腰椎间盘后缘高信号区在诊断椎间盘源性腰痛中的意义

Significance of the high.intensity zone located in the posterior annulus fibrosus for diagnosing discogenic low back pain

目的观察腰椎间盘后缘高信号区（HIZ）的发生率并探讨HIZ与下腰痛的关系。方法统计1000例无选择腰椎MRI中HIZ发生率和200例有完整临床资料MRI中下腰痛组与无下腰痛组的HIZ发生情况。对11例16个HIZ椎间盘行CT椎间盘造影（CTD），观察CTD Dallas分级与疼痛诱发试验的关系。结果腰椎间盘后缘HIZ发生率31．7％（317例），378个椎间盘。其中，L4、5和L5S1水平发生率最高（74．8％），HIZ左侧（153个）多于右侧（94个），可发生于上（15．4％）、中（28．8％）、下缘（55．8％），多节段HIZ 54例（17．0％）。200例HIZ中下腰痛者115例（57．5％），无下腰痛者85例（42．5％）。CTD DallasⅢ级者疼痛诱发试验多为阴性（6／7），Ⅳ级者多为阳性（8／9）。结论HIZ有无腰痛与椎间盘纤维环退变程度有关，当CTD检查退变至DallasⅣ级时多可出现腰痛。故HIZ仅提示椎间盘源性腰痛的可能性，确诊仍需辅以椎间盘造影。

Objective To investigate the prevalence of high-intensity zone （HIZ） and the correlation between HIZ and low back pain （LBP）. Methods The data of 1000 unselected cases, 566 males and 434 females, aged 49.49 （12 -86）, who underwent lumbar MRI were analyzed to examine the prevalence of HIZ. 200 of the 1000 cases with HIZ which had complete clinical history records, 112 males and 88 females, aged 52. 29 （ 18 - 86）, were divided into LBP （ n = 115 ） and non-LBP series （ n = 85）. CT discography （CTD）was performed in 16 discs in 11 cases with HIZ and the correlation between the modified Dallas＇ discegram scale and pain reproduction in provocation discography was explored. Results HIZ located in posterior annulus fibrosus （AF） was shown in 378 discs in 317 cases, most located in L4/5 and L5/S1 （74. 8% ） and the location in left side （153 HIZs） was more common than that in right side （94 HIZs）. HIZs were shown in superior region （15.4%）, middle region （28. 8% ）, as well as inferior region （55. 8% ） in sagittal plane. 115 of the 200 cases with HIZ who had complete clinical history records （57.5%） were symptomatic and 85 cases （42. 5% ） were asymptomatic. According to the modified Dallas＇ discogram scale, LBP could be provoked in 8 of the 9 patients with grade IV and could not be provoked in 6 of the 7 patients with the grade IU. Conclusion Whether HIZ is accompanied with LBP is related to the degree of disc degeneration. When CTD showed the degree of modified Dallas＇ grade IV and over most of the patients will show LBP HIZ only indicates the possibility of discogenic LBP and can not replace provocation discography.