The association of high-intensity zones on MRI and low back pain: a systematic review.
The association of high-intensity zones on MRI and low back pain: a systematic review.
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DOI：
10.1186/s13013-018-0168-9
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发表时间：
2018
影响因子：
--
通讯作者：
Samartzis D
中科院分区：
文献类型：
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作者：
Teraguchi M;Yim R;Cheung JP;Samartzis D
腰椎磁共振成像(MRI)通常用于确定下腰痛(LBP)的来源；然而，其使用一直存在疑问。多年来，许多腰椎表型(如终板异常、MODIC改变、黑盘)被研究为可能的疼痛诱因。高强度区(HIZ)特别令人感兴趣，因为它们可能代表环形撕裂。然而，三十多年来，关于这些成像生物标志物是否与LBP同义词，一直存在激烈的争论。因此，下面的研究对有关HIZ和LBP关系的文献进行了系统的回顾。通过MEDLINE、Scope us、Cochrane、PubMed、PubMed Central、EMbase via Ovid和Web of Science进行了系统的综述，检索词为“Hiz”、“High Intensim Zone”或“High Intensim Zones”和“Low Back Pain”、“Pain”、“Lump ago”和/或“Siegatica”。还保留了具体的排除标准。两位独立的评价者搜索文献，选择研究，并提取数据。我们从我们的搜索策略中确定了6项符合纳入标准的研究，总共有756项可能的研究。确定了一项以人口为基础的横断面研究和五项比较研究，这些研究提供了关于重债穷国流行率的信息。LBP患者HIZ患病率为3%~61%，无LBP患者HIZ患病率为2%~3%。只有三项研究表明HIZ的存在与伴有或不伴有坐骨神经痛的LBP之间存在显著关联。我们的系统回顾发现了HIZ可能是LBP的一个可能的危险因素的证据；然而，不同研究之间HIZ临床相关性的不匹配仍然存在。现有的证据受到样本量小、研究人群的异质性以及缺乏用于表型鉴定的标准化成像方法的限制。HIZ可能是重要的腰椎生物标志物，需要进一步研究，并应考虑在脊柱的全球成像评估中，这可能具有巨大的临床实用价值。有必要利用标准化成像和分类技术进行进一步的大规模研究，以及对重债穷国的模式进行评估，以便更好地了解它们在下丘脑病变发展中的作用。
Magnetic resonance imaging (MRI) of the lumbar spine is commonly used to identify the source of low back pain (LBP); however, its use has been questionable. Throughout the years, numerous lumbar phenotypes (e.g., endplate abnormalities, Modic changes, black disc) have been studied as possible pain generators. High-intensity zones (HIZs) are of particular interest as they may represent annular tears. However, for over three decades, there has been heated debate as to whether these imaging biomarkers are synonymous with LBP. Therefore, the following study addressed a systematic review of the reported literature addressing the relationship of HIZs and LBP. A systematic review was conducted via MEDLINE, SCOPUS, Cochrane, PubMed, PubMed Central, EMBASE via Ovid, and Web of Science with the following search terms: “HIZ,” “high intensity zone,” or “high intensity zones” and “low back pain,” “pain,” “lumbago,” and/or “sciatica.” Specific exclusion criteria were also maintained. Two independent reviewers searched the literature, selected the studies, and extracted the data. We identified six studies from our search strategy that met the inclusion criteria from a total of 756 possible studies. One cross-sectional population-based study and five comparison studies were identified, which provided information regarding the prevalence of HIZs. The prevalence of HIZs was 3 to 61% in subjects with LBP and 2 to 3% in subjects without LBP. Only three studies suggested a significant association between the presence of HIZ and LBP with or without sciatica. Our systematic review has found evidence that HIZs may be a possible risk factor for LBP; however, a mismatch of the clinical relevance of HIZs between studies still remains. The available evidence is limited by small sample size, heterogeneous study populations, and lack of standardized imaging methods for phenotyping. HIZs may be important lumbar biomarkers that demand further investigation and should be considered in the global imaging assessment of the spine, which may have immense clinical utility. Further large-scale studies with standardized imaging and classification techniques as well as the assessment of patterns of HIZs are necessary to better understand their role with LBP development.