Diagnosis of symptomatic disc by magnetic resonance imaging: T2-weighted and gadolinium-DTPA-enhanced T1-weighted magnetic resonance imaging.
Although radial tear of the annulus fibrosus can be detected on T2-weighted and Gd-DTPA-enhanced magnetic resonance (MR) images, the association between the annular tear on MR images and the symptomatic discs is unclear. The purpose of this study was to investigate the relationship between T2-weighted, gadolinium-DTPA-enhanced MR images and pain response through discography in patients with chronic low back pain. A total of 56 lumbar discs from 23 patients with chronic low back pain (13 to 47 years old) underwent MR imaging (T2-weighted, gadolinium-DTPA-enhanced MR images) followed by provocative discography. The sensitivity, specificity, positive predictive value, and negative predictive value of T2-weighted and gadolinium-DTPA-enhanced MR images in detecting the symptomatic discs were calculated. The sensitivity, specificity, positive predictive value, and negative predictive value of T2-weighted images in detecting the symptomatic disc were 94%, 71%, 59%, and 97%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of gadolinium-DTPA-enhanced images were 71%, 75%, 56%, and 86%, respectively. The high sensitivity and the high negative predictive value of T2-weighted MR imaging in detecting the symptomatic disc indicated that MR imaging can be a useful screening tool in avoiding unnecessary discography in patients with chronic low back pain.
Department of Orthopaedic Surgery, Dokkyo University School of Medicine, 880 Kitakobayashi Mibu-machi Shimotsuga-gun, Tochigi, 321-02 Japan.
Hiroyuki
H
Yoshida
Atsushi
A
Fujiwara
Kazuya
K
Tamai
Naoki
N
Kobayashi
Kazuhiko
K
Saiki
Koichi
K
Saotome
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003287:Contrast Media / Q000008:administration & dosage; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology*; D017116:Low Back Pain / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D003287:Contrast Media; D019786:Gadolinium DTPA