|
The value of lumbar spine magnetic
resonance imaging in the demonstration of anular tears. |
|
AUTHORS: |
Saifuddin A; Braithwaite I; White J; Taylor BA;
Renton P |
|
AUTHOR AFFILIATION: |
Department of Radiology, Royal National
Orthopaedic Hospital Trust, Stanmore, Middlesex, United Kingdom. |
|
SOURCE: |
Spine 1998 Feb 15;23(4):453-7 |
|
CITATION IDS: |
PMID: 9516700 UI: 98177343 |
|
ABSTRACT: |
STUDY DESIGN: Retrospective review of magnetic resonance imaging and
discography in patients investigated for low back pain before spinal
fusion. OBJECTIVE: To determine the sensitivity of magnetic
resonance imaging in the detection of painful anular tears
manifested by the high- intensity zone. SUMMARY OF BACKGROUND DATA:
Two studies have produced results showing that magnetic resonance
imaging has a high specificity for the detection of painful anular
tears manifested by a high- intensity zone. However, in a recent
study, results showed no significant correlation between the
high-intensity zone and pain reproduction. The sensitivity of
magnetic resonance imaging in identifying anular tears in a
symptomatic population has not been determined. METHODS: Anular
tears were identified in magnetic resonance images by the presence
of a high-intensity zone in the posterior anulus. The results were
compared with the demonstration of painful anular tears on discogram,
which has been considered the gold standard. RESULTS: The study
group comprised 58 patients (31 men, 27 women; mean age 42, range
21-63 years). One hundred and fifty-two discs were injected and
examined by discography, and 108 were considered degenerate. Of
these, 86 had anular tears (54 posterior, 6 anterior, 26 both).
Seventy anular tears were associated with concordant pain
provocation. Twenty-seven high-intensity zones were identified in
magnetic resonance imaging, of which 24 were associated with pain
reproduction by discography. The sensitivity, specificity, positive
predictive value, and negative predictive value of magnetic
resonance imaging in the diagnosis of concordantly painful posterior
anular tears are therefore 26.7%, 95.2%, 88.9%, and 47%,
respectively. CONCLUSION: These results confirm that the
high-intensity zone is a marker of a painful posterior anular tear.
However, the usefulness of this sign is limited by low sensitivity. |
|
MAIN MESH HEADINGS: |
*Magnetic Resonance Imaging
Spinal Injuries/*diagnosis |
|
ADDITIONAL MESH HEADINGS: |
Adult
Back Injuries/complications
Back Pain/etiology
Comparative Study
Female
Human
Infant, Newborn
Intervertebral Disk/pathology
Intervertebral Disk/radiography
Lumbosacral Region
Male
Middle Age
Retrospective Studies |
