅠ (no with Modic changes group)and groupⅡ(with Modic changes group) ,according to the Admission MRI .GroupⅡ was sub-divided intoⅡa(Mod-ic type Ⅰgroup) andⅡb(Modic type Ⅱgroup) .For lumbar discogenic pain patients ,all patients were divided into group A (without HIZ group) and group B(with HIZ group) .The VAS and ODI scales at the preoperative and follow-up were recorded and analyzed . Results The postoperative scores of VAS and ODI of all the patients were improved ,and the difference was statistically significant (P0 .05) .For lum-bar discogenic pain patients ,the improvement rate of VAS (low backpain) of A was better than that of B ,and the difference was sta-tistically significant(P0 .05) . Conclusion Posterior lumbar interbody fusion is effective for lumbar disc herniation patients with Modic changes ,and can obtain good clinical effect .For lumbar discogenic pain patients with high intensity zone on MRI ,radiofrequency ablation can cause clinical symptoms get some relief ,but the effect is poor .

Distribution of high-intensity zone of lumbar intervertebral disc in patients with low back and/ or leg pain and its related factors / 中国医师进修杂志

ObjectiveTo investigate the distribution of high-intensity zone (HIZ) of lumbar intervertebral disc in patients with low back and/or leg pain,and analyze its related factors.MethodsSix hundred and twenty-eight patients with low back and/or leg pain were examined by MRI scan from June 2009 to August 2010.According to the diagnostic criteria of HIZ,the features of distribution of HIZ on age,segment and degree of intervertebral disc degeneration were analyzed retrospectively.ResultsAmong 3140 intervertebral discs of the 628 patients,172 cases (27.39％,172/628) and 206 discs (6.56％,206/3140)were involved with HIZ.There was no significant difference between men and women [26.38％(86/326)vs.28.48％(86/302)] (P=0.556).HIZ occurred more often [40.22％(72/179)] in those patients between 40 and 49 years of age.The incidence of HIZ at the segments from L1-2,L2-3,L3-4,L4-5,L5-S1 was 0.80％(5/628),2.07％(13/628),2.07％(13/628),14.01％(88/628) and 13.85％(87/628) respectively.In cases with and without HIZ,the incidence of intervertebral disc degeneration up to grade V was 49.03％(101/206) and 23.76％(697/2934) respectively (P ＜ 0.01 ).HIZ was correlated with age,degree of intervertebral disc degeneration and disc segment (r =-0.040,P=0.025 ;r =0.217,P＜ 0.01 ;r =0.179,P＜ 0.01 ).Conclusions HIZ is correlated with age,degree of intervertebral disc degeneration and disc segment.Intervertebral disc degeneration plays the most important role in the occurence of HIZ.HIZ_mainly occur in L4-5 and L5-S1 segment and in those between 40 and 49 years of age.

High-Intensity Zone on L-spine MRI: Clinical Relevance and Association with Trauma History

STUDY DESIGN: This is a retrospective study. PURPOSE: We wanted to investigate the clinical relevance of the lumbar high intensity zone (HIZ) on magnetic resonance imaging (MRI) and the relationship of trauma history to internal disc disruption (IDD). OVERVIEW OF LITERATURE: HIZs on lumbar spine (L-spine) MRI have been suggested as a reliable marker of IDD by some authors. The prevalence and type of spinal trauma in IDD have not yet been carefully analyzed. METHODS: L-spine MRIs of 737 patients with low back pain with or without associated leg pain were reviewed for the presence of HIZs. HIZs on T2-weighted MR images were determined according to the Aprill and Bogduk criteria. A review of medical records and a telephone interview were performed for further analyses of pain. RESULTS: HIZs were found in 117 patients and 153 discs among a total of 737 patients who met the inclusion criteria. Both a medical record review and a telephone interview were possible with 99 patients. Among these, 42 patients had had an episode of trauma. Seventeen of these had a relatively high-energy injury such as a traffic accident or a fall. Regarding back pain, 27 patients complained of typical discogenic back pain. Only 11 patients had both a trauma history and typical discogenic pain and 41 patients (42%) had neither a trauma history nor typical natural pain. CONCLUSIONS: Given the low incidence of discogenic pain, a HIZ on an L-spine MRI appears less meaningful than often assumed as a specific marker of IDD. Trauma, such as a traffic accident, seems unlikely to be the main cause of IDD.

Development and distribution of high-intensity zone in lumbar disc / 中国矫形外科杂志

0.05)between left AF(238,36.62%)and right AF(220,33.85%).More HIZs(446,68.62%)were located in inferior AF than that of middle or superior AF.The motion segments from L3、4 to L5S1 were the region that the HIZ occurred frequently and it could present in single segment or multi-segment.In anterior AF,HIZs often occurred at L2、3 and/or L3、4 discs.Whereas,they usually developed at L4、5 and/or L5S1 in posterior AF. Conclusion The incidence rate of HIZ in lumbar disc is higher.Posterior and inferior AF of discs and lower motive segments have more risk of HIZs.It could develop in single motive segment or multi-segments at one time.

Significance of the High-intensity Zone(HIZ) on Magnetic Resonance Imaging for Diagnosis of the Internal Disc Disruption / 대한척추외과학회지

STUDY DESIGN: Analysis of correlation of high-intensity zone in magnetic resonance image and pain provocation in discography. OBJECTIVES: The purpose of this investigation was to evaluate the relationship of the high-intensity zone to the results of discography in identifying the painful intervertebral disc. SUMMARY OF LITERATURE REVIEW: There is some disagreement in validity of high-intensity zone on MRI for diagnosis of discogenic pain. MATERIALS AND METHODS: Magnetic resonance images were obtained in 52 patients who were considered for surgical intervention after failing to respond to conservative treatment. The presence of a high-intensity zone was specially looked for within anulus fibrosus. Each patient subsequently underwent discography; and types of provocative pain and image were recorded. Statistical analysis was used to evaluate the correlation of high-intensity zone and concordant pain response and disc disruption. RESULTS: The interobserver reliability for detecting a high-intensity zone in a given disc was substantial(kappa=0.646). The sensitivity of high-intensity zone for concordant pain was 47% but its specificity was relatively high(81%). Posttest odds was not so high(68%). CONCLUSION: These results suggest that the usefulness of high-intensity zone is limited by low sensitivity and a high-intensity zone is not indicative of exactly painful disc disruption.