Percutaneous discography: comparison of low-dose CT, fluoroscopy and MRI in the diagnosis of lumbar disc disruption.
OBJECTIVE
To compare the diagnostic accuracy of low-dose computed tomography (CT), magnetic resonance imaging (MRI) and fluoroscopy in percutaneous discography in patients scheduled for lumbar spondylodesis.


METHODS
Within a prospective pilot study, 18 disc segments of 11 patients with radicular or pseudoradicular pain prior to anteroposterior spondylodesis were evaluated. After injection of a mixture of non-ionic iodine-containing contrast agent and gadolinium-based contrast medium into the disc spaces, all patients underwent conventional fluoroscopy, as well as low-dose CT and MRI. The occurrence of memory pain during contrast injection was recorded. CT, MRI and fluoroscopic images were analyzed independently by two readers blinded to the clinical findings.


RESULTS
There was 100% agreement between CT and MRI discography in the detection, localization and grading of degenerative changes. In contrast, conventional fluoroscopy identified only 9 of the 12 abnormal segments. Memory pain following puncture was identified in 3 of the 12 affected segments.


CONCLUSIONS
Low-dose CT and MRI discography have a similar accuracy in the assessment of disc disruption and they are superior to fluoroscopic discography.
Kluner
Claudia
C
Radiology, Charité, Schumannstr. 21, Campus Mitte, 10117 Berlin, Germany. claudia.kluner@charite.de
Kivelitz
Dietmar
D
Rogalla
Patrik
P
Putzier
Michael
M
Hamm
Bernd
B
Enzweiler
Christian
C
D000328:Adult; D003287:Contrast Media / Q000009:adverse effects; D017587:Diskectomy, Percutaneous / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods / Q000592:standards / Q000639:trends; D011829:Radiation Dosage; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods* / Q000592:standards
D003287:Contrast Media