磁共振成像中腰椎间盘高信号区对椎间盘源性下腰痛的诊断价值：Meta 分析。

Does the high-intensity zone of lumbar intervertebral disc at magnetic resonance imaging have diagnostic value for discogenic low back pain? A meta-analysis.

机构信息

Department of Acupuncture and Moxibustion, Dongzhimen Hospital, Beijing University of Chinese Medicine, No. 5 Haiyun Warehouse, Dongcheng District, Beijing, 100700, China.

Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China.

出版信息

BMC Musculoskelet Disord. 2024 Oct 30;25(1):869. doi: 10.1186/s12891-024-07981-2.

DOI:10.1186/s12891-024-07981-2

PMID:39478451

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11523764/

Abstract

OBJECTIVE

The correlation between high-intensity zone (HIZ) of lumbar disc magnetic resonance imaging (MRI) and discogenic low back pain (DLBP) is currently controversial, this study aimed to systematically evaluate the correlation between HIZ of lumbar disc MRI and positive discography, as well as its diagnostic value for DLBP.

METHOD

Databases were searched to include research literature on high intensity zone (HIZ) related to discography and DLBP diagnosis. HIZ is a separate small, confined area of high signal located at the posterior border of the annulus fibrosus on MRI T2-weighted images of the lumbar spine, which is separated from the nucleus pulposus but has a higher signal than the nucleus pulposus. Studies on the correlation of HIZ with discography and DLBP diagnosis were searched in the Pubmed, EMBASE, Cochrane Central, Science Direct, China Knowledge Network, Wanfang Database, and China Biomedical Literature Databases, Scopus from January 1992 to June 2024. The outcomes were diagnostic values of HIZ for DLBP. The risk assessment was performed by Deeks' funnel methods in the Stata 17.0 software after 2 investigators independently screened the literature, extracted information and evaluated the risk of bias of the included studies.

RESULTS

A total of 25 studies including 5889 patients were included. meta-analysis showed that the sensitivity of HIZ for the diagnosis of DLBP was (0.49, 95% CI [0.37,0.61]) and specificity was (0.89, 95% CI [0.85,0.93]); the positive likelihood ratio was (4.52, 95% CI [3.28,6.25]) and the negative likelihood ratio was (0.58, 95% CI [0.46,0.71]). The diagnostic ratio was (7.87, 95% CI [5.05,12.26]).

CONCLUSION

The available evidence suggests that HIZ has acceptable sensitivity and high specificity in the diagnosis of DLBP. Due to the limitation of the number and quality of included studies, the above conclusions need to be validated by more high-quality studies.

摘要

目的

腰椎间盘磁共振成像（MRI）高强度区（HIZ）与椎间盘源性下腰痛（DLBP）之间的相关性目前存在争议，本研究旨在系统评估腰椎间盘 MRI 中 HIZ 与阳性椎间盘造影术之间的相关性，以及其对 DLBP 的诊断价值。

方法

检索数据库以纳入与椎间盘造影和 DLBP 诊断相关的 HIZ 研究文献。HIZ 是腰椎 MRI T2 加权图像上纤维环后缘的一个单独的小而局限的高信号区域，与核髓分离，但信号高于核髓。在 Pubmed、EMBASE、Cochrane Central、Science Direct、中国知识网络、万方数据库和中国生物医学文献数据库、Scopus 中搜索了与 HIZ 与椎间盘造影和 DLBP 诊断相关性相关的研究，检索时间为 1992 年 1 月至 2024 年 6 月。研究结果为 HIZ 对 DLBP 的诊断价值。在 Stata 17.0 软件中，由 2 位研究者独立筛选文献、提取信息和评估纳入研究的偏倚风险后，采用 Deeks 漏斗图方法进行风险评估。

结果

共纳入 25 项研究，包括 5889 例患者。meta 分析显示，HIZ 诊断 DLBP 的敏感度为（0.49，95%CI [0.37，0.61]），特异度为（0.89，95%CI [0.85，0.93]）；阳性似然比为（4.52，95%CI [3.28，6.25]），阴性似然比为（0.58，95%CI [0.46，0.71]）。诊断比为（7.87，95%CI [5.05，12.26]）。