title: Lumbar disc high-intensity zone. Correlation of magnetic resonance imaging and discography.
abstract: METHODS
  This study correlated a specific lumbar disc abnormality described as the high-intensity zone observed on high-field magnetic resonance imaging with discography.
  
  
  OBJECTIVE
  To analyze the significance of high-intensity zones in lumbar discs of symptomatic patients with low back/radicular pain.
  
  
  BACKGROUND
  Aprill and Bogduk described an 86% incidence of concordantly painful discography in lumbar discs exhibiting a posterior high-intensity zone on T2-weighted magnetic resonance imaging studies performed on back pain sufferers. They assert that the high-intensity zone is a reliable marker of discogenic pain in symptomatic subjects.
  
  
  METHODS
  Consecutive cases of lumbar spine high-field magnetic resonance imaging using T2-weighted images on symptomatic patients followed by discography at all high-intensity zone levels and at non-high-intensity zone control levels were reviewed until 100 high-intensity zone discs in 63 patients were found. Seventeen lifelong asymptomatic (for low back/radicular pain) adults were also scanned as magnetic resonance imaging controls. All magnetic resonance scans and discograms were agreed on by at least two of the radiologist authors.
  
  
  RESULTS
  Eighty-seven of 100 of the high-intensity zone discs proved concordantly painful at discography. All 87 painful and concordant discs exhibited abnormal morphology with anular tears extending either well into or through the outer third of the anulus fibrosus. Sixty-five of 67 non-high-intensity zone control discs were nonconcordant and of lower sensation intensity than the high-intensity zone discs. Only one high-intensity zone was found in the control subjects.
  
  
  CONCLUSIONS
  In patients with symptomatic low back pain, the high-intensity zone is a reliable marker of painful outer anular disruption.
authors.affiliation: Center for Diagnostic Imaging, St. Louis Park, Minnesota, USA.
authors.forename: K P
authors.initials: KP
authors.lastname: Schellhas
authors.forename: S R
authors.initials: SR
authors.lastname: Pollei
authors.forename: C R
authors.initials: CR
authors.lastname: Gundry
authors.forename: K B
authors.initials: KB
authors.lastname: Heithoff
mesh_terms: D000328:Adult; D001416:Back Pain / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000473:pathology*; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008499:Medical Records; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D012016:Reference Values; D012189:Retrospective Studies; D013123:Spinal Fusion; D013126:Spinal Nerve Roots