J Korean Soc Spine Surg.  1999 Dec;6(3):451-457.

Significance of the High-intensity Zone(HIZ) on Magnetic Resonance Imaging for Diagnosis of the Internal Disc Disruption

• Kim DJ
• Wang JM

Abstract

STUDY DESIGN: Analysis of correlation of high-intensity zone in magnetic resonance image and pain provocation in discography.
OBJECTIVES
The purpose of this investigation was to evaluate the relationship of the high-intensity zone to the results of discography in identifying the painful intervertebral disc. SUMMARY OF LITERATURE REVIEW: There is some disagreement in validity of high-intensity zone on MRI for diagnosis of discogenic pain.
MATERIALS AND METHODS
Magnetic resonance images were obtained in 52 patients who were considered for surgical intervention after failing to respond to conservative treatment. The presence of a high-intensity zone was specially looked for within anulus fibrosus. Each patient subsequently underwent discography; and types of provocative pain and image were recorded. Statistical analysis was used to evaluate the correlation of high-intensity zone and concordant pain response and disc disruption.
RESULTS
The interobserver reliability for detecting a high-intensity zone in a given disc was substantial(kappa=0.646). The sensitivity of high-intensity zone for concordant pain was 47% but its specificity was relatively high(81%). Posttest odds was not so high(68%).
CONCLUSION
These results suggest that the usefulness of high-intensity zone is limited by low sensitivity and a high-intensity zone is not indicative of exactly painful disc disruption.

Keyword

Intervertebral disc; Internal disc disruption; Magnetic resonance image; High-intensity zone

MeSH Terms

Diagnosis*
Humans
Intervertebral Disc
Magnetic Resonance Imaging*
Sensitivity and Specificity