Saifuddin A, Braithwaite I, White J, Taylor B A, Renton P
Department of Radiology, Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, United Kingdom.
Spine (Phila Pa 1976). 1998 Feb 15;23(4):453-7. doi: 10.1097/00007632-199802150-00009.
Retrospective review of magnetic resonance imaging and discography in patients investigated for low back pain before spinal fusion.
To determine the sensitivity of magnetic resonance imaging in the detection of painful anular tears manifested by the high-intensity zone.
Two studies have produced results showing that magnetic resonance imaging has a high specificity for the detection of painful anular tears manifested by a high-intensity zone. However, in a recent study, results showed no significant correlation between the high-intensity zone and pain reproduction. The sensitivity of magnetic resonance imaging in identifying anular tears in a symptomatic population has not been determined.
Anular tears were identified in magnetic resonance images by the presence of a high-intensity zone in the posterior anulus. The results were compared with the demonstration of painful anular tears on discogram, which has been considered the gold standard.
The study group comprised 58 patients (31 men, 27 women; mean age 42, range 21-63 years). One hundred and fifty-two discs were injected and examined by discography, and 108 were considered degenerate. Of these, 86 had anular tears (54 posterior, 6 anterior, 26 both). Seventy anular tears were associated with concordant pain provocation. Twenty-seven high-intensity zones were identified in magnetic resonance imaging, of which 24 were associated with pain reproduction by discography. The sensitivity, specificity, positive predictive value, and negative predictive value of magnetic resonance imaging in the diagnosis of concordantly painful posterior anular tears are therefore 26.7%, 95.2%, 88.9%, and 47%, respectively.
These results confirm that the high-intensity zone is a marker of a painful posterior anular tear. However, the usefulness of this sign is limited by low sensitivity.
对脊柱融合术前因腰痛接受检查的患者的磁共振成像和椎间盘造影进行回顾性研究。
确定磁共振成像检测高强度区所显示的疼痛性纤维环撕裂的敏感性。
两项研究结果表明，磁共振成像对检测高强度区所显示的疼痛性纤维环撕裂具有较高的特异性。然而，最近一项研究结果显示，高强度区与疼痛再现之间无显著相关性。磁共振成像在有症状人群中识别纤维环撕裂的敏感性尚未确定。
通过后纤维环中高强度区的存在来识别磁共振图像中的纤维环撕裂。将结果与椎间盘造影中疼痛性纤维环撕裂的显示情况进行比较，椎间盘造影一直被视为金标准。
研究组包括58例患者（31例男性，27例女性；平均年龄42岁，范围21 - 63岁）。对152个椎间盘进行了注射并通过椎间盘造影检查，其中108个被认为是退变的。在这些椎间盘中，86个存在纤维环撕裂（54个在后侧，6个在前侧，26个前后侧均有）。70个纤维环撕裂与一致性疼痛激发相关。在磁共振成像中识别出27个高强度区，其中24个与椎间盘造影的疼痛再现相关。因此，磁共振成像诊断一致性疼痛的后侧纤维环撕裂的敏感性、特异性、阳性预测值和阴性预测值分别为26.7%、95.2%、88.9%和47%。
这些结果证实高强度区是疼痛性后侧纤维环撕裂的一个标志。然而，该征象的有用性因敏感性低而受限。
