High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging

TLDR

The study aimed to determine the prevalence, validity, and reliability of high‑intensity zones in the annulus fibrosus on T2‑weighted MRI among patients with intractable low‑back pain. This was assessed by evaluating high‑intensity zones on T2‑weighted MRI scans in a cohort of 500 patients with back pain. High‑intensity zones were identified by two observers in 28 % of patients, correlated with Grade 4 annular disruption and pain reproduction, and, while having modest sensitivity, exhibited high specificity and an 86 % positive predictive value for diagnosing painful internal disc disruption.

Abstract

Abstract The prevalence, validity and reliability of high-intensity zones in the annulus fibrosus seen on T 2-weighted magnetic resonance images of patients with intractable low-back pain were determined. This sign was readily recognized by two independent observers. It occurred in 28% of 500 patients undergoing magnetic resonance imaging for back pain. The presence of a highintensity zone correlated significantly with the presence of Grade 4 annular disruption and with reproduction of the patient's pain. Its sensitivity as a sign of either annular disruption or pain was modest but its specificity was high, and its positive predictive value for a severely disrupted, symptomatic disc was 86%. This sign is diagnostic of painful internal disc disruption.