腰椎间盘MRI高信号区在诊断椎间盘源性下腰痛中的意义

The significance of the high-intensity zone(HIZ) of painful lumbar disc on MRI in diagnosing discogenic low back pain

目的:探讨腰椎间盘MRI高信号区(HIZ)在诊断椎间盘源性下腰痛中的作用。方法:对52例经保守治疗无效、CT影像上无腰椎间盘突出的下腰痛患者行腰椎MRI检查和腰椎间盘造影术,分析腰椎间盘MRI高信号区与腰椎间盘造影诱发的下腰痛之间的关系。结果:在行腰椎间盘造影的142个椎间盘中,共有38个椎间盘呈现疼痛复制反应,其中17个椎间盘显示高信号区。这17个有高信号区的椎间盘在椎间盘造影过程中全部呈现2～3级的纤维环破裂和疼痛复制反应。结论:无椎间盘突出的下腰痛患者在腰椎MRI上存在椎间盘内高信号区,可表明该椎间盘是产生腰痛的破裂椎间盘。

Objective:To explore the role of a high-intensity zone of painful lumbar disc on magnetic resonance imaging in diagnosing discogenic low back pain.Method:According to MR imaging and awake discography of 52 patients with low back pain without disc herniation in lumbar vertebrae,we analysed the correlation between the HIZ and discography.Result:In all of 142 discs in 52 patients at discography,38 proved concordantly painful,17 presented HIZ.All 17 discs with HIZ showed pain reproduction and abnormal morphology with anular tears extending either well into or through the outer third of the annulus fibrosus.Conclusion:In patients with symptomatic low back pain without disc herniation,the HIZ is a reliable marker of painful outer anular disruption.