Department of Radiology, General Hospital of Chinese People's Liberation Army, Beijing 100853, China.
Chin Med J (Engl). 2009 Dec 20;122(24):3062-5.
Discography is a gold standard for the diagnosis of the low back pain (LBP), but it has potential dangers for the development of discitis, cerebral spinal fluid leakage, retroperitoneal bleeding, acute new back pain and the tremendous radiation exposure to the patient. Using "evidence-based radiology" methods, the comparative roles of high intensity zone (HIZ) in diagnosing discogenic LBP were evaluated.
A focused clinical question was designed and a Pubmed and manual search were performed to identify the role of HIZ on MRI T2WI compared with discography. The studies retrieved were assessed for validity and strength. Sensitivity, specificity, likelihood ratios (LRs) and graphs of conditional probability were evaluated from the best current study by evidence-based radiology.
Best evidence was retrieved in ten articles from 1992 to 2007. The best evidence level was 1b and the strength of the evidence included: sensitivity 0.63 (0.51, 0.76), specificity 0.97 (0.92, 1.00), positive predictive value 0.95, negative predictive value 0.72, positive LRs 18.37 and negative LRs 0.38. The gold standard of discogenic LBP is the provocative discography.
For suspected discogenic LBP, HIZ is limited for the diagnosis if HIZ is positive, which suggests further discography. In contrast HIZ is a good test for diagnosis if HIZ is negative, which indicates the disease can be excluded.
椎间盘造影术是诊断下腰痛（LBP）的金标准，但它存在引发椎间盘炎、脑脊液漏、腹膜后出血、新发急性腰痛以及患者接受大量辐射的潜在风险。通过采用“循证放射学”方法，评估了高强度区（HIZ）在诊断椎间盘源性 LBP 中的作用。
设计了一个针对性的临床问题，并通过 Pubmed 和手动搜索，确定了 MRI T2WI 上 HIZ 与椎间盘造影术在诊断椎间盘源性 LBP 中的作用。对检索到的研究进行了有效性和强度评估。通过循证放射学，从最新的最佳研究中评估了灵敏度、特异性、似然比（LR）和条件概率图。
从 1992 年至 2007 年的 10 篇文章中检索到最佳证据。最佳证据水平为 1b，证据强度包括：灵敏度 0.63（0.51，0.76），特异性 0.97（0.92，1.00），阳性预测值 0.95，阴性预测值 0.72，阳性 LR 18.37，阴性 LR 0.38。椎间盘源性 LBP 的金标准是激发性椎间盘造影术。
对于疑似椎间盘源性 LBP，如果 HIZ 阳性，则 HIZ 对诊断的作用有限，这提示需要进一步进行椎间盘造影术。相反，如果 HIZ 阴性，则 HIZ 是一种很好的诊断试验，表明可以排除该疾病。
