Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?
Can magnetic resonance imaging accurately predict concordant pain provocation during provocative disc injection?
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DOI：
10.1007/s00256-009-0709-7
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发表时间：
2009-09-01
影响因子：
2.1
通讯作者：
Sung, Deuk Jae
中科院分区：
文献类型：
--
作者：
Kang, Chang Ho;Kim, Yun Hwan;Sung, Deuk Jae
为了将磁共振 (MR) 图像结果与椎间盘源性腰痛患者的激发椎间盘造影的疼痛反应相关联，重点是高强度区 (HIZ) 和椎间盘轮廓异常的组合分析。 62 名可能与椎间盘相关的轴性腰痛患者（年龄 17-68 岁）接受了腰椎间盘造影（测试了 178 个椎间盘）。评估 MR 图像的椎间盘退变、椎间盘轮廓异常、HIZ 和终板异常。根据 HIZ 和椎间盘轮廓异常的组合，确定四类：（1）正常或膨出的椎间盘，无 HIZ； (2) 正常或伴有 HIZ 的椎间盘膨出； (3)椎间盘突出，无HIZ； (4) HIZ 椎间盘突出。这些 MR 图像结果和新的组合 MR 分类在通过椎间盘造影确定的一致疼痛的基础上进行了分析。 HIZ 椎间盘突出 [敏感性 45.5%；敏感度 45.5%；特异性97.8%；阳性预测值（PPV），87.0%]与一致的疼痛激发显着相关（P < 0.01）。正常或凸出的 HIZ 椎间盘与疼痛再现无关。椎间盘退变（敏感性 95.4%；特异性 38.8%；PPV 33.9%）、椎间盘突出（敏感性 68.2%；特异性 80.6%；PPV 53.6%）和 HIZ（敏感性 56.8%；特异性 83.6%；PPV 53.2%）对于识别具有一致疼痛的椎间盘没有帮助。 MR 分类可用于预测具有一致疼痛的椎间盘。磁共振成像上的 HIZ 椎间盘突出预示椎间盘源性腰痛患者椎间盘造影呈阳性。
To correlate magnetic resonance (MR) image findings with pain response by provocation discography in patients with discogenic low back pain, with an emphasis on the combination analysis of a high intensity zone (HIZ) and disc contour abnormalities.Sixty-two patients (aged 17-68 years) with axial low back pain that was likely to be disc related underwent lumbar discography (178 discs tested). The MR images were evaluated for disc degeneration, disc contour abnormalities, HIZ, and endplate abnormalities. Based on the combination of an HIZ and disc contour abnormalities, four classes were determined: (1) normal or bulging disc without HIZ; (2) normal or bulging disc with HIZ; (3) disc protrusion without HIZ; (4) disc protrusion with HIZ. These MR image findings and a new combined MR classification were analyzed in the base of concordant pain determined by discography.Disc protrusion with HIZ [sensitivity 45.5%; specificity 97.8%; positive predictive value (PPV), 87.0%] correlated significantly with concordant pain provocation (P < 0.01). A normal or bulging disc with HIZ was not associated with reproduction of pain. Disc degeneration (sensitivity 95.4%; specificity 38.8%; PPV 33.9%), disc protrusion (sensitivity 68.2%; specificity 80.6%; PPV 53.6%), and HIZ (sensitivity 56.8%; specificity 83.6%; PPV 53.2%) were not helpful in the identification of a disc with concordant pain.The proposed MR classification is useful to predict a disc with concordant pain. Disc protrusion with HIZ on MR imaging predicted positive discography in patients with discogenic low back pain.