title: The clinical significance of the high-intensity zone on lumbar spine magnetic resonance imaging.
abstract: METHODS
  Prospective observational study of anular tears, diagnosed by a high-intensity zone within the anulus on lumbar spine magnetic resonance imaging, and correlation with the clinical features.
  
  
  OBJECTIVE
  To assess the prevalence of high-intensity zones in patients who are investigated for back and leg pain and to determine whether there are clinical features that can be used for diagnosis of the presence of a high-intensity zone.
  
  
  BACKGROUND
  Results in previous studies have shown that the presence of a high-intensity zone is associated with reproduction of a patient's pain on stress discography. Neural compression on magnetic resonance imaging has been shown to be associated with back pain, but to date, no study has correlated the presence of a high-intensity zone with the clinical features.
  
  
  METHODS
  The lumbar spine magnetic resonance images in 156 patients in whom back and leg pain were investigated were analyzed for the presence and appearances of high-intensity zones. The clinical features of those patients with a high-intensity zone but with no evidence of neural compression on magnetic resonance imaging were analyzed by t test and X2 test.
  
  
  RESULTS
  A high-intensity zone occurred in patients at a prevalence of 45.5% and usually occurred posteriorly (77%) and posterolaterally (22%) within the anulus. There were no features within the history, functional disability questionnaire, or physical examination that aided in a clinical diagnosis of those patients with a high-intensity zone.
  
  
  CONCLUSIONS
  A high-intensity zone is a common finding in patients in whom low back and leg pain are investigated, but the presence of a high-intensity zone does not define a group of patients with particular clinical features.
authors.affiliation: Department of Diagnostic Radiology, University of Manchester, Salford, United Kingdom. jrankine@fs1.sdr.man.ac.uk
authors.forename: J J
authors.initials: JJ
authors.lastname: Rankine
authors.forename: K P
authors.initials: KP
authors.lastname: Gill
authors.forename: C E
authors.initials: CE
authors.lastname: Hutchinson
authors.forename: E R
authors.initials: ER
authors.lastname: Ross
authors.forename: J B
authors.initials: JB
authors.lastname: Williamson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis*; D007866:Leg / Q000473:pathology; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000175:diagnosis; D013126:Spinal Nerve Roots / Q000473:pathology; D011795:Surveys and Questionnaires