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.